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In re Marriage of Zandi

Supreme Court of Washington, En Banc

February 23, 2017

In the Matter of the Marriage of VICTOR M. ZANDI, JR., Petitioner, and DEANNA M. ZANDI, Respondent.

          STEPHENS, J.

         This case asks if out-of-network health care costs qualify as '"[u]ninsured medical expenses'" under RCW 26.18.170(18)(d). Victor and Deanna Zandi's dependent daughter, T.Z., incurred approximately $13, 000 in medical bills when she had a kidney stone removed while traveling outside the Kaiser Permanente network. The superior court ordered Victor Zandi to pay 75 percent of the cost and Deanna Zandi to pay the remaining 25 percent. The Court of Appeals reversed, finding that the superior court abused its discretion by modifying the parties' 2009 order of child support, which required Victor Zandi to pay 100 percent of "uninsured medical expenses." In re Marriage of Zandi, 190 Wn.App. 51, 52, 357 P.3d 65 (2015).

         We affirm the Court of Appeals. The legislature defines "'[u]ninsured medical expenses'" as costs "not covered" by insurance. RCW 26.18.170(18)(d). WAC 388-14A-1020 clarifies that this includes costs "not paid" by insurance, even if those costs would be covered under other circumstances. Because the health care expenses in this case are unambiguously within the scope of RCW 26.18.170(18)(d), financial responsibility is allocated by the 2009 order and may not be modified absent evidence of changed circumstances or other evidence consistent with the requirements of RCW 26.09.170(6)-(7).


         T.Z. is the daughter of Deanna and Victor Zandi.[1] In June 2011, T.Z. developed a four millimeter stone in her left kidney. The following month, while visiting her maternal aunt in Ohio, T.Z.'s condition worsened. T.Z. was admitted to a hospital in the Cincinnati area, where doctors installed a temporary stent. T.Z.'s surgeon referred her to the Urology Group in Cincinnati to have the kidney stone removed via lithotripsy. Lithotripsy uses ultrasound shock waves to break up a stone, allowing it to be passed from the body.

         T.Z. has medical insurance through her father's plan with Kaiser. Kaiser is not available in the Cincinnati area. T.Z.'s aunt lives in Goshen, a suburb of Cincinnati in southwestern Ohio; the closest Kaiser facility is near Cleveland, 186 miles to the northeast. When Deanna contacted Victor to advise him of T.Z. 's situation, Victor told her that T.Z.'s aunt should either drive T.Z. to Cleveland or wait to see if Kaiser would authorize an out-of-network provider. Deanna disagreed, believing T.Z. needed immediate surgery. T.Z.'s aunt took her to the Urology Group in Cincinnati on July 7, 2011, where doctors used lithotripsy to successfully treat T.Z. 's kidney stone. Medical expenses for T.Z.'s time in Ohio totaled approximately $13, 000. Concluding that T.Z.'s treatment was both nonemergent and out of network, Kaiser ultimately declined to cover these costs.

         Under the terms of the Zandis' 2009 order of child support, Victor is responsible for providing T.Z. with medical insurance and paying any uninsured medical expenses. Paragraph 3.19 states, "The father shall pay 100% of uninsured medical expenses and the mother shall pay 0% of uninsured medical expenses . . .." Clerk's Papers (CP) at 7. Deanna sought enforcement of this provision under RCW 26.18.170. See Resp't's Suppl. Br. at 10-13. Victor argued that he should be excused from the terms of the child support order because Deanna did not "go through the appropriate channels" (i.e., obtain preauthorization before sending T.Z. to a non-Kaiser facility). CP at 207. The trial court found that Deanna's status as primary residential parent put her in a "better position to secure coverage for the kidney stone treatment by Kaiser Permanente" and ordered Deanna to pay 25 percent of the medical costs. Id. at 247.

         A divided Court of Appeals reversed, finding that because T.Z.'s medical costs were '"[u]ninsured medical expenses'" under RCW 26.18.170(18)(d), paragraph 3.19 of the 2009 order controlled the allocation of financial responsibility. Zandi, 190 Wn.App. at 54-55. The majority acknowledged the dissent's concern that a parent with control over a child's health care could unfairly subject the financially responsible parent to unnecessary out-of-network expenses. Id. at 56-57. Noting that nothing in the record before the superior court suggested Deanna acted in bad faith or unreasonably, the majority held that the lower court abused its discretion by effectively modifying the 2009 order of child support without adequate cause. We granted Victor's petition for review. In re Marriage of Zandi, 185 Wn.2d 1002, 366 P.3d 1244 (2016).


         Victor argues that the health care costs in this case were not "uninsured medical expenses" within the scope of the 2009 order of child support because the health care T.Z. received would have been covered by Kaiser under different circumstances. Pet. for Review at 7. We disagree, and affirm the Court of Appeals. Reading RCW 26.18.170(18)(d) and its interpretive regulation in the context of chapter 26.18 RCW, "uninsured medical expenses" unambiguously includes the costs Kaiser declined to cover in this case. See WAC 388-14A-1020. By contrast, the narrow interpretation of "uninsured medical expenses" advanced by Victor and the dissenting Court of Appeals judge reads RCW 26.18.170(18)(d) out of context and runs contrary to the core purpose of chapter 26.18 RCW.

         Chapter 26.18 RCW governs the enforcement of child support orders. Under that chapter, one parent's financial responsibility for a dependent child's medical expenses can be enforced by the other parent. See RCW 26.18.170. Specifically, RCW 26.18.170(17) states:

If a parent required to provide medical support fails to pay his or her portion of any premium, deductible, copay, or uninsured medical expense... the parent seeking reimbursement of medical expenses may enforce collection of the obligated parent's portion.

(Emphasis added.) The legislature, recognizing the importance of ensuring that child support obligations are met, instructed courts to "liberally construe[]" chapter 26.18 RCW in order to "assure that all dependent children are adequately supported." RCW 26.18.030(3). Here, the 2009 order of child support states that Victor is financially responsible for 100 percent of his daughter's uninsured medical expenses. CP at 7. Because the superior court reduced Victor's financial burden to 75 percent, this case turns on whether the medical bills T.Z. incurred while in Ohio qualify as "uninsured medical expenses" under RCW 26.18.170.

         Statutory interpretation involves a question of law, subject to de novo review. See, e.g., Clallam County v. Dry Creek Coal,161 Wn.App. 366, 385, 255 P.3d 709 (2011). The purpose of our inquiry is to identify and give effect to the legislative intent behind the statute. Jametsky v. Olsen, 179 Wn.2d 756, 762, 317 P.3d 1003 (2014). If the plain meaning of a statute is unambiguous, our inquiry ends. Id. When attempting to ascertain a statute's plain meaning, we consider the "context of the entire act" as well as ...

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