Medical and dental insurance questions

[spudtwin]

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

The father is ordered to carry the medical insurance, which has not been a problem up till now.

Dec 2010, he told me his plan was changing, only thing that was changing was the amount of deductables. I asked for a plan, which he told me I could find online. I can't, because BCBS will not let me access that information.

Jan 2011, I took the child to the dentist. I called him from the dentist office at his work for the insurance info, as I had not received anything from him. He gave me the information.

Feb 2011, I received a copy of letter that FOC sent to his employer. The letter stated that the child's insurance ended Jan 1, 2011, and that by law if insurance was available his employer needed to put the child on. I also showed the letter to him and he said he had insurance. I was then mailed a BC card.

July 2011, I received a bill from the dental visit in Jan. They said that BCBS policy expired Jan 1, 2011 and they denied the claim. I am now responsible for this bill. I showed the bill to him, he again claims he has insurance. I asked him to take the letter to work and to call the insurance company and get this straightened out. He told me to do it, which I have told him numerous times, I can't call the insurance company or his work, they will not deal with me, unless he authorizes it.

It's been 2 weeks, I have heard nothing from him. I have left several messages and he has not returned my calls. There is also a Dr bill from March that the insurance company has not paid yet.

My child is due back this month to the Dr's for immunizations, to his next dental appt and an eye appt. I have no clue if there is insurance on any of this.

How do you find out if your child has insurance or not? Is there something I can file on this?

 

[TinkerBelleLuvr]

you must submit a letter to FOC to help with enforcement of the medical portion.

 

[spudtwin]

you must submit a letter to FOC to help with enforcement of the medical portion.

He is court ordered to carry medical insurance, but would that include the dental insurance to? He has always had the dental. If dental insurance is not required, would dental be part of uncovered medical expense?

I have 6 months to turn it in from the date of denial under uncovered.

 

[TinkerBelleLuvr]

It depends on the plans thru work. If it's under the, I believe 5% rule, it'll include dental. My X refused to give me the insurance info. I called the employer, explained who I was, and asked that they give me the insurance provider. Once I had that, I was able to get the insurance info. I provided that to the dentist and THEY got the scoop. (Can you tell that I have an obstinant x).

 

[spudtwin]

It depends on the plans thru work. If it's under the, I believe 5% rule, it'll include dental. My X refused to give me the insurance info. I called the employer, explained who I was, and asked that they give me the insurance provider. Once I had that, I was able to get the insurance info. I provided that to the dentist and THEY got the scoop. (Can you tell that I have an obstinant x).

It was at the time under that. He claimed in Dec he was changing to a cheaper plan through BCBS, that would lower his premiums. He said the deductables would go up, but everything else on coverage would stay the same. I would assume though if his premium now was high enough to go over, then he would have to file for a modification.

The child support order is figured with him getting credit for those premiums, so I actually pay a portion of those.

I am just pissed, I could have the child on my insurance, which I can get medical, dental and vision. He has no vision coverage. He claimed though if I take the child to certain eye dr's, that I can get the basic vision paid through the medical. But that is probably BS to, and I already made that appt, guess I will cancel it till this is straightened out.

Is it that hard for them to give you the policy, so you can figure this out prior to making appts. They don't care, your the one taking the child, your the one billed.

 

[mommyof3jkc]

have dealt with the same thing....

I am not sure if BCBS follows the same guidelines that Kaiser Permanente does, but per Kaiser, if you have joint legal custody and you are the primary custodial parent, they can and will release only the child's information to you, if the child's deductable has been met, when the child's coverage began and ended and will also issue an insurance card if one had not been given. As long as the request for information has nothing to do with the other parent, they will share what they can. I had to show member services the court papers that stated I was primary parent responsible for day to day activities, etc. Again, BCBS might not follow those same guidelines but it's worth a try.

