insurance issues

[luckymom]

What is the name of your state?
Texas has jurisdiction. We live in Illinois.

Two years ago, my ex filed to get daughter's health insurance transferred to his wife's policy arguing that the cost was lower. It was, but her insurance is an HMO versus my PPO. Since then I have kept paying for my daughter's insurance on my policy since the benefits are far better. My thought was that in the case of major illness, I wanted the freedom to go out of the HMO if necessary. Anyway, ex insists that I file each time with my insurance company in the hope of lowering is out of pocket expenses. Do I have to do this? He doesn't pay for the insurance, why should he benefit from it?

 

[haiku]

who is the primary insurance carrier by court order?

And how are uninsured and copay costs handled per court order?

 

[luckymom]

Primary insurance is the stepmom's policy per the order. It says that we are to divide up uncovered expenses 50/50.

 

[haiku]

OK, doesn't it benefit YOU to use your ins. as secondary for what his doesn't cover?

that way the uncovered 50% is much less, or nothing?

the big picture being the less out of pocket expenses BOTH of you have to pay the better?

 

[luckymom]

My point is--why should he benefit from the fact that I am paying (of my own volition) for addiitonal coverage?

 

[nextwife]

If you want YOUR coverage to be primary, then petition to have his additional coverage dropped and have him reimburse you half. Otherwise, it is your choice to have a secondary policy.

 

[luckymom]

Again, my question is---legally, can he insist that I file with my insurance company as secondary coverage, given that there is no order in place that compels me to even have that coverage?

 

[nextwife]

NO, you can use any you wish.

BUT, but I do not believe you cannot legally compel him to pay MORE for a medical expense if you chose to use the secondary over the primary coverage. The rate at which he may have to reimburse for any OOP expenses could be limited to the OOP amount of his plan. So, for example, if his plan would have a OOP of 0% and yours has 20% OOP, you may end up having to pay the 20 yourself should you chose to go outside his policy that he IS required to carry.

 

[VeronicaGia]

What is the name of your state?
Texas has jurisdiction. We live in Illinois.

Two years ago, my ex filed to get daughter's health insurance transferred to his wife's policy arguing that the cost was lower. It was, but her insurance is an HMO versus my PPO. Since then I have kept paying for my daughter's insurance on my policy since the benefits are far better. My thought was that in the case of major illness, I wanted the freedom to go out of the HMO if necessary. Anyway, ex insists that I file each time with my insurance company in the hope of lowering is out of pocket expenses. Do I have to do this? He doesn't pay for the insurance, why should he benefit from it?

As nextwife said, technically if you use insurance that is not per the court order, you are solely responsible for the out of pocket costs. In other words, you have to use his insurance, and if you don't, you pay the difference. He doesn't seem to know that, but if he brings it up, you'll be paying unless a court order dictates otherwise.

 

[tammy8]

Gosh BE THANKFUL YOUR CHILD HAS HEALTH INSURANCE. Seems like you don't like the fact that SM is providing it. Get over it cause even though you don't think that your ex is absorbing the costs he is, being that his new wife is paying for it.

I smell CONTROL on this one.

 

[luckymom]

You are so wrong. Let me guess-- you are a second wife.

What I object to is the fact that ex thinks he can use the fact that I am paying for extra coverage in order to reduce his share of our child's out of pocket medical expenses. Here is the procedure--I submit bills to his policy. His coverage leaves, for example, $50 bucks unpaid. If I didn't pay for insurance, his share is 25, as is mine. Right? So if my policy then pays $25 of what is not covered. I say it is only fair that that $25 be applied to the my share of out of pocket expenses. He is paying $25, no more or less than he would pay if I wasn't shelling out $50 a month for extra coverage. The point of disagreeement is his insistence that he is only responsible for what is left after my insurance pays off.

As for having coverage, yes, I have a very nice job with excellent benefits. So shoot me.

 

[VeronicaGia]

You are so wrong. Let me guess-- you are a second wife.

What I object to is the fact that ex thinks he can use the fact that I am paying for extra coverage in order to reduce his share of our child's out of pocket medical expenses. Here is the procedure--I submit bills to his policy. His coverage leaves, for example, $50 bucks unpaid. If I didn't pay for insurance, his share is 25, as is mine. Right? So if my policy then pays $25 of what is not covered. I say it is only fair that that $25 be applied to the my share of out of pocket expenses. He is paying $25, no more or less than he would pay if I wasn't shelling out $50 a month for extra coverage. The point of disagreeement is his insistence that he is only responsible for what is left after my insurance pays off.

As for having coverage, yes, I have a very nice job with excellent benefits. So shoot me.

So what you're really saying is that you want him to pay 100% of the out of pocket costs. You see, if you didn't have the extra insurance, this point would be moot. But you do, why should he pay 100% of what is left over after you claim your portion? So no, it is not fair that he pays 100% of what's left simply because you decided to get insurance to avoid extra out of pocket costs. The court order likely specifically states that each parent split what is left after insurance coverage. So you can either drop the insurance you have and split the difference or you can split what is left after the claims have been made to both insurance companies.

 

[luckymom]

The decree says that we split the cost of what is left after his insurance company pays. It doesn't address the issue of my secondary coverage. Again, I don't see why the fact that I pay for extra coverage (to reduce my share of insurance costs) should effect his responsibility to pay what is left after his (legally required) coverage pays! If it works the way you suggest, I am on my way to Human Resources to cancel . . .

 

[stealth2]

I believe VG is correct. A judge is likely to feel that you're being spiteful here. Personally - this wouldn't be a hill I'd be willing to die on.

 

[haiku]

You are so wrong. Let me guess-- you are a second wife.

What I object to is the fact that ex thinks he can use the fact that I am paying for extra coverage in order to reduce his share of our child's out of pocket medical expenses. Here is the procedure--I submit bills to his policy. His coverage leaves, for example, $50 bucks unpaid. If I didn't pay for insurance, his share is 25, as is mine. Right? So if my policy then pays $25 of what is not covered. I say it is only fair that that $25 be applied to the my share of out of pocket expenses. He is paying $25, no more or less than he would pay if I wasn't shelling out $50 a month for extra coverage. The point of disagreeement is his insistence that he is only responsible for what is left after my insurance pays off.

As for having coverage, yes, I have a very nice job with excellent benefits. So shoot me.

WOW! and just think what your share of uninsured costs would be if he did not have insurance!!!

goes both ways, ya know?

oh and I forgot, if after dad pays his half your insurance cuts you a check for it, (your half PLUS some or all of his) you are commiting fraud against the ins. company...