Are orthodontic braces considered to be a medical expense? I can't find an orthodontist ANYWHERE that accepts medical insurance. Are braces cosmetic, or medical?

I ask because the bf's X-wife is sending him bills for hundreds of dollars saying that he's responsible for the kids "medical" bills. She's taking the kids to a orthodontist who's not an in-network provider for his insurance. Therefore, the insurance won't cover it.

Hmmm... can't tell you for sure. Aren't medical bills BOTH parent's responsiblity? Does he have joint legal custody? If so, then she should have discussed braces with him before going through with it. Maybe he could check into getting the kids switched to an in-network provider (if you can find one- try the IC website provider directory). Good luck!

Bio-hag doesn't have to discuss anything with him, she has sole legal. It should be both their responsibility, but she had a darned good lawyer in the divorce..he didn't have a lawyer.

All it says in the CO is he has to pay 100% of uninsured medical expenses. It doesn't say anything about orthodontic/dental expenses.

Well, then I think I would consult with the IC on wether they consider orthodontia cosmetic or medical... it probably depends on each case. I would then check with the courts and see what they have to say about it. Personally, I would think that he wouldn't have to pay.

My daughter is 11, livign with me and just started in braces.

With Cigna, and most major insurance plans, you are alloted a certain amount for Orthodontic work. Once that limit has been reached, you are responsible or the rest. In my case the amount was $1200, her expander was $300, the braces will be around $2500..so i'm left with about $100 mo for around 2yrs + a retainer afterwards if needed.

So the question is, if you are responsible for the dental work? If your court order for child support states that you are to provide medical coverage ins. for the child, then you are responsible for 1/2 of money. If it does not, then you arenot legally responsible. Having said that, I expect you will want to do all you can to pay for the braces, but can use the information to get your ex to pony up 1/2 the money.

Also, if your kid is on your insurance, but she went to an out of network provider, your ins co will typically accept the information from the dentists office faxed from dentist to ins co. and cover a certain percentage of the money. The amount will be less than an in network provider, but will be something.

The key to all of this, is what is covered in the court order. Read it carefully and let us know..

Mark,

He has a different name for her..

Leftover,
Calling names is not going to help. Yuki is right. This does not concern you at all. This is between him and his ex. not you. He needs to check the court order and see what it says. If he is in question he needs to go to court and find out for sure. Not you.

The key is truly in the wording of the agreement. The word "medical" must be clearly defined. In my coverage through work, orthodontics are not covered in the basic or secondary "medical" packages but is available in a third package at a high increase in fees.(We pay a portion through our pays). I would therefore deduce that to my insurer anyways, orthodontics are not considered medical. Cosmetic probably.

Check the paperwork carefully. And is there not a clause concerning consultation of some sort? I mean can she go out and get say, rhinoplasty for one of the children and stick him with the bill without first consulting him?

Orthodontics could be considered medical and not cosmetic, depending on the re-alignment neeeded to be done. For instance, a cross bite would be medical as it would throw out of alignment the kids bite and cause problems later....braces are purely cosmetic.

also....never bring a knife to a gun fight.

She had a lawyer, you didn't....you're basically chumming the water for her.

It's no different than anything else in life. You do your research, find out the worst possible scenario and decide if you can live with it. If you can't, you had better have a plan in place to minimize the damages that you will incur.
Mark,

JD has an excellent point: could she run off and get nose jobs for the kids because they have an odd shaped nose and make him pay? That's just not right without talking to Dad first. I know you're not trying to me malicious to the ex, you're just simply trying to help your man dig up info to help him out. Nothing wrong with that. But Mark J and JD also had a good point about the definition of medically necessary. Simply out of line teeth? Cosmetic. Cross bite? Medical. Have your BF consult the IC and then call the courts to get an interpretation of the court order, and also so that they can know what's going on. Good luck!

Yes, Adrainne. That's what he's concerned about.. She has mentioned Lasik surgery for the kids.. (And I am here to get some legal information, not moral guidance this time, but thanks anyways)

He's read the court order and there's nothing about orthodontic. I only bring this up because he pay almost $2000 a month in child support and is financially breaking him. He thinks that she's taking the kids to a non-networked provider just for the purpose of squeezing the last drop of cash from him. She's a mean, hateful woman, and uses the children to hurt him.

He in the midst of forclosure, while his X just had a 5000sq ft home built. But I really don't care to go into the whole story at this time. He's a good father and is getting the shaft by the CS office and his X.

But that's what I'm wondering JD, is is medical? All his CO says is he is responsible for un-insured medical expenses.

G'morning leftover, you're up early.

That was my point in my example. I can't say whether those expenses are or are not considered medical. Each agreement (including say coverage at work) is different. Somehow, your b/f must get that defined clearly.

My real concern is that there doesn't seem to be any avenue for your b/f to be consulted before expenses are incurred. I don't think that is fair or equal; to be responsible for expenses that one has no say in. This gives her carte blanche to do whatever she feels including using that clause as a weapon.

I think your best bet is to consult a legal expert with the CO and ask him/ her if that can be defined clearly.

Good luck leftover and let us know. That info could be very useful here.

Leftover, this poor man can't catch a break, huh? OK! After reading this I was sickened. I have sole legal and physical custody of Ty and his father has no contact w/him at all, by his own choice. It is stated in our CO that he either needed to provide Ty w/insurance or pay me for the coverage I have on him and he is responsible for half of all other medical expenses. I would think that if orthodontic work was medically necessary, he should be responsible for half. If it is just cosmetic to improve looks, that should be discussed prior and agreed upon by both parties involved. Is there a way he can call the orthodontist to find out if the procedure is medically necessary? I know that in FL they don't consider dental insurance when figuring medical expenses. The best bet is to seek advice from a lawyer. They have free consultations that would allow him to get the info he needs.

Leftover, the CS office should be not be giving anyone the shaft....he can quickly go to the office, talk to the CS Supervisor and find out what's going on with their department. The CS office has a certain amount to collect, and that is it. They can help if you're ex is doing things outside of the court order, and can warn her that funds could be cut if she continues. Oh, and Lasik....definately cosmetic.

Seeing as you're feeling like a cow being milked, I'd find a lawyer..(yes i knowit costs money). Have him look over, the court order adn tell you what she can and can't do. He can also write her a letter telling her that things outside of the court order will not be covered. This would make ask you if you would be willing to cover 1/2 on certain items etc... (in writing).

Mark

Hi yuki,

I must disagree here. The issue isn't whether the man can provide or if the children need the procedures; it's the lack of control over the expenses. Too many times the CP gets that "priveledge" only to abuse it and turn it into a weapon.

Why couldn't she consult with him first? Were there no other opinions on the procedures? Why did she go outside the network?

The idea of put up and shut up leaves a bad taste in my mouth. If he is the father and is responsible for these expenses, then he should be consulted before hand. I don't question the man's ability to be a parent but the motives of the mother. If he were consulted, could another solution be found? Financing? Splitting the expenses? Another medical opinion?

Sorry yuki, I understand what you're trying to say but each child has two parents. Not one parent and one walking wallet. JMO