Health insurance

[Corona99]

Unfortunately have so much more than this going on but too exhausted to type it all out. Quick question about insurance - Sunlife. I’m the stepmom. Dad has ADHD and a learning disability so I do a lot of admin.

He is in reunification therapy with his 14 year old daughter as mom has slowly alienated both kids from him over the last 5 years. Daughter decided in February she was not coming to dads anymore. At all.

We retained a lawyer, multiple issues about finances, etc. But $3000 later we are nowhere.

In the meantime, mom is refusing to use daughters insurance coverage for the sessions now. Says daughter needs all her own coverage but has over $1000 remaining for this year under dad alone. Dad needs counselling too, so it seems fair to share them.

She agreed for 2 sessions and then got mad about something else so she refused to pay for the last session. Dad had to put it on his credit card, but as it was to go under the daughters coverage, and moms birthday is first, it must be submitted to her plan first. We had no choice but to give her the invoice.

She submitted it, received the $100+ in reimbursement from Sunlife and flat out told him today she would not be giving it to him, as she ‘feels’ he owes money for other things.

How is this ok? Is this not insurance fraud or theft?

We’ve begged Sunlife for help as she did this 4 years ago as well, but they are insistent that the persons who’s birthday falls first must claim first.

So he pays and she just gets to keep that money? My head is literally going to explode with how frustrating all of this has been.

Any experience with this? Thanks in advance. You guys are a wonderful source of info and your post secondary 1/3 stuff is really helpful. I hope to try and type it all out one day and see if you can help us as I’m at the end of my rope ��.

[rockscan]

Yes it is insurance fraud but the only way to get it back would be to either subtract it from support or other costs because it is so low.

There are a few things here. If you are in court trying to get kid to see dad, it is a losing battle. I have not seen a case lately where a parent was punished for withholding a teen and if mom is as bad as you say, fighting will make it worse. Kid is doing what mom wants to keep the peace at home and while that is terrible to say, it is more a “stop wasting your money” comment. Forcing kid to go to therapy will also be difficult. Dad should be seeing a therapist himself but someone who specializes in alienation.

At this point he needs to leave the lawyer out of it and simply send ongoing documentation reminding mom that he is entitled to see the kids and he expects make up time. He should also be sending messages of support and encouragement to kid that aren’t in the vein of forcing them. (Like: I wish you would come here or I wish you would see this hurts me) etc.

It is truly a horrible situation to be in but you are wasting money fighting this. She will never support the relationship and you will now have to work with the kids. I say this as the wife of a man who hasnt seen his youngest in six years. He should focus on ways to cope and heal himself. I also recommend a really great book- A Family’s Heartbreak by Mike Jeffries.

[SmallTalker]

Having a lawyer to dispute something so small won’t pay off even if other sides agrees and reimburses you that $100. It may sound unfair, unethical, but if financially not worth it, unless of course you self rep and write to her lawyer demanding that $100 - in that case his ex eventually would understand that paying $100 better than paying lawyer 10 times more.
As for alienation. Unfortunately I don’t see what would help. Yea, mom would continue agenda, the court would be writing that they extremely concerned in their endorsements but will do nothing to force teenagers see dad. Some kids understand with time they were just used, some not

[Tayken]

How is this ok? Is this not insurance fraud or theft?

No. Insurance pays to the plan holder and not parents. So if the other parent is the plan holder then they get the money.

In the future only pay after the claim has been adjudicated and funds have been distributed. Pay only the proportion not coved by insurance to the other parent.