Unreimbursed medical/dental expenses

[NSA4answers]

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...

Think about it this way.... how much do you think you'll spend going after the money in court?

 

[NSA4answers]

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.

Just out of curiosity does dad not have access to the childs medical records?

 

[SMinNJ]

Just out of curiosity does dad not have access to the childs medical records?

Dad has access - of course, if he doesn't know that the child is going to the ortho, he doesn't know to access the records, and since mom simply told him that she wasn't going to sign the consent order, not that she was going to have the ortho done anyway, he didn't know to ask... it's the problem with the pediatrician too... if he doesn't know that the child has been taken to the doctor, he doesn't know to send his $15 check in to get a copy of the records.

To clarify, based on your other posts, the child in this case would not be lacking medically if she didn't have the braces - many children do not have braces because their parents can't afford it, etc., and generally we don't think how sad it is that their parents won't get them the braces.

The insurance company has stated that if there is a court order stating dad's should be primary, they will honor it. Mom refuses to sign a consent order, and the judge is ignoring the request for an order in favor of the larger issues. So, the insurance company can't get what they need in order to process it in the most beneficial order, even though many representatives have expressed that they wish they could.

 

[SMinNJ]

Think about it this way.... how much do you think you'll spend going after the money in court?

Dad wouldn't be going after money, mom would since she is paying it out of pocket, and dad is pro se, so he has no attorney fees. This is strictly in response to your question, and not meant to indicate "so, who cares attitude?". It all affects the child, and clearly if mom is suffering financially, the child will also. That is very sad for the child. It is also sad for the child that mom has made this and other issues "court" issues rather than dealing with the situations with a cooperative spirit. We all (the two blended families) are an oddity in that together, the two parents and two steps all live at better levels than would have been possible in the marital home (Mom remarried someone in IT, who makes good money, and dad married someone (me) who was able to earn an excellent lesson while he went back to school). Even supporting the two households, there is more money available for the child. Unfortunately, both sides have spent so much money in legal fees and private school tuition, all of which is unnecessary, and have wasted much of the resources.

Of course, if they could agree, they probably wouldn't be divorced .

 

[NSA4answers]

Dad has access - of course, if he doesn't know that the child is going to the ortho, he doesn't know to access the records, and since mom simply told him that she wasn't going to sign the consent order, not that she was going to have the ortho done anyway, he didn't know to ask... it's the problem with the pediatrician too... if he doesn't know that the child has been taken to the doctor, he doesn't know to send his $15 check in to get a copy of the records.

If dad has access to medical records he can access them anytime, he does not need to wait for mom to let him know. He could regularly make requests of them, either to the Dr or to mom directly. Does dad see the child? From your posts treatment started in Jan. It's April now. Wouldn't dad have noticed the child had braces thus raising questions? Does the custody order state that either parent will inform the other parent of medical attention/treatment for the child as soon as reasonably possible?

To clarify, based on your other posts, the child in this case would not be lacking medically if she didn't have the braces - many children do not have braces because their parents can't afford it, etc., and generally we don't think how sad it is that their parents won't get them the braces.

based on you other posts, the parents have the ability to provide these services for the child and it sounds like both are using the child as a pawn in their vendetta for the other. That is what is sad, to me at least.

The insurance company has stated that if there is a court order stating dad's should be primary, they will honor it. Mom refuses to sign a consent order, and the judge is ignoring the request for an order in favor of the larger issues. So, the insurance company can't get what they need in order to process it in the most beneficial order, even though many representatives have expressed that they wish they could.

Thus my expression of sadness... dad wouldn't sign the needed documents for the Orthodontist and mom won't sign the consent order to arrange insurance in the most beneficial manner. Sounds like the judge is right to favor the larger issues. I agree with the order of insurance being presented for payment so as there would be no need of out of pocket expense, but it sounds like both parents are playing tug-of-war and the child is in the middle.

 

[NSA4answers]

Dad wouldn't be going after money, mom would since she is paying it out of pocket, and dad is pro se, so he has no attorney fees. This is strictly in response to your question, and not meant to indicate "so, who cares attitude?".

