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Michael J, Esq.
Michael J, Esq., Lawyer
Category: Family Law
Satisfied Customers: 3471
Experience:  Licensed Attorney - represented hundreds of clients in criminal cases, family law disputes, traffic issues, and general legal issues. Youth Court Prosecutor.
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I am a divorced father of 2 living in the State of Washington.

Customer Question

I am a divorced father of 2 living in the State of Washington. My children also reside in Washington.
As part of our final degree, it was clearly stated that all non-emergency medical care must be made jointly.
Recently, my ex-wife allowed an oral surgeon to extract several teeth from my 10 year old child. 4 of the 5 teeth that were extracted were adult teeth. This has left my child with only 12 teeth at the moment (in total).
My family has had a long history with dentists and orthodontists as most of our family close friends were in the field. Given what I have learned from them, I was opposed to this procedure.
My ex-wife decided to make an appointment anyway. I sent the oral surgeon a copy of our degree that clearly stated that all medical decisions needed to be made jointly and that I was opposed to this procedure. He sent back a polite message saying that he said it was absolutely necessary. I spoke with him briefly and continued to disagree.
This oral surgeon, then working with my ex wife called my insurance company. I am required to insurance my children and pay for 2/3 of the out of pocket health care expenses. They called to get a pre-authorization from the insurance company for the procedure. The insurance company denied the coverage because it was not covered care.
The oral surgeon then went ahead and created an estimate which stated that the insurance company would in fact cover most of the cost ($1250 out of the $1700 bill). I was given this information that the total cost was going to be $450 out of pocket. I continued to disagree with the procedure.
Either way, the procedure went ahead against my wishes. When the oral surgeon filed a claim on my insurance, they denied coverage and he then sent me a bill for $1700.
I am refusing to pay.
Based on this information, am I on solid legal grounds? Should my ex-wife (and the oral surgeon) be responsible for this cost?
Submitted: 2 years ago.
Category: Family Law
Expert:  Michael J, Esq. replied 2 years ago.
Hello and thank you for contacting JustAnswer. My name is Michael; I look forward to assisting you today. The answer is "it depends". Your claim is that since you didn't agree to it per what the Order states, you wouldn't be liable for the cost. Your ex's argument will be that because it was "medically necessary", there wasn't really any decision to agree to, and the procedure had to be done whether you agreed to it or not. This will be an issue for the Judge to decide. If your ex can show that it was medically necessary, I do believe you will be on the losing end of this one. This decision is regarding your liability to your ex under the Order There is also the matter of your liability to the oral surgeon. I think you're on pretty firm footing to argue that since you didn't agree to it contracturally with him, you aren't liable to him for the payment. That's a separate issue outside of the Order that would have to be dealt with in civil court. I hope this helps. If you valued my time, please consider leaving a positive review. Experts don't get credit for our answers until you do. I'll be happy to follow up until you're completely satisfied. Michael
Customer: replied 2 years ago.
A question for you about 'medically necessary'. Clearly my insurance company did not provide coverage. That is neither a definition of 'medically necessary', but it might be an indicator. Furthermore, the ACA allowed each of the states to determine what 'medically necessary orthodontic services'. I went to the State of Washington ACA website and found very easily that they define it as: Medically necessary orthodontic treatment and orthodontic-related services for severe handicapping malocclusions, craniofacial anomalies, or cleft lip or palate for clients 20 years of age and younger. My daughter is not on an ACA insurance plan, but I don't see why if that is the definition the state use for the plans it offers why that makes any difference.My daughter did not have any of these situations. Her treatment was clearly for a perceived cosmetic value.
Expert:  Michael J, Esq. replied 2 years ago.
That's a great argument to make before the Judge. I tend to agree. Michael