Question..something is not right. Seriously think BM is screwing DH over with money. Opinions needed please!
Back story..DH shares joint custody with BM but BM is the primary residential parent and carries the step kids on her insurance. Per the divorce agreement BM pays the first $100 of uncovered medical expenses per month then after that both parents spilt the uncovered medical expenses. At the beginning of every month BM sends DH copies of all the medical/dental receipts from the previous month along with a total of what DH owes BM minus the first $100.
Here is the "odd" issue....BM insists on using a out-of-net work provider for the kids. Both kids have asthma/allergies and seem to be running the the Dr every few weeks for something. That being said the uncovered medical expenses from BM using a out-of- network provider is outrageous.
The reason BM gives for refusing the change providers is the "kids are comfortable there". Hmmm we are not buying that for a reason to justify the huge expense. We think BM has a second "secret" insurance that she is hiding from DH. Why? We think what BM is doing is submitting what her primary insurance DOES NOT pay to this second "secret" insurance having them reimbuse her for most if not all of the rest of the bill BUT not telling DH. Example if the medical bill is $500 and the main insurance only pays $100 because BM is using a out-of-network provider. BM will then pay the first $100 per the agreement which will make the bill $300 which they spilt now and DH will owe BM $150. If BM has a second "secret" insurance like we think she could submit the remaining bill for $400 and the second insurance could pay most if not all the remaining costs. BM could actually be making money on this deal.
My question is there a way to find out if BM does have a second insurance she is not telling DH about??
This is the ONLY reason we can think WHY anyone would use a out-of-network provider.
Eventhough DH shares joint custady the divorce agreement states BM gets to make medical decisions and DH gets to make schooling decisions. That being said DH has no say in who BM uses for the kids BUT I would think if we can prove she has second secret insurance that BM is using to over charge DH for medical bills we could have something.
DH could probably find out
DH could probably find out from the doctor, assuming he has the right to medical information. He could request bills if he has to pay for part of them.
We do get a copy of the dr bill BUT
I did not know if BM could take out a independent (?) insurance or something like that where she could submit for reimbursement AFTER she paid the original bill. If she did that she would be the one getting directly reimbursed NOT the dr's office as she already paid what the main insurance did not cover. If that was the case there would be no record of second payment at the Dr's office as the money went directly to BM. Is there such a thing?
Yes its a HUGE cost difference using a out-of-network provider the reason we are questioning why BM is doing it BUT the divorce agreement gives BM control over who the kids go to so DH has no say
I don't know of any insurance
I don't know of any insurance policies like that - but who knows. This isn't really about DH trying to control where she goes, it's more of a financial issue. I'd consult an attorney - maybe the order can be changed so that if she wants to go to an out of network provider, she pays more of the out of pocket expenses.
I would think that an
I would think that an additional policy would cost BM as much as the reimbursement she's getting from your DH. I'd try to verify insurance payments with the doctor's billing department, but I doubt there's a secret second policy, unless BM has a husband who is carrying them on his policy as well. It really could be that BM likes, and the kids are comfortable with, the out of network provider. If the cost is getting out of hand, your DH could try to modify his order so he'd only have to reimburse half of the in-network cost, but going to court isn't cheap, either.
So you think BM is paying for
So you think BM is paying for a second insuance poilcy on the kids? That sounds kind of expensive to me unless she is getting it through her employer.
Sounds like a stretch to me.
Sounds like a stretch to me. But, Dad could call the doctor and get the insurance information they have on file. A "secret" policy that she submits bills to might not be on file with the out of network providers.
I am not sure there is any way to confirm or disprove the existence of her "secret" policy.
As for her insistence on using out of network providers, dad could attempt to just reimburse her at the in network care rate. BM would then have to take him to court to recover the rest which if that were to go as our attempts to recover the SpermIdiot's half of medical care costs not covered by insurance would not go well for BM. Our Judge avoided the topic and advised us to go to small claims court to recover the SpermIdiot's medical care obligations.
I think your DH needs to put
I think your DH needs to put his foot down on the out of network usage unless there is a legitimate health related reason why the children have to see those providers. Being comfortable with a DR is NOT enough reason to pay more. I think he does need to possibly update his order and modify it to say that the parents will use IN Network Providers unless it there are exentuation emergency circumstances or unless both parents agree in advance.
This!
This!
And in bonafide medical emergencies, insurance pays at "in network" level.
I think this is a bit too
I think this is a bit too much work for the BM to just to mess with your DH, but i don't know, if she has a pattern acting like this of course it's not a surprise you'd think this way.
Some insurance company wouldn't even allow a secondary one ti be held for the same household. Plus holding a secondary insurance still cost a lot of money..
Stop paying, make BM take you
Stop paying, make BM take you to court.
If she does, which she might not, argue that she's purposefully using a more expensive provider to bleed you for money.
If you lose, you'll just pay back what you would have paid anyway.
If you win, presto chango the kid's doctor, with lower bills.
It's much more easy and effective to ask for forgiveness in this world, than it is to ask for permission.
Maybe but doubtful
if she is married, she could have insurance through her DH and be using both. Most times the bill will reflect the insurance is paid by primary and pending with secondary. I used to do med billing.
However she could have something like Aflac which would pay part of that bill as well. But here is my opinion on that. She would have to pay for that. It is not required by the court. Therefore I’m not sure DH should benefit from Aflac if he isn’t paying for it.
Regardless, I doubt she is using the out of network provider to screw over DH as she would actuallt
have to pay more out of pocket as well. Even if she has Aflac she would be money ahead to use in network providers
How about something like this
How about something like this via email?
BM,
I have found the following In Network Allergists near your house. Please use In Network Drs going forward. If you opt to choose Out Of Network when In Network is available that is up to you. But at your own cost. Out of Netwotk really should only be used if no other option exists. I believe this is typical and reasonable.
Also please send me a copy of both medical report and receipt when requesting reimbursement for a medical appt going forward.
Dad