• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Unreimbursed medical/dental expenses

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.

casa

Senior Member
So, apparently this sounded good, but not to mom or her counsel. After receiving the consent order proposed by dad, mom's counsel wrote back that insurance companies have their own policies as to how things are billed and are not bound by any court order in which the company is not a party to the action and that attempting to manipulate the policies simply because mom and dad are divorced does not appear proper. This is why they can't consent.

Clearly, none of this would be an issue if the parties are not divorced, and the insurance companies very clearly say, when asked, that if the order says who will be primary, they will process accordingly. However, the insurance companies claim they have nothing in writing that they can send which will state this.

Uggh.
Because of the specifics of your case...Let this one go. Kiddos are covered by TWO ins. when many kids have NONE. Remember that Dad wants to Completely Avoid any situation where he's seemingly fighting for 'control' of an issue.

And to other's reading: This is ONLY FOR THIS POSTER'S SITUATION.
 


casa

Senior Member
And if there are costs above/beyond both insurance companies ~ then BOTH parents should split it.
 

LdiJ

Senior Member
So, apparently this sounded good, but not to mom or her counsel. After receiving the consent order proposed by dad, mom's counsel wrote back that insurance companies have their own policies as to how things are billed and are not bound by any court order in which the company is not a party to the action and that attempting to manipulate the policies simply because mom and dad are divorced does not appear proper. This is why they can't consent.

Clearly, none of this would be an issue if the parties are not divorced, and the insurance companies very clearly say, when asked, that if the order says who will be primary, they will process accordingly. However, the insurance companies claim they have nothing in writing that they can send which will state this.

Uggh.
Well, its not surprizing that an attorney would not want to do something that might be improper, legally. However, it also sounds like this attorney really doesn't understand much about how insurance in general, works, or doesn't understand that dad's insurance company clearly understands what dad is attempting to do and is perfectly ok with it. Therefore no manipulation is going on.

Has dad tried actually TALKING to mom? Not letters, not emails but a face to face conversation? If he can get mom to understand that there is no insurance "manipulation" or game playing going on, then maybe she can get her attorney on board as well.
 

SMinNJ

Member
Well, its not surprizing that an attorney would not want to do something that might be improper, legally. However, it also sounds like this attorney really doesn't understand much about how insurance in general, works, or doesn't understand that dad's insurance company clearly understands what dad is attempting to do and is perfectly ok with it. Therefore no manipulation is going on.

Has dad tried actually TALKING to mom? Not letters, not emails but a face to face conversation? If he can get mom to understand that there is no insurance "manipulation" or game playing going on, then maybe she can get her attorney on board as well.
True, an attorney would not want to do something improper. My entirely biased opinion is that this is not actually what's going on here, but we all know my opinion doesn't really count :). Everyone involved has no reason not to understand that there is no manipulation involved - they are just not willing to make this happen. I'm struggling to say this without assigning them motives. In the history I've seen between them, there has never, ever been a single time that dad asked for something without it either being denied or changed so it no longer represents what he asked for. (They split holidays, no definition of what that means. So, dad will ask for Christmas day at 2pm, and mom will say - oh, not enough time, so and so is coming to town. She can come at 4pm. Every holiday, every day off from school. Every request for information. The only time she ever gave him what he asked for was the one time he didn't ask for it. The child knew there was a social activity sponsored by the church, and she, w/o talking to dad, mentioned it to mom.
Mom said yes, and even offered to drop the child off earlier than necessary and to pick the child up later than necessary. Cynically enough, we found out later that she had a date with her now husband, so the event with dad gave her something she needed. But all of that is neither here nor there. He recently sent a letter with six requests regarding various matters, at least one of which had previously been offered by mom, and all six requests were denied. Cooperation does not exist here.)

Dad has explained this insurance stuff six times to Sunday. Mom has his insurance card, and with it, clearly has the insurance company's phone number. She has called them previously about their daughter's benefits - she's apparently chosen not to do so this time. Dad has not spoken to mom directly regarding it - they are in the middle of an eight month long visitation dispute, so currently, there is no shot in you know what that mom would answer the phone if dad called. Additionally, mom has not consented to speak verbally to dad, outside of an emergency, in years. She simply refuses to answer the phone.

