Court ordered Insurance questions

[DadneedshelpOK]

What is the name of your state (only U.S. law)? Oklahoma

I am the non-custodial parent and have some questions about private health insurance. I recently could provide health insurance through my employer to my child. She is on Medicare (SoonerCare) and now my insurance will be the primary insurance and Soonercare will be secondary. My insurance plan is a high deductible policy. My ex has been taking our child to see a speech pathologist for several months. SoonerCare picked up the bill for a few months and then the doctor made special payment arrangements ($60 sessions lowered to only $3 each) with my ex to be able to continue getting therapy. I have been paying for half, which has been no problem as they are so inexpensive. My ex just informed me that the doctor would now be billing my insurance for the therapy. So I have some questions

1. My insurance won't pay anything until the deductible is met ($3000). Since the child is on Soonercare, will they pay the charges? Even the deductible? What if Soonercare says that the therapy is not medically necessary (which they covered our child at first so I don't know if they will say this or not)

2. If Soonercare will not pay then I have questions about the billing. My ex is terrible with money and I don't really want the bills coming to me and her having to reimburse me for payments. I would rather her be responsible for paying and then I pay her. I have read that since I never signed a consent to treatment agreement then I can force my insurance to bill her and not me under the Fair Credit Act. Is this true? If not, is there a way for the bills to go to her and not me.

The therapy has been very beneficial to our child and I want them to continue. My issue is not having to pay, my issue is that dealing with my ex is very difficult when it comes to money. I have to be very calculated and deliberate when approaching her with anything. I am trying to get all my ducks in a row and get a feel for what the process is for these types of matters. Thanks for any help, feel free to ask me any questions, and I may have follow up questions....

 

[adjusterjack]

Number 1 involves coverage questions that you have to be asking of your insurance company.

Number 2 involves something that's between you and your ex that you will have to iron out with her. I don't know what you mean by your insurance billing you but if the doctor sends the bill to your insurance company, your insurance company doesn't send you a bill for anything.

Example: Dr bill is 100, you have a 3000 deductible, all the insurance company will do is send you an Explanation of Benefits saying you have met 100 of your deductible and nothing gets paid to the Dr. Then you write a check to the Dr for the amount of the bill.

That will happen every time the insurance company gets a bill until you have met the full deductible and then the insurance company will start paying the Dr.

 

[LdiJ]

What is the name of your state (only U.S. law)? Oklahoma

I am the non-custodial parent and have some questions about private health insurance. I recently could provide health insurance through my employer to my child. She is on Medicare (SoonerCare) and now my insurance will be the primary insurance and Soonercare will be secondary. My insurance plan is a high deductible policy. My ex has been taking our child to see a speech pathologist for several months. SoonerCare picked up the bill for a few months and then the doctor made special payment arrangements ($60 sessions lowered to only $3 each) with my ex to be able to continue getting therapy. I have been paying for half, which has been no problem as they are so inexpensive. My ex just informed me that the doctor would now be billing my insurance for the therapy. So I have some questions

1. My insurance won't pay anything until the deductible is met ($3000). Since the child is on Soonercare, will they pay the charges? Even the deductible? What if Soonercare says that the therapy is not medically necessary (which they covered our child at first so I don't know if they will say this or not)

2. If Soonercare will not pay then I have questions about the billing. My ex is terrible with money and I don't really want the bills coming to me and her having to reimburse me for payments. I would rather her be responsible for paying and then I pay her. I have read that since I never signed a consent to treatment agreement then I can force my insurance to bill her and not me under the Fair Credit Act. Is this true? If not, is there a way for the bills to go to her and not me.

The therapy has been very beneficial to our child and I want them to continue. My issue is not having to pay, my issue is that dealing with my ex is very difficult when it comes to money. I have to be very calculated and deliberate when approaching her with anything. I am trying to get all my ducks in a row and get a feel for what the process is for these types of matters. Thanks for any help, feel free to ask me any questions, and I may have follow up questions....

Does your high deductible plan come with an HSA that is all or partially funded by your employer?

 

[DadneedshelpOK]

Does your high deductible plan come with an HSA that is all or partially funded by your employer?

Yes. Partially. I guess since I am wanting to use that, I would need to pay the doctor directly and not my ex.

I have been told that anything not covered by primary insurance would be picked up by Soonercare. But I just don't know if that would apply here

 

[cbg]

The only one who can answer your first question is Soonercare. The second question is a matter between you, your ex, and the providers; it's not a issue of law.

 

[LdiJ]

Yes. Partially. I guess since I am wanting to use that, I would need to pay the doctor directly and not my ex.

I have been told that anything not covered by primary insurance would be picked up by Soonercare. But I just don't know if that would apply here

Yes, if you want to use your HSA you will need to pay the doctor directly.

 

[DadneedshelpOK]

Thanks for all the advice. I will call my insurance and SoonerCare about the fees.

One last question I have is can my ex take our child for medical care whenever and wherever she sees fit? I understand in an emergency, but I'm asking about "other" medical care that may or may not be a necessity. Am I required to pay my part whether I agree or not to the medical care? She will not include me in health care decisions and has told me so verbally and over text, she likes to play the martyr card and pretend she does everything without any help.

Anyway, I just need to know if I'm screwed and have to pay for whatever she decides to do or if I have some sort of say or recourse legally.

 

[cbg]

I have not read your court order so I don't know what she can do or what you must pay.

What does your attorney say?

 

[DadneedshelpOK]

I have not read your court order so I don't know what she can do or what you must pay.

What does your attorney say?

I don't have the court order with me, but will post tomorrow or tonight with it. I do know that I am required to pay 65%. I am pretty sure the rest of the language is pretty standard and generic. I will post it later

 

[cbg]

Apparently I was too subtle.

I am not an attorney in your state. You need one of them to interpret your court order.

 

[DadneedshelpOK]

Follow up question

First of all, thanks to those offering advice.

I am resurrecting this post because I have a new situation that I would like input on.

I will do my best to communicate what is going on, it's a bit complicated. I am looking for general thoughts and advice, I realize that this isn't necessarily a "legal" matter. But I may need to hire an attorney to straighten all this out

As stated in my original post, my ex worked out with the speech therapy place a highly discounted rate based on her income. They were charging this rate for lessons all the way through October 2016. My ex would pay and I would reimburse her the 65% that I owed. The one exception is that I called them at the end of October and paid the entire bill ($15) (5 sessions) at the end of October. So everything was paid through October and we had a zero balance. I have statements sent by my ex showing the amount billed to her ($3 a session) and the balances. I also would only pay my ex with a check so I would have record. Also, I gave her my insurance information in July 2016

Two days ago I logged into my health insurance and found that the therapy place is now trying to charge my insurance for therapy lessons from July 2016 - October 2016 amounting to over $800. Also, the claim they turned in didn't show any of the payments that we had already made. I am on a HDHP so my insurance won't pay any of it as I haven't met my deductible yet.

I feel like my ex told them to do this intentionally just to cost me more money. An agreement had already been made, lessons billed and paid for. Now they are trying to go back in time and I don't think it should be possible (legal). The fact that the claim they turned in was for the full amount and didn't show any adjustment for our payments AND the fact that their statements show a completely different amount and balances...

Right now I am thinking that my course of action is to not pay her for anything before November 2016 as I was paid up until then per the agreement. Then see where the dust settles with the insurance company and the therapy office. Wait for a statement from my ex. Not pay it and let her take me to court over it. Lawyer up and make my ex and the therapy place explain why.

Thoughts, questions, advice welcome

Thanks