Requesting Healthcare Expense Payments

Through the Friend of the Court

Prior to contacting the FOC

• Check your court order to verify that it requires the other party to pay a portion of health care expenses.

• Submit your request for payment to the other party within 28 days of either the date insurance has paid on the expenses or the date the insurance denies payment.

Prior to contacting the FOC

• For each expense that you list on the first notice:

– Include the date insurance paid on the expense (or),

– Include date insurance denied payment (or),

– Include date of service for the expense when there is no insurance available.

Response from the other party• You and the other party

may reach an agreement concerning the expenses.

• Agreement must be in writing.

• Agreement must state the total to be paid and the payment schedule.

• Both parties must sign the agreement.

The “Request for Healthcare Expense Payment” form

• Obtain from the Friend of the Court OR from http://courts.michigan.gov/scao/courtforms/domesticrelations/ drindex.htm

• Use this form to submit to the other party.

• Wait 28 days for response from the other party.

Attach copies ofBills and Insurance

notifications

Contacting the FOC• Present bill and white copy of the

first notice that you sent to the other party- to the FOC within:– One year after the expense was

incurred - OR-– 6 mos. after insurer’s final denial of

coverage for the expense (was incurred) - OR -

– 6 mos. After a default in a repayment agreement between you and the other party per the terms agreed upon

When default occurs• You have not received an

agreement for payment.• You have waited 28 days

from the mailing of the first notice to the other party

• The other party has missed an agreed upon payment within the payment schedule.

Contacting the FOC• You will need to fill

out a SECOND form to request enforcement.

2nd FORMThe ComplaintFor Enforcement of Healthcare Expense Payment

The second notice• Complete the “Complaint

for Enforcement of Healthcare Expense Payment” form

• Attach supporting bills and receipts for each expense you list.

• Attach copy of all insurance notifications for each expense you list.

The Complaint

Complete

02-012345-DM

JOHN DOE JANE DOE

JOHN DOE123 MAIN ST.ADRIAN, MI 49221

The Complaint

Complete

Complete

Complete

Date & Sign

Medical Enforcement

• Your Enforcement Officer is your primary contact for Medical Enforcement through the FOC.

• The FOC fax line is: 264-4765.

Requesting Healthcare Expense Payments

Thank you. Please contact your Enforcement Officer if you need

further information.