Acceptance of Claims & Payment of Uncovered Expenses

Acceptance of Claims & Payment of Uncovered Expenses

Acceptance of Claims: After receiving a claim, the insurance company will send a claim acceptance letter to the insured showing how much, if anything, it will pay on the bill. The insured should keep it for his/her records. If there is an amount not paid by the insurance company, that amount should be recorded on the medical enforcement form. A separate form must be used for each individual covered by the Court Order.

Once the unreimbursed amount for an individual has reached $250, a copy of the medical enforcement form(s) should be send to the Defendant with copies of the medical bills, receipts for payment, insurance statement and a letter indicating the amount that is to be paid and where to send the payment. Do not send any information to the Domestic Relations Office at this time. The terms of your support order outline what percentage of medical support expenses each party must pay.

Also, keep in main that in new cases, the bills may not have been for services rendered prior to the effective date of the initial order on the case. Also, the annual deductible of $250 will be prorated on a monthly basis for the year that your initial order became effective.

Example

An example would be if your order became effective June 1, 2010, only bills for medical services incurred after June 1, 2010 are eligible for reimbursement and the deductible for each dependent during 2010 would be $145.81 ($250 divided by 12 months equals $20.83 per month times 7 months plus $145.81).

  • Pay by check or money order: When sending a medical reimbursement payment to the Plaintiff, the Defendant should send the Plaintiff a check or money order for the amount the Defendant owes the Plaintiff in 30 days. If the Defendant pays the Plaintiff cash, he/she should have the Plaintiff sign a receipt for the payment.
  • Use Certified Mail: The Plaintiff should send the information to the Defendant by certified mail. The Plaintiff should keep the green certified mail receipt as proof that the Defendant received the letter.