Uncovered Medical, Preferred Provider?

[WetNap]

What is the name of your state? TX

I'm a JMC. My support order specifies that each parent is responsible for 50% of uncovered medical costs for the child. The order details that both parents are to use preferred providers, etc. in order to fully benefit from medical insurance.

My ex refuses to use preferred services (doctors, pharmacy, etc.) as outlined in the insurance info I have provided her. I have written her twice over the last two years to specifically address this. She responded that she will use whoever/whatever she wants. I responded that if I couldn't convice her to comply with the insurance programs that I would reimburse only the 50% of the amount which would have been uncovered if a preferred provider been used. No response from her.

Now I'm being sued for the difference (about $1500.) Any experience with this issue?

 

[MrsK]

What is the name of your state? TX

I'm a JMC. My support order specifies that each parent is responsible for 50% of uncovered medical costs for the child. The order details that both parents are to use preferred providers, etc. in order to fully benefit from medical insurance.

My ex refuses to use preferred services (doctors, pharmacy, etc.) as outlined in the insurance info I have provided her. I have written her twice over the last two years to specifically address this. She responded that she will use whoever/whatever she wants. I responded that if I couldn't convice her to comply with the insurance programs that I would reimburse only the 50% of the amount which would have been uncovered if a preferred provider been used. No response from her.

Now I'm being sued for the difference (about $1500.) Any experience with this issue?

Frankly, if your order says she is to be using the preferred providers and it should be very easy to prove she is not (do you get the EOB's? have paperwork showing they are out of network?) I dont imagine she will get too far.

Hopefully the judge will give her a little talking to & make her absorb the costs as a lesson in why she should follow the court order. (btw, if you are using a lawyer, you should ask that she be responsible for your lawyer/court costs b/c the only reason you are going to court over this is b/c of HER refusal to follow the order)

Do you have proof (emails, in writing, a recording) of her saying she will use whoever, whenever she wants? That, and the EOB's/proof she is using out of network providers, should get you somewhere. Also, proof that you offered to pay the "50% of the amount which would have been uncovered if a preferred provider been used." would look good for you.

I'm surprised she's willing to go to court over this, considering it should be very obvious to the judge that she isnt following the court order.

Good luck, I hope it goes your way...sounds like mom needs a little reality check.

 

[LdiJ]

I agree....however if for some reason the preferred providers are not local to mom's area..that could be an issue.

 

[WetNap]

I'm surprised she's willing to go to court over this, considering it should be very obvious to the judge that she isnt following the court order.

My ex obviously has some mental problems...

MrsK: This is her fourth attorney -- they never get the full story beforehand and wind-up with egg on their face. Unfortunately, this is the third judge as well -- so I don't have a judge that has seen (is familiar with) these continuing problems.


LdiJ: Medical Ins has a ton of proferred services in her area. She won't use them. Dental does not. I have asked her to work with me to schedule routine dental work (cleanings, fillings) in my area as it would be covered 100%. She refuses that option. Therefore, I get bills for the FULL COST of uninsured dental work.

Although the court order specifies that HIPPA releases were to be given to the dental offices within ten days, and I wrote reminding her to send them, she refuses to do so. The dental offices say that she has given them emphatic instructions not to disclose any dental care or billing info.

I found out from one of the dental offices that she is carrying her own dental coverage on the children and has been submitting to her insurance AFTER she sends me the bill for the total as well. I instructed her six months ago that to do so is wrong and should be considered fraud. She's basically been getting PAID to take the child to the dentist.

In spite of all of this, I have to answer the lawsuit and pay for an attorney to defend myself. It's insane.

 

[ceara19]

If bringing the child to a dentist in your area would interfere with her parenting time, she has a good argument for holding you responsible for 50% of the UNCOVERED expenses. Uncovered expenses would be any charges not covered by ANY insurance. So her sending you the "total bill" and then submitting it to her insurance is wrong. You need to set it up with the dentist so that the bill comes directly from their office and you pay them directly, instead of sending the money to mom.

 

[CandiceH]

If bringing the child to a dentist in your area would interfere with her parenting time, she has a good argument for holding you responsible for 50% of the UNCOVERED expenses. Uncovered expenses would be any charges not covered by ANY insurance. So her sending you the "total bill" and then submitting it to her insurance is wrong. You need to set it up with the dentist so that the bill comes directly from their office and you pay them directly, instead of sending the money to mom.

As OP stated, he cant do this unless MOM signs the HIPAA forms. The dental office should not even be speaking to him without that form signed. He needs to address this issue in court also. Sounds like mom is pulling a fast one. Get your proof together, take it to court and ask for your attorney fees from HER. You may not get them but it is worth a shot.

 

[ceara19]

As OP stated, he cant do this unless MOM signs the HIPAA forms. The dental office should not even be speaking to him without that form signed. He needs to address this issue in court also. Sounds like mom is pulling a fast one. Get your proof together, take it to court and ask for your attorney fees from HER. You may not get them but it is worth a shot.

Since the HIPPA release is actually mentioned in the court order and they are going to court on related issues, the OP can bring the proper release forms with him so that the judge can "compel" mom to sign them then and there. He needs to make sure that HE takes the forms instead of relying on mom to send them to the dentist though.

 

[WetNap]

If bringing the child to a dentist in your area would interfere with her parenting time, she has a good argument for holding you responsible for 50% of the UNCOVERED expenses.

My written proposal indicated that I had scheduled semi-annual appointments (cleanings / check-ups) in my area during my periods of possession. I acknowledged that extensive or emergency dental work would best be handled in her area with the 50/50 split. I detailed the dentist's info as well. Ex refused this saying that it was unreasonable but that I could duplicate as much dental work as I wanted. Since I take no pleasure in a power-play that would require the child to visit the dentist four times a year, I cancelled the appointments in my area.

I have money. I can pay. I am required to provide health coverage, though, and want it to be used.

 

[WetNap]

As OP stated, he cant do this unless MOM signs the HIPAA forms. The dental office should not even be speaking to him without that form signed. He needs to address this issue in court also. Sounds like mom is pulling a fast one. Get your proof together, take it to court and ask for your attorney fees from HER. You may not get them but it is worth a shot.

Exactly...I don't like being taken for a ride. I will contact my attorney to obtain the proof and I will be requesting the court costs and attorney's fees.

I will have the forms in court as ceara19 suggested.

 

[ezmarelda]

I just have to say...every time I read your name..."WetNap"...I think of fried chicken and BBQ ribs... ​

 

[WetNap]

I just have to say...every time I read your name..."WetNap"...I think of fried chicken and BBQ ribs... ​

That's what I was going for. It has nothing to do with my arch-nemesis "WetDream"!