Covered medical/dental..CP won't use it

[Luv_N_Stepmom]

What is the name of your state? KY

Husband has my his son covered under his medical and dental insurance as ordered by the court.
He has to go to a military aproved facility for services.
The nearest facility is about 30-45 minutes away from CP's residence. She initially started using the medical insurance immediately because she was so excited to prance around on base, but after she found out she couldn't get permanent decals for her car or go on base alone without son, she doesn't want to take him on base any longer.
My question is...just found out through a family member of CP, that the CP has son on medicaid again and getting SSI checks as well, CP has took son to get braces through medicaid instead of using husbands insurance.
Is my husband going to be responsible for paying this medicaid back to the state/govt since the CP is using this instead of the provided insurance?
The reason i am asking is because if hubby has to pay back this money, we need to contact the case worker and find out why they are allowing her to disregard what hubby has provided. But everything the CP does is always money motivated..meaning there has to be something she gains financially in order for her to do this...this is how she operates.

 

[GrowUp!]

What is the name of your state? KY

Husband has my his son covered under his medical and dental insurance as ordered by the court.
He has to go to a military aproved facility for services.
The nearest facility is about 30-45 minutes away from CP's residence. She initially started using the medical insurance immediately because she was so excited to prance around on base, but after she found out she couldn't get permanent decals for her car or go on base alone without son, she doesn't want to take him on base any longer.
My question is...just found out through a family member of CP, that the CP has son on medicaid again and getting SSI checks as well, CP has took son to get braces through medicaid instead of using husbands insurance.
Is my husband going to be responsible for paying this medicaid back to the state/govt since the CP is using this instead of the provided insurance?
The reason i am asking is because if hubby has to pay back this money, we need to contact the case worker and find out why they are allowing her to disregard what hubby has provided. But everything the CP does is always money motivated..meaning there has to be something she gains financially in order for her to do this...this is how she operates.

Your husband should contact the case worker assigned to his case ASAP.

 

[ceara19]

Your husband should contact the case worker assigned to his case ASAP.

It is possible for a custodial parent to qualify for medicaid for the child, even when the CP is receiving child support and/or private insurance provided by the NCP. Unless mom gave a false SS# when applying, the state is well aware that the child is covered by other insurance. The state enters the child's SS# into the insurance coverage registry (I don't remember the exact name of the database). If the child is insured by another state or private insurance company, it will be in the report.

As long as mom obtained the assistance legitimately, the private insurance is billed first and medicaid picks up the rest for approved medical care. Also, as long as the NCP is meeting their child support obligation, he will not have to repay the amount.

However, this information is meaningless since it has already been given to the OP in another thread.

https://forum.freeadvice.com/showthread.php?t=325297

 

[nextwife]

OK, out of curiousity:


Will someone PLEASE explain to me WHY the taxpayers pay for health care when a parent HAS private covereage?

I have private coverage, for example, and sometimes must use Children's Hospital for various specialists, which is about thirty miles away. Sure, it's not as convenient, but I use what I have. If a parent has private coverage, WHY do they also get (need) medicaid? Shouldn't private coverage be required to be used BEFORE a party is allowed to tap into taxpayer provided services?

 

[NCP Dad in TN]

OK, out of curiousity:


Will someone PLEASE explain to me WHY the taxpayers pay for health care when a parent HAS private covereage?

I have private coverage, for example, and sometimes must use Children's Hospital for various specialists, which is about thirty miles away. Sure, it's not as convenient, but I use what I have. If a parent has private coverage, WHY do they also get (need) medicaid? Shouldn't private coverage be required to be used BEFORE a party is allowed to tap into taxpayer provided services?

I have often asked the same question. I, too, provide insurance through my employer for my three kids, but my ex ALSO has them on the state insurance. I personally think my kids shouldn't have the gov't insurance when I am paying to have them on MINE. Recently THOUSANDS of Tennesseans were cut from Tenncare, many who needed it to LIVE, and there are so many out there who are still on it (didn't get cut- like my ex) who are CAPABLE of working and HEALTHY and they are taking up the spots of people who truly need it.

Now, since I have insurance on the kids, and they are also on Tenncare, my insurance is Primary and the other is secondary. So whatever mine doesn't pay the other picks up, which is usually ALL of it. But I still have to pay a lot of money to have them on it, which is frustrating. But oh well.

