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  • Insurance - how to get compensated if the other parent is the "middle man"

    I can't find a previous post that nails this...

    My stbx works 24 hours per wk to maintain insurance coverage. However, since he obtained this benefit via his employer (approx. a year ago) I have been unable to use it for our kids.

    (I have defacto custody. Nothing is settled - even after the OCL looked into our situation. But the kids continue to live with me and see their dad regularly.)

    Anyway when I go to the dentist I must pay upfront. Apparently, forms can be submitted to the insurance company after payment is processed. However, my stbx insists that the reimbursement can only go to him (via forms or doing the transactions completely online).

    But, in the end he would get money transferred from me to him. BTW he pays less than $390 in CS for 2 kids - each month. So that would be quite a "kickback" - twice a year at least.

    Is there anyway that I can get compensated by the insurance company instead - I mean directly?

    How does this work when only parent has an insurance plan but is not the custodial parent? My stbx took the kids to the dentist once in 11 years... so that is not a viable option for many reasons.

    I've also had to buy eyeglasses recently w/o the insurance plan. I've probably spent at least $500 for things that should have been covered.

    Incidentally, I was a SAHM throughout or marriage. I now work on call and/or on contract - but I have little chance of getting health benefits through any job in the near future.

    I should also mention that my stbx has ranted about my refusal to use his insurance many, many times. It is a nutty situation (like most things with him).

    Don't expect me to trust him on compensating me after he's compensated. Until the FRO became involved in mid-2012 he didn't pay a nickel for C/S. Also, he's the kind of guy who won't let his kids bring their Christmas presents to the other house - very controlling and manipulative.

    Maybe the dental office has not provided me with all the possible options? Am I missing something. I only recieved a policy number for the insurance coverage recently. That was one of the problems for the dental office obviously.

  • #2
    Ok...so a quick.solution. Since nothing is settled. Consider what you have already spent to be resolved in the settlement.

    In the future have Dad take the children to anything involving an up-front payment and reimbursement by his insurance. This way he is using his insurance and you aren't out of pocket.

    I'd probably go as far as to have a clause in the separation agreement just for this.

    Comment


    • #3
      Some insurance companies have an "insurance card", that one can show, that they use to lookup coverage at the dentist, etc. Does your ex's insurance company have one of those? If so, it may be worth changing dentists, to go to a place that submits on the spot, and then you only pay the "non-covered" remainder, that is left.

      If you are getting the "reimbursed" money, back...eventually, from the ex, perhaps have a credit card that you use for these dentist visits, so at least, the money is not coming out of your pocket directly, but is instead getting charged to the credit card? Gives you 30 days.

      Your ex's insurance company is not going to knowingly send you the reimbursed funds, as you are not the insurance holder.

      FYI... a situation where this has happened, kind of...was with my insurance provider. One of the "large" Canadian ones, but I won't say who.

      Their "system" sucks, in that if one of my kids' moms submit a claim, and incorrectly submit it using their own address, that triggered the insurance provider to think my address had updated, and they would send a "cheque" to the Mom(s), but in my name. They were also sending my benefit statements there as well. This happened a few times. Grrr...

      I complained to the insurance provider enough, that they finally don't seem to have this happen anymore. My address has remained correct, for a few months anyway.

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      • #4
        Also, being that you have kids, and that insurance seems pretty important/vital for you, you should probably start looking for other work/different work, where you have "benefits". One can also buy their own 3rd-party insurance. One doesn't have to get it through their employer, although, that is usually the more convenient, cost-effective method.

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        • #5
          When i seperated in 2001 we had a clause put in our agreement that we would keep each toher as alternate payors on each others benefits in order for us to be able to claim directlyto the company on the others benefits.... it can be done we have Sunlife for medical and Great WEst LIfe for Dental... until you are settled keep all your receipts submit them because with ours you can only claim them for up to a year after they';ve been issued. Keep track of what you ahve submiited and what you shoudl have gotten back .. document document document everything if he refuses to give you the refund then at court you can ask for an order to be reimbursed. I would try to document all your requests through email so that you have proof.

          my ex is a bit of a not so nice person at first wouldnt give me access even though he was obligated to ..once i got access one time he changed my mailing address to his house so that he got my check .. had to call to get the cheque cancelled and reissued to my address ...his latest stunt is he removed me completely from both benefits but i keep track of it all and i document it all via email .. we go to court next week and one of the orders i am seeking is for the judge to order him to reinstate me pursuant to the seperation agreement and to have him remove the password so that i can call and verify the status of my claims i make for the kids.

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          • #6
            Thanks for the tips. I need to do a bit of in-depth analysis. Next week I'm taking the kids to the dentist for the first time with all the policy numbers in my possession.

            It's incredible how much energy can be wasted in petty, never mind outright nasty actions.... The focus is on wounding, controlling, whatever. It's all bad. He's preventing you from getting compensated by the insurance company, right? What is the "gain" for him? Can't see any loss.

            I'm sad to hear that you have to pursue this again and again... something that is reasonable, related to the best interests of your children.

            Good luck next week!

            Comment


            • #7
              his gain is power and control lol its been 12 years and this will be our 7th time in court .... i was granted sole custoday back in 2001 by the judge had to have the CAS involved, womans shelter i'm actually still an outpatient client ... now its the fight over post secondary education costs ....if he invested the money he paid in lawyers to our chilldren's education it would probably cover 2 years .... i self represented for 5 years and am again this round but my knowledge is pretty limited lol but i know alot about benefits because it happened to me .!!! lol i had to put a password on my dental benefits because he had his g/f call in impersonate me and change my mailing address to his house so he could get my cheques even though he coulnd't cash them cause they were in my name... lol hte only person that knew my account number beside me that could call in is him but since he's a man hed have to have a woman do it.... so Great WEst LIfe were nice cancelled the cheque and reissued to the correct address but htey told me i had to password my account to something he didnt know. its ridiculous

              Comment

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