Questions regarding uncovered dental expenses

[steplady]

What is the name of your state? New York
My husband's ex carries dental insurance on her daugter, and my husband does as well as they were both ordered to in their order of support. They both must then pay half of any uncovered medical/dental expenses. My husband has no problem with this. Recently, she took his daughter to the dentist for a checkup which cost over $200. Then says that the dentist wasn't in her plan. She claims she didn't realize it at the time. Is my husband obligated to pay half of this amount, since she took her daughter to a dentist that was not covered at her own choosing, when both she and my husband have dental coverage for her? I would like to know if anyone knows the statute that applies to this as well.

[LdiJ]

What is the name of your state? New York
My husband's ex carries dental insurance on her daugter, and my husband does as well as they were both ordered to in their order of support. They both must then pay half of any uncovered medical/dental expenses. My husband has no problem with this. Recently, she took his daughter to the dentist for a checkup which cost over $200. Then says that the dentist wasn't in her plan. She claims she didn't realize it at the time. Is my husband obligated to pay half of this amount, since she took her daughter to a dentist that was not covered at her own choosing, when both she and my husband have dental coverage for her? I would like to know if anyone knows the statute that applies to this as well.

Is the dentist not in dad's plan either? Is nothing going to be covered at all?

[haiku]

have you read the order recently? if not dig it out. Sometimes it will address what happens if a parent takes a child out of network.

[Tooder]

My husband's order states his child's mother is responsible to make sure she follows all procedures to have the insurance pay. If she doesn't she is responsible for 100% of the uninsured amount of the claim.

Edited to add: In my opinion, if she went out of network and didn't make sure the practitioner would be covered, she should pay the whole bill. She made the decision to go to that particular provider. (Just my thoughts)

[fairisfair]

My husband's order states his child's mother is responsible to make sure she follows all procedures to have the insurance pay. If she doesn't she is responsible for 100% of the uninsured amount of the claim.

Edited to add: In my opinion, if she went out of network and didn't make sure the practitioner would be covered, she should pay the whole bill. She made the decision to go to that particular provider. (Just my thoughts)

I doubt that is the exact wording of the court order, however, based on what you have posted, yes, mom would be responsible for any portion of the bill that would have been normally covered by insurance had she used a network provider. That does NOT mean that she is responsible for the entire bill necessarily.

[steplady]

Does anyone know what section of family law I can look this up in? A statute? I know that we would have to still pay half the uncovered expenses, which in this case would be half of the copay, because the other stuff would have been fully covered if she used a participating provider. It was a checkup, xrays, and cleaning, which is covered. The problem is, if we just say... we aren't paying, back to court we go. She loves family court, and they seem to always favor the mom here, no matter what evidence we produce. It isn't worth it for a little over $100. If I have some legal backing to show, then I think the problem is solved. Any help is appreciated.

[stealth2]

I doubt that is the exact wording of the court order, however, based on what you have posted, yes, mom would be responsible for any portion of the bill that would have been normally covered by insurance had she used a network provider. That does NOT mean that she is responsible for the entire bill necessarily.

fair - Tooder is not the OP, so her husband's situation may or may not apply.

[GrowUp!]

My husband's order states his child's mother is responsible to make sure she follows all procedures to have the insurance pay. If she doesn't she is responsible for 100% of the uninsured amount of the claim.

Edited to add: In my opinion, if she went out of network and didn't make sure the practitioner would be covered, she should pay the whole bill. She made the decision to go to that particular provider. (Just my thoughts)

And your order is relevant here because......???

[fairisfair]

fair - Tooder is not the OP, so her husband's situation may or may not apply.

oh, oops. . . . . my bad

[MrsK]

Does anyone know what section of family law I can look this up in? A statute? I know that we would have to still pay half the uncovered expenses, which in this case would be half of the copay, because the other stuff would have been fully covered if she used a participating provider. It was a checkup, xrays, and cleaning, which is covered. The problem is, if we just say... we aren't paying, back to court we go. She loves family court, and they seem to always favor the mom here, no matter what evidence we produce. It isn't worth it for a little over $100. If I have some legal backing to show, then I think the problem is solved. Any help is appreciated.

There is unlikely to be any statute. You can either pay the $100 and risk her doing this over and over again, or dont pay it, and let her take you to court...and then ask the judge to modify the order to SAY specifically how it should be handled when she does something like this. If there is language that makes HER responsible for payment in situations like this, she is less likely to do it.

[steplady]

thanks for your help. I had a feeling that was the way it would have to be. Was just hoping there would be some legal language that would be helpful. Thanks anyway!

[haiku]

actually you WILL want to look up the state guidelines for child support, quite a few states require the custodial parent to pay 100-200 dollars of uninsured medical BEFORE the NCP's percentage in thier court order kicks in.

[JazzHands]

Sorry, not legal advice here, but did the insurance claim go to both insurance companies? Were they both out of network providers? Because with two plans, you'd think something would be paid of it. Check-ups are almost always paid at 100%.

(Sorry, I missed where this was already asked of you, but I submit dental claims for a living, and I can't believe nothing would be paid unless they were both managed care type plans. Even out-of-network claims for Preferred Provider Plans would have a payment, albeit at a reduced level.)