The concept of the conference call between the attorney and the insurance company seems to be a good one. I'll mention it to dad, but I think he's decided to let things lie until someone needs him to do something. He's been arguing this matter since last February. The doctors have indicated that without the treatment, things will be fine, and even with, not all the issues will be corrected. So, the child won't be hurt, and he can argue over the payment later if necessary if mom goes forward with the treatment without his consent.
 

wileybunch

Senior Member
What a pain. I'm not sure a call with the insurance company will make any difference, either, since they cannot TELL the attorneys TO put that language together. They could tell the parties how certain language would be applied, though. Not sure they would do cut/dry hypothetical enough to satisfy the attorneys who are going to probably ask permission from the insurance company to change it because they're looking for the "no" answer to cover themselves (assuming they are concerned with being wrong in the first place which is questionable, but I don't think they'll drop that angle, either).
 
What a pain. I'm not sure a call with the insurance company will make any difference, either, since they cannot TELL the attorneys TO put that language together. They could tell the parties how certain language would be applied, though. Not sure they would do cut/dry hypothetical enough to satisfy the attorneys who are going to probably ask permission from the insurance company to change it because they're looking for the "no" answer to cover themselves (assuming they are concerned with being wrong in the first place which is questionable, but I don't think they'll drop that angle, either).

Yes, and they could let the attorney know that it is not shady or illegal for them to have an agreement stating that dad's insurance can go before the other. This whole thing sounds like the X just doesn't want to budge and money is not the issue. The issue is control. I would let a judge decide this and refuse to pay a dime until ordered to do so. If the X wants things to remain the way they are then she should be willing to foot the bill.
 

casa

Senior Member
Yes, and they could let the attorney know that it is not shady or illegal for them to have an agreement stating that dad's insurance can go before the other. This whole thing sounds like the X just doesn't want to budge and money is not the issue. The issue is control. I would let a judge decide this and refuse to pay a dime until ordered to do so. If the X wants things to remain the way they are then she should be willing to foot the bill.
'Zactly what I told her. Especially re; the ortho which the Dr. themself said is NOT Necessary. :cool:
 

SMinNJ

Member
'Zactly what I told her. Especially re; the ortho which the Dr. themself said is NOT Necessary. :cool:

Sorry I've been missing... yes, it is ridiculous, and my opinion is that it is all about control... unfortunately, that is also what mom claims re: dad, and in their current situation, dad doing anything for which he can be accused of trying to take control is ill-advised. If you've read any of my other posts, they are in an 8 month long custody issue... dad filed for custody, stating the child's spoken and written desires, mom's lack of co-parenting, and the child's perception of "abuse" (emotional neglect type stuff, not physcial) and mom immediately filed (as in the next day) stating the child was in a panic about seeing dad and withheld visitation. An ex parte temporarily suspended regular visitation until psych evals were done on child and dad (not on mom). Even though the court ordered supervised visitation and phone calls, mom claims child refused to participate, and the court let it all go. Dad has seen child 1x in 8 months (during the psych eval). Dad has been asking for the child to go to court ordered counseling since September, either individually or with him, and mom's counsel refuses, stating that mom is waiting for the recommendation of the psych eval. No investigation has been done on what the child or dad claim regarding mom. This is the pattern over the years, mom makes accusations against dad, dad defends himself, and he ends up losing rights and privileges with his daughter. A previous attorney told him that what you can hope for in each of these events is to restore things to status quo and ask for sanctions against next time. Unfortunately, that has never happened - parenting time is always restored, with no sanctions, and mom feels free to accuse again. At least the child is 13 1/2 now... only 4 more years... and I bet at least another year before things are returned to normal, so maybe the court stuff can end. Dad has pretty much given up on the concept of "joint legal", which they have - mom's going to do what she wants, and the judges in the case refuse to slap her down.

Thanks for the replies...
 

SMinNJ

Member
New Question...

So, an EOB arrived the other day for the child's ortho... it indicated that the child had been in for x-rays, etc. Upon talking with the insurance company, they confirmed that yes, there was a few new service dates.

In speaking with the ortho's office, they confirmed that the child is seen there monthly for ortho work. When questioned about billing, they stated that mom brought in a copy of the custody papers, which state that they have joint custody and mom is the parent of primary residence. The ortho interpreted this to say that mom has primary custody, and therefore could approve of the treatment. Mom has made the complete payments to them, and they will not be seeking payment directly from dad unless mom doesn't provide the complete payment.

When asked, they said that dad's approval was tacit, since they sent him the financial agreement and treatment plan and he did not let them know that he did not approve.

In reality, dad has informed them multiple times that he is not comfortable signing any financial agreement or providing approval until the insurance issue was worked out, since that would save parties $1000's.

