Courts Michigan Gov Scao Courtforms - PowerPoint

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					Requesting Healthcare Expense
   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
     – Include the date insurance paid on the
       expense (or),
     – Include date insurance denied payment
     – 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
•   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
                                        Attach copies of
•   Obtain from the Friend             Bills and Insurance
    of the Court OR from                   notifications
•   Use this form to submit
    to the other party.
•   Wait 28 days for
    response from the
    other party.
Contacting the FOC
     •   Present bill and white copy of
         the first notice that you sent
         to the other party- to the FOC
         – 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
•   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

     2nd FORM
     The Complaint
     For Enforcement of
     Healthcare Expense
                 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
     The Complaint

JOHN DOE                      JANE DOE

           JOHN DOE                             Complete
           123 MAIN ST.
           ADRIAN, MI 49221
The Complaint




                     Date & Sign
              Medical Enforcement
•   Your Enforcement
    Officer is your
    primary contact for
    Medical Enforcement
    through the FOC.
•   The FOC fax line is:
Requesting Healthcare Expense
   Thank you. Please contact your
   Enforcement Officer if you need
         further information.

Description: Courts Michigan Gov Scao Courtforms document sample