 

[stealth2]

I have my kids on state insurance, even though my ex covers them. Why? His (out of state) insurance is a pita to use. Basically, I can take them for emergency care. That's it. ANY other care must be (a) refered by an in-network physician and (b) approved by the insurance company. So for "regular" illnesses that crop up? It generally takes the course of the illness to get the necessary approvals to go through that insurance. And THEN I get a hassle about his paying the portion of the copay he's to pay if I didn't get HIS approval to take them as well (joint legal). LOL Which can take longer than the insurance approvals. Just not worth it for me, to be honest. So I just deal with it myself and he can go pound sand.

 

[CandiceH]

All states can look through Epaces and HealtheNet to see what coverage the children have just by using their birthdate, ssn and full name. This type of technology has prevented a lot of the earlier insurance frauds. So, yes the state KNOWS the children are otherwise covered but due to Mom's income and the fact that Dad has Tricare (military insurance), she may have been eligible to put the children on Medicaid. My thought is that it is more of a "Medisource" plan than "Medicaid" - which has several differences.

I would STILL contact the case worker to answer some of your questions and make sure you get DEFINITIVE answers - many case workers find insurance and medicaid regulations just as confusing as anyone else. It is NOT illegal to be covered by both Tricare and "Medicaid - Medisource" but it can lead to SOME confusion and some issues.

As Stealth stated, in other scenarios, there are NCP's who live out of state and their insurance is pretty much useless. This has pushed for many states to opt for state plans such as "family health plus or child health plus" plans (named differently in each state). It is a nice thing to have and it insures that children are covered.

 

[ceara19]

OK, out of curiousity:


Will someone PLEASE explain to me WHY the taxpayers pay for health care when a parent HAS private covereage?

I have private coverage, for example, and sometimes must use Children's Hospital for various specialists, which is about thirty miles away. Sure, it's not as convenient, but I use what I have. If a parent has private coverage, WHY do they also get (need) medicaid? Shouldn't private coverage be required to be used BEFORE a party is allowed to tap into taxpayer provided services?

The private insurance IS billed first. The state insurance only pays what is NOT covered by the private insurance. Many times, the CP's income allows the child to be covered by state insurance even though the NCP is providing insurance.

I don't LIKE supporting anyone else's children, but when it comes to medical treatment, the general public ends up paying whether through government insurance plans or higher insurance an medical costs due to unpaid out of pocket expenses. Medicaid programs actually end up costing LESS in the long run. The same procedure that the state would pay $500 for, would cost an insurance company $1000 and an uninsured person would pay $2000.

I think it is more of a health care industry issue then a government issue. If provider's would start giving the price breaks to the people that can't afford insurance in the first place, not as many individuals would NEED to go to the government for help. The US has one of the most technologically advanced health care systems in the world. We have the ability to find and treat health problems early. The problem is that the average American can't afford a $120 visit to the doctor's office, the $150 test for a simple UTI and the $200 for the prescription to treat the simple UTI. So instead, they end up waiting until the problem gets so bad that they are forced to go to the ER for treatment and what started as a $470 problem is now a $5000 hospital bill.

I'm done with my rant on the US health care system. I'll return the soapbox to the corner now.

 

[CandiceH]

Im with you on this one Ceara. This is my field of study - health insurance and regulations. You brought up a good point about providers charging less to those who can not afford it. It isnt legal. A provider has to charge the same for each and every patient within a procedure code. If they do not, then they are liable and could be charged with fraud. Medicaid, medicare and private insurance companies pretty much have providers by the balls. It is incredibly disheartening.

A provider knows that he has to charge $145 for a mid-level office visit because he/she is aware that they are only going to be reimbursed a portion of that (varies). So, they charge the max in hopes of getting part payment - and can not fluctuate the amount between and insured person and a self-payer. Providers can also be in serious trouble if they do not collect the copays from the patient. I avoided going to the dr because I could not afford my copays. I had insurance but still would not go if it meant the difference between paying a copay for MY health or getting something my children needed.

Our health system is ridiculous - but progress IS being made. Not many ppl are aware of a program called "charity care". It is NOT advertised. If you can not pay your medical bills, you can apply for charity care (all states as far as I know and it is transferable) where they take all of your income AND bills into consideration and a patient can qualify for 25-100% of all medical being covered. So, if you dont have insurance, cant qualify for a state insurance, there is an alternative that not many people know about.

Now I have to apologize for MY rant LOL.

 

[Luv_N_Stepmom]

Thanks everyone for your response.

 

[ceara19]

Thanks everyone for your response.

