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Braces

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crystal1318

Junior Member
What is the name of your state (only U.S. law)? NY
About a 1 1/2 yrs ago my husbands ex got his son brace. The dentist gave her 3 payment plan options of an option to pay in full and get a discount. He told her he didn't have the money so she needed to wait till we got our tax return or go with a payment plan. She paid in full. Now she is taking him to court for half of the bill($2000). I called the insurance co and they have covered all of the bills so far plus she still has almost $200 that they will cover before there are any out of pocket costs. Divorce decree states half of unreimbersed medical, dental and orthodontic bills. Will the courts make him pay?
 


LdiJ

Senior Member
What is the name of your state (only U.S. law)? NY
About a 1 1/2 yrs ago my husbands ex got his son brace. The dentist gave her 3 payment plan options of an option to pay in full and get a discount. He told her he didn't have the money so she needed to wait till we got our tax return or go with a payment plan. She paid in full. Now she is taking him to court for half of the bill($2000). I called the insurance co and they have covered all of the bills so far plus she still has almost $200 that they will cover before there are any out of pocket costs. Divorce decree states half of unreimbersed medical, dental and orthodontic bills. Will the courts make him pay?
He will have to pay 1/2 of whatever the insurance doesn't cover. It sounds to me like the insurance is not going to cover all of it, so he will be responsible for some of the cost.
 

CJane

Senior Member
I find it really difficult to believe that the insurance company released that information to the step-mother. It's pretty obvious to me that Dad is NOT the one who carries insurance for kiddo - so they don't know SMom from any other meddling stranger.
 

mommyof4

Senior Member
I find it really difficult to believe that the insurance company released that information to the step-mother. It's pretty obvious to me that Dad is NOT the one who carries insurance for kiddo - so they don't know SMom from any other meddling stranger.
My husband carries our insurance and I have NEVER had an issue getting information about anything insurance related from them. As a matter of fact, I'm the only one that has ever dealt with the ins. company. As long as she's on the policy and has the necessary information, she shouldn't have any issue getting any information.
 

CJane

Senior Member
My husband carries our insurance and I have NEVER had an issue getting information about anything insurance related from them. As a matter of fact, I'm the only one that has ever dealt with the ins. company. As long as she's on the policy and has the necessary information, she shouldn't have any issue getting any information.
I don't think THIS FATHER carries the insurance or he'd ALREADY KNOW what was covered and what wasn't. Certainly before the braces had been in the kid's head for EIGHTEEN MONTHS.

I'm willing to bet that MOM carries the insurance.
 

mommyof4

Senior Member
I don't think THIS FATHER carries the insurance or he'd ALREADY KNOW what was covered and what wasn't. Certainly before the braces had been in the kid's head for EIGHTEEN MONTHS.

I'm willing to bet that MOM carries the insurance.
Okay, I misunderstood what you were saying. :eek:
 

proud_parent

Senior Member
I don't think THIS FATHER carries the insurance or he'd ALREADY KNOW what was covered and what wasn't. Certainly before the braces had been in the kid's head for EIGHTEEN MONTHS.

I'm willing to bet that MOM carries the insurance.
Or Step-Mom does. Which could explain why the insurance company had no problem giving her the info.
 

nemom3

Member
What is the name of your state (only U.S. law)? NY
About a 1 1/2 yrs ago my husbands ex got his son brace. The dentist gave her 3 payment plan options of an option to pay in full and get a discount. He told her he didn't have the money so she needed to wait till we got our tax return or go with a payment plan. She paid in full. Now she is taking him to court for half of the bill($2000). I called the insurance co and they have covered all of the bills so far plus she still has almost $200 that they will cover before there are any out of pocket costs. Divorce decree states half of unreimbersed medical, dental and orthodontic bills. Will the courts make him pay?

So 18 months ago you realized your husband would be required to pay half - but could not afford the lump sum right away and asked if ex could wait till income tax returns came in.

My BIG question here is WHERE is that tax return? I doubt it has not been received yet (for that matter Dad should have received 2 of them!)so why was the bill not paid at that time. Yes at this point the insurance has covered everything but if Mom had not paid in full there would have been monthly charges - has dad made any attempt to pay monthly? Apparently Dad has not made any attempt to pay anything.

Bottom line is if the Ortho could not get a commitment to a form of payment kiddo's braces would not have been started. Kuddo's to Mom for being able to pay the lump sum up front and save herself (and your husband by the way) some extra money and finance charges.

Daddy has known about this for 18 months and chose not to either pay it with the tax return (remember the one he asked her to wait for) or set up a payment plan. Mom paid her portion of the bill Dad needs to step up and pay his!
 
