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Insurance and BM Need Advice fast

Elle36's picture

Submitted by Elle36 on Wed, 09/05/2007 - 4:49pm

Need help on how to deal with insurance and BM. I just had my first child last week. (Everything is fine and she is beautiful) As of right now we met our deductible for family by all the DR. appts, tests, and delivery. Out of pocket we probably are going to have to pay over $1000. Step son just went in yesterday for surgery on his throat. Now all SS's medical bills will be paid since WE or I met the deductible. His mother will not have to fork over a dime. If it wasn't for us already paying out of our pocket for this baby she would be paying half a deductible. For some reason I do not think this is fair. What do others think and how can we even this out. Could we ask her for half of a deductable????? Or should we at least ask for a third of it. Meaning I paid my third, my husband paid his third, and she is responsible for a third????

Comments

Colorado Girl's picture

Submitted by Colorado Girl on Wed, 09/05/2007 - 5:17pm

She should NOT get out of it but I'm a little confused - what if the roles were reversed and the SS surgery was first and the baby was second? How would that have been dealt with? You wouldn't have to have paid ANY of that deductible for your baby because the deductible had been met? I am in a similar situation but there is a per person deductible that is itemized on a monthly statement, with a $10,000 out of pocket maximum. So BM always reimburses ONLY for skids. Otherwise, it wouldn't seem fair either way.

I think the 1/3 idea sounds like a great idea but good luck convincing her of that and it doesn't sound like there would be a legal stand point since there are no "bills" pertaining to the SS that are going to be paid out of pocket. I would see if you could call the insurance company and see if it could get allocated out evenly between the two of you otherwise the BM does get away with paying nothing.

On the bright side, it does sound like you have fabulous insurance though.

Good luck!

"To the ass, or the sow, their own offspring appears the fairest in creation."

luvdagirl's picture

Submitted by luvdagirl on Wed, 09/05/2007 - 5:19pm

I agree its not quite fair but I don't think any judge will give you any part of the deductable since it was all covered by bills in your name,They usually only grant reimbursement for bills incurred by the minor children in the case.

Anne 8102's picture

Submitted by Anne 8102 on Wed, 09/05/2007 - 5:39pm

I agree with what's been written above. No, it doesn't feel exactly fair, but then again it's got to be nice to know you don't have to kick in on anything for SS's care. He's part of the family and it's a family plan, so... I'm afraid it is what it is. Probably the only way of getting around it is putting SS on a separate policy from now on, but that would probably cost even more and besides, what's done is done.

I think you need to let it go and enjoy your new baby girl. You'd be paying what you're paying on her if SS didn't exist, right? And as far as what BM has to pay, hey, I'd just be glad that there's no out-of-pocket costs for you guys. Forget about what she has to pay. What would you rather have? Your bouncing baby girl or for BM to have to pay for SS's care? I think it's one of those things that you have to chalk up to being not quite right, but probably pointless to obsess over.

Congratulations! I'm sure she's beautiful!

~ Anne ~

"Love, having no geography, knows no boundaries."
(Truman Capote)

Elle36's picture

Submitted by Elle36 on Wed, 09/05/2007 - 6:05pm

I forgot to mention that she has full coverage insurance on SS too BUT she does not use hers as the primary. I have insurance on myself which is my primary. My husband's insurance is my secondary. Maybe this will help you all see things and why I am upset. I have to pay my deductable for my insurance ($1000) my husband's insurance has a $1000 family.....So WE have paid close to $2000 out of pocket and rightfully so because it is me and my child and yes we would have been paying it anyway. If this surgery on his son was done months ago BM would have been paying half deductable on HER and my husbands son. I still would be paying $1000 for me. Because my bills we so high (I had complications) that everything poured over for my husbands insurance to cover the rest and she gets off free.

Anne 8102's picture

Submitted by Anne 8102 on Wed, 09/05/2007 - 6:22pm

That's determined by law. Whomever's birthday comes first in the year, that is the primary insurance. We're primary, because DH's birthday is in March and BM's birthday is in June. If her birthday comes after your DH's in the calendar year, then she CAN'T use hers as primary. If her birthday month occurs BEFORE your DH's birthday month, i.e. she was born in April and he was born in September, then she MUST file hers as primary. Hope this helps! I have no idea why it is this way, but I do know that's how it's determined which insurance is primary. The only exception I know of is in the case of military (Tricare), which ALWAYS pays secondary to anything else, unless it's specifically a Tricare supplement. Probably Medicare and other similar insurances are the same, but for most commerical or employer-provided insurances, primary vs. secondary is determined by birth month.

~ Anne ~

"Love, having no geography, knows no boundaries."
(Truman Capote)