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  1. #1
    Join Date
    Jan 2008
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    Question Medical Costs

    In CA - I thought that I could find what is considered a necessary medical expense in the Family Code division 9 chapter 7 - but no luck.

    Here's the reason I need the specific code...
    Child has dental insurance thru her father - my X husband. I am not on the plan and therefore the insurance company will not speak with me regarding the account. Two weeks ago at the dentist, the child had a routine cleaning. At that time it was recommended to me that she have sealants (sp?) put on her teeth to prevent decay. I asked how much this procedure would cost and was told it was covered 100% by the insurance as part of their/her plan for preventative care.

    The father received a statement from the insurance. The procedure was denied because she is 16 and they only cover sealants for young(er) children. It was $77 a tooth - for 10 teeth. The ex-husband says he is not going to help me with 50% of the $770 charge because it was not medically necessary.

    I know the dentist has a disclaimer on their consent form making me responsible for anything not paid by the insurance.
    Is there anything in the code that would imply a Court would require me to pay 100% for this procedure? - or anything that leans toward splitting the cost with Dad?

  2. #2
    Join Date
    Nov 2007
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    Officially across the country from where I've been all my life
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    Default Re: Medical Costs

    Per MY dentist and my son's dentist, sealants are NOT medically necessary. Yeah, they prefer them, yes, it makes them money and if I were your ex, you would be footing 100% of that bill.

    What was your ex's response when you approached him about the dental sealants BEFORE you had the treatment done? I'm assuming you have joint legal custody and have to make that information available to him. Did he agree to the treatment PRIOR to the treatment being performed? If he did, then he's on the hook. If you decided to do it first and tell him later, then you're on the hook.

  3. #3
    Join Date
    Jan 2008
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    Question Re: Medical Costs

    My XH has 'forbidden' me from speaking with him - making consent very hard to receive. I have copies of emails that say "obviously - you can do what you want" when I have asked him any questions about her medical treatment along with other e-mails telling me to stop even e-mailing him as he is "kept well enough informed" by our daughter.

    I read another thread where the OP talked about "detrimental reliance". Do you know what that is or how that might come into play in this situation?

    OH - and for the sake of argument - if this was not sealants but something else - do you know where in the family code it talks about sharing medical expenses?

  4. #4
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    Default Re: Medical Costs

    Detrimental reliance has nothing to do with this. Obviously, you are in enough contact with him for him to reply to you "obviously, you can do what you want," then why not send another email that says, this is what the dentist suggests, what do you think? So then he can say "obviously, you can do what you want." THEN you have a detrimental reliance issue. It means, that you relied to your detriment that something was going to happen. For example, he said he was going to do something (say pay a bill), and didn't. Now your credit is shot because of the nonpayment. In fact, what does the CO say exactly about medical/dental treatment and expenses? He probably relied to HIS detriment that you were going to follow the CO and not authorize any treatment that he would be financially responsible for that wasn't an emergency.

    This is simply a case of you doing what you wanted to do and wanting him to foot half of the bill. If you were sitting in front of my judge, you'd be paying the bill completely. You'll find nothing in the family code that speaks of sharing medical expenses, because it's not mandated by law. It's ordered on a case by case basis.

    If anything, if you have something in writing from the DENTIST'S office stating that the copay for the sealants were zero (which you probably don't have because I can't think of one insurance company that covers it), you MAYBE have a detrimental reliance case against THEM, but even still, someone is responsible for veriifying the benefits BEFORE treatment is rendered, and that's not the dentist's office responsibility, either.

    You screwed up on this one, and it's going to cost you about $800

  5. #5
    Join Date
    Jan 2008
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    Question Re: Medical Costs

    My mistake in writing - I meant was there anything I could do with the DENTIST regarding reliance. Not the X The X just switched our daughter's insurance carrier and the dental office told me that the procedure was 100% covered as it was preventative. Oh yeah - that leads me to another question...

    1/2 the cost of the dental/medical insurance was deducted from the guideline support when it was originally calculated. Do I have any say in changing insurance carriers? Does the coverage have to be the same or better than the previous coverage? For example - can he switch to a plan with a cheaper premium and higher out-of-pocket costs without my consent?

  6. #6
    Join Date
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    Officially across the country from where I've been all my life
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    Default Re: Medical Costs

    You have no say in the type of medical/dental insurance he carries

    You have no say in which company he chooses to insure the child

    There is nothing barring him from switching carriers, nor is there anything that says the policy has to be the same or better.

    In fact, if he can prove he can't afford it, he doesn't have to provide it at all. The code says he is to provide it IF it is available at low or no cost to him. He doesn't have to break the bank providing insurance you like.

    You have no cause of action towards the dentist, because it is YOUR responsibility to verify benefits before treatment is rendered. The office simply bills insurance as a courtesy, they don't HAVE to. Oh, and if this isn't your policy, they don't have to speak to you or do business with you at all.

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