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mommyof4

Senior Member
So 18 months ago you realized your husband would be required to pay half - but could not afford the lump sum right away and asked if ex could wait till income tax returns came in.

My BIG question here is WHERE is that tax return? I doubt it has not been received yet (for that matter Dad should have received 2 of them!)so why was the bill not paid at that time. Yes at this point the insurance has covered everything but if Mom had not paid in full there would have been monthly charges - has dad made any attempt to pay monthly? Apparently Dad has not made any attempt to pay anything.

Bottom line is if the Ortho could not get a commitment to a form of payment kiddo's braces would not have been started. Kuddo's to Mom for being able to pay the lump sum up front and save herself (and your husband by the way) some extra money and finance charges.

Daddy has known about this for 18 months and chose not to either pay it with the tax return (remember the one he asked her to wait for) or set up a payment plan. Mom paid her portion of the bill Dad needs to step up and pay his!
No, Dad only has to pay 1/2 of the costs not covered by insurance. Apparently, so far, insurance has covered all of the cost. Once insurance stops covering charges, then he will be responsible for 1/2 of that cost. That day hasn't come, yet.
 

proud_parent

Senior Member
No, Dad only has to pay 1/2 of the costs not covered by insurance. Apparently, so far, insurance has covered all of the cost. Once insurance stops covering charges, then he will be responsible for 1/2 of that cost. That day hasn't come, yet.
Exactly.

BTW, strike my previous comment about Step-Mom carrying the insurance. I was imagining something way more convoluted than is likely the case here.

My thought was Step-Mom carries the insurance, ergo Step-Mom/Dad receive all reimbursements. Mom sues to reclaim her half of the reimbursements that Dad has never advanced to her, since Mom was the one who shelled out the entire amount up front.

Of course, if this were what was going on, Step-Mom wouldn't have needed to call the insurer to find out what had been covered -- she'd have all the EOBs (and check stubs).
 

mommyof4

Senior Member
Exactly.

BTW, strike my previous comment about Step-Mom carrying the insurance. I was imagining something way more convoluted than is likely the case here.

My thought was Step-Mom carries the insurance, ergo Step-Mom/Dad receive all reimbursements. Mom sues to reclaim her half of the reimbursements that Dad has never advanced to her, since Mom was the one who shelled out the entire amount up front.

Of course, if this were what was going on, Step-Mom wouldn't have needed to call the insurer to find out what had been covered -- she'd have all the EOBs (and check stubs).
I had the same thought and discarded it for the same reason.:)
 

LdiJ

Senior Member
No, Dad only has to pay 1/2 of the costs not covered by insurance. Apparently, so far, insurance has covered all of the cost. Once insurance stops covering charges, then he will be responsible for 1/2 of that cost. That day hasn't come, yet.
Actually, if mom paid up front, and insurance has reimbursed HER so far the amount that the insurance is willing to cover, as the work has been done, and they know that the insurance will only cover 200.00 more, then dad DOES own mom NOW, 1/2 of the remaining balance.
 

mommyof4

Senior Member
Actually, if mom paid up front, and insurance has reimbursed HER so far the amount that the insurance is willing to cover, as the work has been done, and they know that the insurance will only cover 200.00 more, then dad DOES own mom NOW, 1/2 of the remaining balance.
Mom is taking Dad to court for the $2000. Insurance has covered that portion. Dad does NOT owe Mom that money. (keep in mind I am going solely off what OP wrote).

Dad will owe 1/2 of unreimbursed bills when those unreimbursed bills are issued, not before the work is done resulting in further charges.
 

nemom3

Member
Mom is taking Dad to court for the $2000. Insurance has covered that portion. Dad does NOT owe Mom that money. (keep in mind I am going solely off what OP wrote).

Dad will owe 1/2 of unreimbursed bills when those unreimbursed bills are issued, not before the work is done resulting in further charges.
From what I know of braces I'm pretty sure that the $4,000 was what will be required AFTER insurance - even our normal dentist only charges us what insurance won't cover so Dad will end up paying her the $2,000. If she had elected to pay monthly he would have been required to pay 1/2 the monthly charges as well. Braces are VERY expensive!! Most insurances only covers X and leaves a large balance left to be paid. I have been researching this since my son will soon need braces. Average (and even great) dental insurance only covers a specific ammount per month and to even start treatment payment is required.

The Dr will not continue to treat the child if regular payments (or in this case up front payment) are not received. If Dad had no intention of paying for 18 months "until insurance coverage maxed out" why did he ask her to wait till he got his tax return? He should be happy she paid up front and if he had a problem with that he should have said something at the time instead of playing dumb for 18 MONTHS!!
 

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