The insurance issue still has not been worked out. Dad is concerned that mom will try to get the money from him later. This ortho work was not necessary, and mom has made the unilateral decision to have it done. Mom also did not inform dad that she was going forward without his consent.

Question - does dad need to address this to mom, stating the obvious - that he did not consent to the orthodontia? Is it better to be proactive, or wait until/if she tries to get him to pay in the future. The child just started the work in January, and mom has never, over 7 years, sent any requests to have any medical expenses reimbursed (dad does not know whether there were actually any to be reimbursed previously).

What do you think?

Thanks.
 

SMinNJ

Member
So, an EOB arrived the other day for the child's ortho... it indicated that the child had been in for x-rays, etc. Upon talking with the insurance company, they confirmed that yes, there was a few new service dates.

In speaking with the ortho's office, they confirmed that the child is seen there monthly for ortho work. When questioned about billing, they stated that mom brought in a copy of the custody papers, which state that they have joint custody and mom is the parent of primary residence. The ortho interpreted this to say that mom has primary custody, and therefore could approve of the treatment. Mom has made the complete payments to them, and they will not be seeking payment directly from dad unless mom doesn't provide the complete payment.

When asked, they said that dad's approval was tacit, since they sent him the financial agreement and treatment plan and he did not let them know that he did not approve.

In reality, dad has informed them multiple times that he is not comfortable signing any financial agreement or providing approval until the insurance issue was worked out, since that would save parties $1000's.

The insurance issue still has not been worked out. Dad is concerned that mom will try to get the money from him later. This ortho work was not necessary, and mom has made the unilateral decision to have it done. Mom also did not inform dad that she was going forward without his consent.

Question - does dad need to address this to mom, stating the obvious - that he did not consent to the orthodontia? Is it better to be proactive, or wait until/if she tries to get him to pay in the future. The child just started the work in January, and mom has never, over 7 years, sent any requests to have any medical expenses reimbursed (dad does not know whether there were actually any to be reimbursed previously).

What do you think?

Thanks.
Bump for response... is the consensus as CASA said earlier, and let sleeping dogs lie? Dad is uncomfortable with this as this potentially would cost him over $1000, which he #1 doesn't have to spend, and #2 didn't agree to spend, especially since it should have been free.

Thanks for any input...
 

wileybunch

Senior Member
Refresh here ....

Who told Dad ortho work was not necessary?
Also, ortho has a financial agreement they sent to dad, but don't they require signatures on it? Who signed it?
 

SMinNJ

Member
Refresh here ....

Who told Dad ortho work was not necessary?
Also, ortho has a financial agreement they sent to dad, but don't they require signatures on it? Who signed it?
Ortho said work was not necessary. It corrects a minor overbite, and maloclusion, both of which have been concluded to be mainly cosmetic.

Ortho sent financial agreement, which previously had been signed by mom, to dad for his signature as well. Dad advised them verbally that until the insurance situation was settled, he was not comfortable signing the agreement and having the work done.

When asked why/how the work has gone ahead without his approval, they advised that mom had shown them the custody agreement, which they say shows mom as primary (it says "joint custody with mom being the parent of primary residence") and that they sent dad the financial agreement. When pointed out to them that he had not signed it and returned it, they said it ws only necessary for them to send it to him and that since he didn't send it back denying approval that it was understood that he was giving them the approval. Since the ortho had previously told him that the office's policy was, in divorce situations, for both parents to sign off on the work, it never occurred to him that they would permit it to continue without his express consent.

Mom has paid each payment in full so far, including dad's portion. The ortho says that unless mom fails to pay in the future, they will not be looking for payment from dad, and that it would be up to mom if she wanted to go after him for payment.

Truth be told, he doesn't mind the work being done, it's just that they could have had it done for free if everyone had cooperated. He does mind paying a grand for the work, especially now...

Hope that answered the question...
 
When we specified the order of the insurance submissions in our court order, the insurance companies complied.
I work daily with our coordinators of patient affairs and patient financial services in a medical company. More than likely the insurance companies will comply with whichever you submit as primary and secondary.

Mostly what I see as incredibly unfortunate in the OP's post is that it seems like the parents are not working together to achieve the best outcome with their insurances. If there's a more beneficial way to use the insurances that the parents carry for the child... why not do so? In the meantime both parents are hindering their child from receiving med/dental attention. :(
 

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential
data-ad-format="auto">
Top