Mom very possibly could request that dad pay moms attorneys fees or any portion there of. Especially if he does not comply with the order that states that after the first $250 is reached for the year the costs are shared. So not only would costs of out of pocket medical expenses be incurred but so would legal fees.

It all affects the child, and clearly if mom is suffering financially, the child will also. That is very sad for the child.

Clearly she's not as according to the orthodontist mom has been paying all out of pocket expenses when due.

It is also sad for the child that mom has made this and other issues "court" issues rather than dealing with the situations with a cooperative spirit.

Dad did the same thing by not dealing with the docs he was given from the orthodontist.

We all (the two blended families) are an oddity in that together, the two parents and two steps all live at better levels than would have been possible in the marital home (Mom remarried someone in IT, who makes good money, and dad married someone (me) who was able to earn an excellent lesson while he went back to school).

Oh so you're not even a parent in this case and actually have no say anyways... gotchya.

Even supporting the two households, there is more money available for the child. Unfortunately, both sides have spent so much money in legal fees and private school tuition, all of which is unnecessary, and have wasted much of the resources.

Yup, it's pathetic how much people spend in legal fees instead of just sucking up their pride and working on their issues to resolve them at a much lower cost. Personally I don't think that private school is unnecessary. But that's just my opinion and nothing legal. Then again... you're not even a parent in this case so don't ask me why it matters to you.

Of course, if they could agree, they probably wouldn't be divorced .

Even married people don't always agree. It's how you handle the disagreements that's the key, married or not.

 

[wileybunch]

Mom very possibly could request that dad pay moms attorneys fees or any portion there of. Especially if he does not comply with the order that states that after the first $250 is reached for the year the costs are shared.

Of *what* costs, though? Are you saying Mom has a solid case that the ortho costs are medically necessary?

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.

I don't think anyone can say how this would end up if there's maneuvering via the courts, but for now I would just leave it alone since Mom isn't asking for anything. Maybe Mom really wants the braces even if they are totally cosmetic and is willing to pay for them. I totally get you that a child isn't lacking just b/c they can't have braces, but the fact one professional says they aren't necessary I don't know will outweigh the ortho's opinion that thought they were when he banded her if Mom takes Dad to court.

How much time does Mom have to present receipts to Dad for reimbursement?

 

[SMinNJ]

If dad has access to medical records he can access them anytime, he does not need to wait for mom to let him know. He could regularly make requests of them, either to the Dr or to mom directly. Does dad see the child? From your posts treatment started in Jan. It's April now. Wouldn't dad have noticed the child had braces thus raising questions? Does the custody order state that either parent will inform the other parent of medical attention/treatment for the child as soon as reasonably possible? .

Yes, dad can request the medical records whenever he wants. The child's pediatrician will not release information over the phone, and charges $15/request for records. Life would be simpler and less expense-filled if there was cooperation. Dad saw no reason to access the ortho records since last time he spoke with the ortho, there was going to be no orthodontics done until the insurance issue was worked out.

Parenting time is currently suspended, which is explained elsewhere if you're interested, so no, dad is not seeing the child. One could also expect that if the child just showed up with braces, dad might have questions for the child, thus putting the child in the awkward position of having to explain some portion of the situation. This is what happened last year when the child showed up at a concert with eyeglasses. The convo went something like this - "Oh, I didn't know you were having trouble seeing." "Yes, the school nurse sent me to the eye doctor after testing last year, but the eye doctor said I didn't need glasses yet. This year, the nurse sent me again, and the eye doctor decided to go ahead and give me glasses." Dad knew nothing of any of that, he has been in contact with the school requesting information such as that and been denied, and in fact had received a copy of the child's school records, which did not include either recommendation to seek vision care. He was also not aware the child had an eye doctor, so he couldn't just randomly call to ask questions.