 

[cbg]

Speaking from an insurance and not a child support point of view, many, many employers offer medical and dental insurance separately. It is becoming more and more rare for dental expenses to be covered on a medical policy, with the occasional exception of impacted wisdom teeth which generally (but not always) fall under medical. The other exception would be if, for example, your child was hit in the face with a softball. For that kind of accident, the medical plan would apply. The same applies to vision care - an eye exam may be covered under the medical, but you would have to look at the specific policy to know if anything beyond that is covered.

So having medical insurance does not mean that there is dental insurance. Whether your ex is required to provide dental or vision care insurance (which many employers do not provide at all - my employer offers one of the richest benefit plans I've seen in 30 years and we get a vision plan for the first time in January) I will leave to others to determine.

 

[TxPE2011]

I am not sure if BCBS follows the same guidelines that Kaiser Permanente does, but per Kaiser, if you have joint legal custody and you are the primary custodial parent, they can and will release only the child's information to you, if the child's deductable has been met, when the child's coverage began and ended and will also issue an insurance card if one had not been given. As long as the request for information has nothing to do with the other parent, they will share what they can. I had to show member services the court papers that stated I was primary parent responsible for day to day activities, etc. Again, BCBS might not follow those same guidelines but it's worth a try.

I could have written OP's thread about a year ago. It was such an issue we had insurance changed to my responsibility and dad had to reimburse 1/2 of my premium cost. Dental is not included in the order of health insurance but it is included in the 'reimbursement' section of the order. Dental expenses that is.

BCBS as well as Cigna will release the policy # and other information if you call them directly. I have dealt with both. I didn't even have to prove to them who I was... I gave dad's social security number and they gave me what I needed....

 

[mistoffolees]

BCBS as well as Cigna will release the policy # and other information if you call them directly. I have dealt with both. I didn't even have to prove to them who I was... I gave dad's social security number and they gave me what I needed....

In today's HIPAA climate, that's a dangerous move.

Legally, you are not entitled to the information under the terms of the policy. If the policy says that only the policyholder can access that information, then you don't have the right. By calling them (even if you know the social security number), you are asserting that you have a legal right to access the records. You may have created a HIPAA violation or, perhaps, even an identity theft situation.

It's better to go through the person who has a legal right to the information. If they don't comply, have the FOC tell them to. If that doesn't work, file for contempt. Alternatively, get a court order stating that you have access to the records so that it's legal.

(NOTE. SOME information is automatically available to the parent by law, but that would be more along the lines of medical records. I don't believe that a parent automatically has access to insurance records and documents).

 

[spudtwin]

I'm a nurse so well aware of HIPPA laws and I'm not accessing information that could get me in trouble. Dad don't get this and I have talked to many departments at BCBS, including department heads. They all say I have no legal right to the information, I can only access it if dad gives me his online log in and password. I don't want that either, cause dad could say I accessed it myself without his permission. Dad says he has never logged in online and I believe him, as he has zero computer skills.

He did give me a new BCBS card, different then the one he gave me in Jan. However it is medical only, I asked for the dental information and have not gotten anything as of yet.

The new BCBS, well it turns out it is a HMO. You need to pick a primary care physician, which I can't do, because you must access that online account to do that. Dad didn't pick one for the child either. So now the Dr bill from March is going to be denied. I can't get dad to understand that a primary must be picked. I had to cancel the eye Dr appt, because I need a referral from the primary care physician to have that covered under the medical. This much I can get from the plan name on the BCBS website. But they don't let you access the full policy. On top of that the ped I have has been the child's Dr since he was born, and this ped is not listed as a Dr on the BCBS website for this HMO plan. I am not happy about changing Drs, he never told me any of this last Dec.

Had he told me the truth then or provided me with the policy as I had asked, I would have just put the child on my insurance. I do not want to change the Dr, my other child also goes to this ped. I then would have filed a motion to make me responsible to carry the insurance. I already have myself on this plan and my other child, not that expensive to add another child.