You're welcome. Even though she is most likely receiving the benefits legitamately, your husband should still call and inform the state of the private insurance (just to cover his own butt). While he's got them on the phone, he can ask if the state will be billing him and, if so, how much.

Technically, he could be ordered to pay 50% of what the uncovered expenses would be if mom had gone to the preferred provider for the private insurance, but it is unlikely that the state will bill him.

 

[NCP Dad in TN]

You're welcome. Even though she is most likely receiving the benefits legitamately, your husband should still call and inform the state of the private insurance (just to cover his own butt).

That is good advice. I did the same thing, by the way. Turns out my ex hadn't even informed the state of the insurance I had the kids on. They made note of my insurance, took my info, and listed it as primary.

What's ironic about the whole insurance thing... even though it's not completely related... is that when I switched jobs a few years ago (which my ex supported) I was without insurance for a period of 3 months while I waited to become eligible. Later we ended up in court over an unrelated matter, and she filed contempt charges on me for not maintaining insurance on the kids during those three months... despite supporting the job change.. despite knowing there would be a temporary lapse in coverage... despite the fact that she incurred NO expenses during that time... and despite the fact that she had the kids on the state insurance, so they were never truly "without" insurance... it wasn't until we went to court for that unrelated matter and tried to nail me for contempt that she actually started TELLING doctors offices that the kids had insurance through me...

Sorry to get off track... hope this woman doesn't try to "double bill" you guys for the braces. I can completely relate to dealing with a woman who bases ALL of her decision on money or how SHE (and ONLY she) will benefit from something... You shouldn't get stuck paying back the state when you are already paying once with the insurance to begin with. (But that is just my persoanl opinion, not legal advice) Good luck Stepmom!

 

[MrsK]

OK, out of curiousity:


Will someone PLEASE explain to me WHY the taxpayers pay for health care when a parent HAS private covereage?

I have private coverage, for example, and sometimes must use Children's Hospital for various specialists, which is about thirty miles away. Sure, it's not as convenient, but I use what I have. If a parent has private coverage, WHY do they also get (need) medicaid? Shouldn't private coverage be required to be used BEFORE a party is allowed to tap into taxpayer provided services?

Private insurance is billed, then the rest is picked up by the state insurance (or in my state anyway, though I think it works this way everywhere/most states?). So at least they arent requiring NCP's to pay for insurance CP's arent using.

I dont know why other people have private insurance & medicaid, I'm sure there are a few reasons. I know in my husband's other kid's case, the mother complained about having to pay for $10 copays when he put the kid on his insurance , so she went & got on medicaid so the taxpayers could pay for it. We were informed she got a real job as of late that offers reasonably priced insurance & has still kept medicaid rather than having the kid on 2 private insurances. Apparently, even with a job, she still meets the income limits for medicaid b/c of her # of out-of-wedlock children.

 

[CandiceH]

Private insurance is billed, then the rest is picked up by the state insurance (or in my state anyway, though I think it works this way everywhere/most states?). So at least they arent requiring NCP's to pay for insurance CP's arent using.

I dont know why other people have private insurance & medicaid, I'm sure there are a few reasons. I know in my husband's other kid's case, the mother complained about having to pay for $10 copays when he put the kid on his insurance , so she went & got on medicaid so the taxpayers could pay for it. We were informed she got a real job as of late that offers reasonably priced insurance & has still kept medicaid rather than having the kid on 2 private insurances. Apparently, even with a job, she still meets the income limits for medicaid b/c of her # of out-of-wedlock children.

Yep, and this is the problem with the Medicaid program. It should NOT be allowed. If there is a private insurance already in place and the deductibles/copays are reasonable then IMO Medicaid should not be an option. I cant afford the copays for my kids, the ex is court ordered to pay them (doesnt) and I qualified for Medicaid. I did NOT do it. I found other alternatives and cut costs everywhere else. There are more needy people out there than I.

In my industry I am finding that more than 80% of all patient's I am billing for have some sort of Medicaid and it astounds me how many "young" ppl are on MEDICARE! I could go on and on and this but I wont go any further. The OP has had her question answered and some suggestions made. She doesnt have too much to worry about, as the NCP has done what is ordered and if he notifies case worker himself, he is covering himself on that end also. I would also send a LETTER, return receipt. Some of these case workers

 

[ceara19]

Sorry to get off track... hope this woman doesn't try to "double bill" you guys for the braces.

If the OP's husband receives a bill from mom, they need to call the Doctor or Dentist and verify that there is an out of pocket expense for the services. If mom is using the state insurance, she should never even see a bill.