The divorce decree is very sparse when it comes to parenting, just who is who, when parenting time is, and where the child will go to school.

based on you other posts, the parents have the ability to provide these services for the child and it sounds like both are using the child as a pawn in their vendetta for the other. That is what is sad, to me at least. .

Dad does not actually have the resources at this time to pay for the braces. He's not using the child as a pawn, and I'm sorry if I have made it seem this way. I cannot speak for mom's motivations, and I have tried not to make blanket statements one way or the other. I can only report her actions, not her motives.

Thus my expression of sadness... dad wouldn't sign the needed documents for the Orthodontist and mom won't sign the consent order to arrange insurance in the most beneficial manner. Sounds like the judge is right to favor the larger issues. I agree with the order of insurance being presented for payment so as there would be no need of out of pocket expense, but it sounds like both parents are playing tug-of-war and the child is in the middle.[/QUOTE]

 

[SMinNJ]

Mom very possibly could request that dad pay moms attorneys fees or any portion there of. Especially if he does not comply with the order that states that after the first $250 is reached for the year the costs are shared. So not only would costs of out of pocket medical expenses be incurred but so would legal fees.

She clearly could request such. His argument would be that he categorically told her (mom's counsel) that he didn't consent to the expense. He was clear and elementary in explaining how they could avoid spending the money, and mom opted to do the procedure anyway. He'll have to see how it works out... at this point, no one is asking for money from him.

Dad did the same thing by not dealing with the docs he was given from the orthodontist.

Dad did deal with the docs he was given from the ortho. He told the ortho that they were working on the insurance stuff and that he was not going to sign until they got it straightened out. He called the insurance company to find out what they needed in order for it to be done properly. He wrote to mom's counsel explaining what they needed to do, in order to eliminate costs for BOTH parties. When mom refused to sign the consent order, he wrote, as part of a larger matter, to the judge requesting that the judge sign the order (which the judge had previously said he would sign if necessary) allowing dad's insurance to be first.

I'm just the stepmom, but that sounds like an awful lot of "dealing with the docs" to me.

Oh so you're not even a parent in this case and actually have no say anyways... gotchya.

True, I am not one of her parents. I don't represent otherwise, nor have I complained about not having a say.

Yup, it's pathetic how much people spend in legal fees instead of just sucking up their pride and working on their issues to resolve them at a much lower cost. Personally I don't think that private school is unnecessary. But that's just my opinion and nothing legal.

All that you say is true. In this case, however, private school was only necessary because mom chose to provide false information to the child's original public school district and the child was not permitted to enroll. This is not dad's side of the story, this is documented, both by the original school district and by mom's counsel. The child instead would have been forced to enroll in an inner city school, which was clearly not in her best interests.

Then again... you're not even a parent in this case so don't ask me why it matters to you.

I am a legal stranger, I have no say with mom or the courts in how this child is raised. However, I love this child with all my heart, would gladly give my life for her, and it is disrespectful to me and my relationship with her to question why it would matter to me.

Even married people don't always agree. It's how you handle the disagreements that's the key, married or not.

Yup, that is true

 

[SMinNJ]

Of *what* costs, though? Are you saying Mom has a solid case that the ortho costs are medically necessary?

I don't think anyone can say how this would end up if there's maneuvering via the courts, but for now I would just leave it alone since Mom isn't asking for anything. Maybe Mom really wants the braces even if they are totally cosmetic and is willing to pay for them. I totally get you that a child isn't lacking just b/c they can't have braces, but the fact one professional says they aren't necessary I don't know will outweigh the ortho's opinion that thought they were when he banded her if Mom takes Dad to court.

How much time does Mom have to present receipts to Dad for reimbursement?

Thanks for the advice Wiley... The ortho who put them on is actually the professional who says they are not medically necessary... Go figure.

There is nothing written in the agreement besides that splitting anything over $250 stuff... Mom has only once requested reimbursement when she had her counsel write a letter requesting a lump sum for services provided by an unnamed provider. Dad requested receipts and the name of the doctor before paying. He never heard about it again (something like three years ago).

Thanks again...