In my court if you don't follow the policy correctly, then you can end up paying all of the denied bills. But I can't follow the policy if I don't have it to follow. I give up arguing with dad, because he just insists the plan is the same, and I can access all information on the website. Dad can just print the policy off his online account, I have offered him the paper or money to cover the paper to do this.

So I have my letter ready to send to FOC. I am asking them to enforce the order or change the one responsible to carry insurance to me. I have been arguing with dad for 3 years over getting me correct cards and the policies to go with them. He has changed his plan each year.

I am going to add to my letter that the court make an order stating I have access to the information, if they leave him to be the party responsible to carry the insurance. Thank you for that suggestion.

Thanks to all others who replied also.

 

[cbg]

I'm a nurse so well aware of HIPPA laws

Then why don't you know that it's HIPAA and not HIPPA?

 

[spudtwin]

I'm a nurse so well aware of HIPPA laws

Then why don't you know that it's HIPAA and not HIPPA?

Seriously? It was late, I worked a double Sat and a double Sun. I wanted to respond to ones who posted and thank them for helping me. I didn't proof read and had a typo. I am sure there are more, probably poor grammer and misspelled words to.

I work in a private, small psych hospital. We don't chart on computers, we still hand chart. Working in a psych hospital, the charting is ten times more then a medical hospital. You learn to write very slopply, very fast, so no one can see misspelled words, poor grammer and when you proof read, you don't correct those things. Your proof reading to make sure you don't miss something of whatever the incident was. The proof reading and correction is for whoever is stuck transcribing your mess and the Dr's mess.

It becomes habit, so sorry if I offended you with my poor skills.

 

[mistoffolees]

Seriously? It was late, I worked a double Sat and a double Sun. I wanted to respond to ones who posted and thank them for helping me. I didn't proof read and had a typo. I am sure there are more, probably poor grammer and misspelled words to.

I work in a private, small psych hospital. We don't chart on computers, we still hand chart. Working in a psych hospital, the charting is ten times more then a medical hospital. You learn to write very slopply, very fast, so no one can see misspelled words, poor grammer and when you proof read, you don't correct those things. Your proof reading to make sure you don't miss something of whatever the incident was. The proof reading and correction is for whoever is stuck transcribing your mess and the Dr's mess.

It becomes habit, so sorry if I offended you with my poor skills.

I'm not buying it. I've never seen a medical facility that encourages people to write sloppily. Case notes are meant to be legible. Furthermore, HIPAA is something that comes up so frequently that typing it would be automatic.

The message from your post is that you work for a sloppy organization that doesn't care much for patient care or legal matters.

In any event, my statement was correct. TX's suggestion to use Dad's SSN and ask for the information might well run afoul of HIPAA laws.

The bottom line is that only the policy holder can do some things, so you can't simply take matters into your own hands. You will need a court order forcing him to select a primary care physician or provide you with documents, and so on.

 

[TheGeekess]

I'm not buying it. I've never seen a medical facility that encourages people to write sloppily. Case notes are meant to be legible. Furthermore, HIPAA is something that comes up so frequently that typing it would be automatic.

The message from your post is that you work for a sloppy organization that doesn't care much for patient care or legal matters.

In any event, my statement was correct. TX's suggestion to use Dad's SSN and ask for the information might well run afoul of HIPAA laws.

The bottom line is that only the policy holder can do some things, so you can't simply take matters into your own hands. You will need a court order forcing him to select a primary care physician or provide you with documents, and so on.

I worked in a general hospital when paper charting was the rule instead of the exception. Believe me, most nurses and doctors have atrocious handwriting/spelling. The saving grace was the use of acronyms.

 

[mistoffolees]

I worked in a general hospital when paper charting was the rule instead of the exception. Believe me, most nurses and doctors have atrocious handwriting/spelling. The saving grace was the use of acronyms.

That's true. But OP said that they INTENTIONALLY write sloppily. I would fire any manager who told employees to write illegibly.