For a long time, psychological expenses under the Pennsylvania Support Guidelines were treated differently than other medical expenses. While “routine” or “traditional” medical expenses such as surgical, dental, optical, and orthodontia were automatically included as reimbursable expenses, the definition of “medical expenses” specifically excluded cosmetic, chiropractic, and most controversially, psychological and psychiatric.
Medical care for children is a legal custody issues, so there was always some interplay between an expense and how it may have come about, however, when therapy was in place and a cost, the disparate treatment of those expenses compared to “routine” expenses was a serious problem. Often therapy costs are not included under medical insurance, but are nonetheless an important form of treatment for a child, particularly one having to navigate issues related to divorce or a custody case. The inclusion of therapy costs as a reimbursable expense required a specific order making them so.
The Pennsylvania Supreme Court, in coordination with Domestic Relations Procedural Rules Committee, has acted to clean up that issue by amending Rule 1910.16-6(c) of the Pennsylvania Support Guidelines to include such expenses as a routine expense stating, “[medical] expenses include insurance co-payments and deductibles and all expenses reasonably incurred for necessary medical services and supplies, including but not limited to surgical, dental, and optical services, psychiatric and psychological services, and orthodontia.” (Emphasis added).
The caveat that the expense is “reasonably incurred” does provide a backstop against voluminous expenses, but presumably any dispute about the reasonableness of the expense would trigger a legal custody dispute. Nevertheless, this update to Rule 1910.16-6(c) better reflects the prevailing perspective on the medical necessity and benefit of psychological services eliminates a barrier to parties having this expense reimbursed through the support order.
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