In the Matter of the Marriage of VICTOR M. ZANDI, JR., Petitioner, and DEANNA M. ZANDI, Respondent.
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).
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).
AND PROCEDURAL HISTORY
the daughter of Deanna and Victor Zandi. 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.
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.
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.
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).
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.
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.
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