When an ex refuses to pay half of medical bills for your child, you can enforce the court order that requires them to pay: document what you spent, send a certified demand letter, and if payment still doesn’t come, file a motion for contempt or open a case with your state’s child support enforcement agency. Those steps can trigger wage garnishment, license suspension, tax refund interception, and other consequences. Most parents who lose these disputes lose them on procedure, not on the merits, so the order in which you do things matters.
Read Your Court Order First
Pull out your divorce decree, custody agreement, or child support order and read the medical expense provisions closely before you do anything else. Most orders spell out each parent’s percentage share of unreimbursed medical costs, often tied to income. Some split expenses 50/50; others assign 60/40 or 70/30. If the order says your ex owes 60 percent and you demand half, you undermine your own claim.
Check what the order actually covers. Some orders distinguish between “ordinary” expenses like annual checkups and “extraordinary” expenses like surgery, orthodontics, or mental health treatment. If the expense you’re trying to recover falls into a category your order doesn’t address, you may need a modification rather than enforcement. Orders that are silent on a category don’t automatically require the other parent to pay.
Watch for notification deadlines. A common requirement is that the parent who pays the bill must send the other parent a copy of the invoice within 30 or 60 days. Miss that window and you can forfeit reimbursement entirely, no matter how clear the underlying obligation was. Confirm you met any deadline before spending time and money on enforcement.
What Counts as a Reimbursable Expense
Your ex owes a share of the out-of-pocket cost that remained after insurance paid. That includes copays, deductibles, and coinsurance, plus services insurance doesn’t touch at all: dental work, vision care, orthodontics, therapy, and prescriptions your plan excludes.
The number that matters is what you actually owed the provider, not the amount originally billed. Medical providers routinely bill $800 for a service that insurance negotiates to $350, of which your plan pays $280. Your ex’s share is based on the $70 you owed, not the $800. Sending the full billing statement without accounting for insurance adjustments is one of the fastest ways to start an argument that delays payment further.
For unusual expenses like braces or a specialist not covered by insurance, courts generally look at whether the treatment was medically necessary. Documentation from the provider explaining why the treatment was needed strengthens your position, especially for costs that could look optional on paper.
Build the Paper Trail
Collect every document tied to the expense: the provider’s itemized statement, the explanation of benefits from your insurer showing what was covered, your receipt or bank statement proving you paid, and any treatment notes establishing medical necessity. These should clearly show the date of service, what was done, and the amount you paid out of pocket.
Save every text, email, and letter where you notified your ex of the bill, asked for payment, or discussed the expense. An acknowledgment or a broken promise to pay becomes powerful evidence later. Keep everything organized by date. A judge reviewing a contempt motion wants to see a clean timeline showing you did everything right and your ex still refused to pay.
Send a Formal Demand Letter
Before filing anything in court, send a written demand for payment. This gives your ex one last clear chance to pay voluntarily, and it creates evidence that you tried to resolve the issue without a judge. Courts expect to see that effort.
Your demand letter should include the specific amount owed, copies of the medical bills and insurance explanations, proof you paid, and the section of your court order requiring your ex to share the cost. Set a firm deadline, typically 15 to 30 days, and state plainly that you intend to seek court enforcement if payment isn’t received.
Send the letter by certified mail with a return receipt so you have proof it was received. You can email a copy for convenience, but certified mail is the method courts find most credible. The signed return receipt or delivery confirmation eliminates any “I never got it” defense.
File a Motion for Contempt
If the demand is ignored, file a motion asking the court to hold your ex in contempt for violating the existing order. Contempt is how family courts enforce compliance, and judges take it seriously because the whole system depends on people following orders.
To win, you generally need to prove three things: a valid court order existed requiring your ex to pay, your ex knew about the order, and your ex willfully failed to comply. This is where the paper trail pays off. Attach the court order, the medical bills, your proof of payment, the demand letter with the return receipt, and any communications showing your ex was aware of the obligation. The person filing typically must show it’s more likely than not that contempt occurred.
At the hearing, both sides present their case. Your ex may argue they couldn’t afford to pay, didn’t receive the bills, or dispute that the expense was covered by the order. Organized documentation and, if you can manage it, legal representation make a real difference. An attorney who handles family law contempt motions regularly will know the procedural requirements in your jurisdiction and can keep the focus on the evidence.
What the Court Can Do to Your Ex
Federal law requires every state to maintain a set of enforcement tools for child support obligations, including medical expense orders. Under 42 U.S.C. ยง 666, those tools include:
- Income withholding, where the court orders your ex’s employer to deduct the owed amount directly from their paycheck.
- Liens against your ex’s real estate, vehicles, and other assets.
- Withholding or suspension of driver’s licenses, professional licenses, and recreational licenses.
- Interception of state and federal tax refunds to satisfy unpaid amounts.
- Reporting of delinquent support to consumer credit bureaus.
Beyond those statutory tools, a judge finding your ex in contempt can impose fines, order your ex to pay your attorney fees for bringing the motion, and in serious cases, impose jail time. Specific penalties vary by state, but the pattern is consistent: courts escalate consequences for repeated non-compliance. A first offense might result in a warning and a payment deadline; continued defiance leads to harsher sanctions. The goal is getting the child’s bills paid, not punishment for its own sake, but judges have little patience for parents who ignore orders.
Your State’s Child Support Agency Can Help
Every state operates a child support enforcement agency, often called a Title IV-D agency after the section of federal law that funds it. These agencies can help enforce medical expense provisions without you needing to hire a lawyer or navigate court on your own. Services typically include locating your ex, initiating income withholding, and pursuing enforcement actions.
You don’t need to be receiving public assistance to use them. Any parent with a child support or medical expense order can open a case. The agency won’t represent you personally the way an attorney would, but it has tools and legal authority individual parents don’t, including access to federal databases for tracking income and assets. If cost is keeping you from hiring counsel, contacting your state’s child support enforcement office is a practical first step.
When Mediation Fits Better Than Contempt
If the dispute is more about confusion or disagreement than outright defiance, mediation can resolve things faster and cheaper. A neutral mediator helps both parents talk through the issue and reach an agreement. Some jurisdictions require an attempt at mediation before the court will hear an enforcement motion.
Mediation works best when your ex is willing to engage but disputes the amount, questions whether the expense is covered, or fell behind financially. It preserves the co-parenting relationship in a way courtroom battles rarely do. The mediator doesn’t take sides or impose a decision; the parents keep control of the outcome.
Pay the Bill Yourself to Protect Your Credit
The medical provider doesn’t care about your court order. The bill is in your name, and the provider will pursue you for the full amount regardless of what a family court has said. Left unpaid long enough, it can end up in collections and on your credit report.
A CFPB rule that would have removed most medical debt from credit reports was struck down by a federal court in July 2025.1Consumer Financial Protection Bureau. CFPB Finalizes Rule to Remove Medical Bills from Credit Reports Under current law, medical debt can still appear on your credit report as long as the listing doesn’t identify the specific provider or type of treatment. An unpaid pediatrician bill or therapy invoice can quietly damage your score while you wait for your ex to comply.
The practical move is to pay the bill yourself and then pursue reimbursement from your ex through the steps above. That protects your credit and puts you in the stronger position of seeking repayment for money already spent, rather than trying to force your ex to pay a provider directly. When you file your contempt motion, include the amount your ex owes you and ask the court to order full reimbursement.