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  • Ex kept health insurance benefit

    Hi everyone,

    My son's father and I both have health and dental coverage for our son through the same provider. I recently paid for and submitted a claim for our son and the reimbursement cheque ($350) was sent to my ex in his name because his birthday falls before mine and therefore goes through his insurance first.

    I have been asking for the money for a month and he is refusing to give it to me.

    What recourse do I have?

  • #2
    Ask again. Document.
    Court next...

    Note: You must have submitted the claim to his insurance policy as they could not have processed it against his policy without his signature and his forms (or through his e-portal for his insurance).

    In the future only put it through yours. We have had to do this because mom does this in our situation too. And she has the earlier birth date. We have never had a problem.

    Comment


    • #3
      other than cancelling coordination of benefits, there is no other option. We are going through the same thing with my husband's ex.

      Comment


      • #4
        You can't cancel coordination of benefits... you just don't coordinate benefits. When I was challenged on this I said "I can't coordinate what I have no control over".

        If the person who is not cooperating is a payor and your order has section 7 on it - put remaining balance thru FRO.

        Comment


        • #5
          Originally posted by Serene View Post
          You can't cancel coordination of benefits... you just don't coordinate benefits. When I was challenged on this I said "I can't coordinate what I have no control over".

          If the person who is not cooperating is a payor and your order has section 7 on it - put remaining balance thru FRO.

          So if benefits are already coordinated then you're screwed?

          Benefit coordination is there to prevent insurance fraud (ie submitting the same claim to two different insurers for two refunds), and due to this, I was under the impression that coordination was mandatory. If it isn't mandatory, why would anyone coordinate the benefits?

          If there is only one insurance plan, and it's the exes - but the ex doesn't take the child for the appt, therefore the other parent pays the bill and the ex gets the money back? What then?

          Comment


          • #6
            They aren't "already coordinated". Every insurance claim you submit is or is not coordinated. You must choose that option to coordinate or not.

            It is mandatory. But you can't force someone to coordinate (obviously). And you can also say you are unaware of any other insurance if questioned why you are putting through only your own. Or you could say that you don't have access for any other policy...

            If you don't have insurance then I guess you are SOL unless you pursue through FRO. Get your MP involved if they banter or take two long (providing your order allows for section 7/extraordinary).

            Your husband doesn't have insurance? You don't have insurance MS Mom? Only bio dad does?

            Comment


            • #7
              Originally posted by Serene View Post
              They aren't "already coordinated". Every insurance claim you submit is or is not coordinated. You must choose that option to coordinate or not.

              It is mandatory. But you can't force someone to coordinate (obviously). And you can also say you are unaware of any other insurance if questioned why you are putting through only your own. Or you could say that you don't have access for any other policy...

              If you don't have insurance then I guess you are SOL unless you pursue through FRO. Get your MP involved if they banter or take two long (providing your order allows for section 7/extraordinary).

              Your husband doesn't have insurance? You don't have insurance MS Mom? Only bio dad does?

              I do have insurance and so DID the ex (but not any longer). But, his birthday is first, so claims had to be submitted to his insurer first, then mine. And, as cooperative as he is, he ignored it all, so I paid out of pocket for everything despite her being insured under both of us.

              My insurer denied claims becuase his insurance had to be used first. So, after paying a bill once, sending him the paperwork and then waiting for reimubursement (which went to him, not me), I stopped submitting any claims directly to his insurer. If I wasn't going to be the receipient of the reimbursement for the expense I paid out, I didn't want it going through any plan so I could at least claim a tax deduction on the money laid out (which if insured, isn't claimable).

              I don't know how you would coordinate on one claim, but not on another? That's sort of picking and choosing when to follow the rules and when not to. When I registered for insurance at my position he already had insurance for her, so I registered as coordinated benefits from the get-go.

              He doesn't have any insurance for her now, which has actually made her medical expenses much less to me as I can at least use my insurance. But our existing agreement states he has to insure her and at CC the judge ordered him to provide proof of insurance or proof that he isn't able to insure her (he's moved south of the border). I'm not expecting that he'll do either really. But, in the event he does insure her, moving forward I don't want the same hassles I've had already.

              Comment


              • #8
                Then just continue as you have been - thru your insurance. And put balance through your current spouse's. That should take care of most your expenses for your daughter.

                You are not breaking any rules as far as I'm concerned. Even when he had insurance. We've never been able to access mom or her husband's insurance for the kids and we've been coordinating through dad's and my own only. And that is despite a court order saying she had to keep coverage on them. Life goes on. And in truth, one less thing for us to have to communicate with her about and one less thing for her to control and punish us with at whim.

                Comment


                • #9
                  Originally posted by Serene View Post
                  Then just continue as you have been - thru your insurance. And put balance through your current spouse's. That should take care of most your expenses for your daughter.

                  You are not breaking any rules as far as I'm concerned. Even when he had insurance. We've never been able to access mom or her husband's insurance for the kids and we've been coordinating through dad's and my own only. And that is despite a court order saying she had to keep coverage on them. Life goes on. And in truth, one less thing for us to have to communicate with her about and one less thing for her to control and punish us with at whim.

                  Well, I can put it through my insurance now that dad has decided to ignore everything, but for almost 3 years I had this crazy hassle over refunds, etc.

                  I understand the communication issues - if the ex can't communicate on these black and white basics, then how the hell do I get more difficult issues addressed?

                  My daughter isn't on my current husband's plan, but I'm taking steps to change that. My ex is a control freak, and it's actually in our agreement that only him and I are to insure her. Just like I can't move outside of the city limits, but he moved to Texas with 10 days notice.

                  This isn't a give and take/fair/equitable or even child centred SA currently. This is a control freak with an unlimited legal fund (thanks to the parents of the control freak) who beat a single mom into submission through delays, bullshit and high legal costs.

                  Comment


                  • #10
                    Being insured is the right of the child. I can't imagine why your SA states your hubby can't insure her. And honestly, it is one of those things I'd put on ignore and do anyways.

                    Comment


                    • #11
                      Originally posted by Serene View Post
                      Being insured is the right of the child. I can't imagine why your SA states your hubby can't insure her. And honestly, it is one of those things I'd put on ignore and do anyways.

                      I can't put it on "ignore" and expect him to honour the remaining items in the agreement.

                      I didn't even have a hubby went the SA was done, it was "preventative" in his opinion. So, at the time it didn't seem like a big huge deal, and also seemed like one of those small "trade-ins" I've gotten so used to.

                      My thought process at the time was - well, this is irrelevant right now, is only there to make him feel better, to make him feel in control, so I'll consent to that. Same with the moving clause - I had no intentions of going anywhere and still don't, but it made him move forward in the negotiations.

                      Right of the child or not, he soon dumped her insurance when he moved south.

                      You see, sometimes we aren't dealing with smart -we're dealing with "crazy".

                      Comment


                      • #12
                        As unfair as it is for you and your daughter not to be covered, did your agreement state that as long as he has work benefits he must cover or just cover in general? The reason I am asking is because if he moved South and his benefits no longer covered in Canada, he may be off the hook, however if it states he must provide third party insurance, he should be paying for coverage in Canada for her.

                        My partners agreement states that as long as WORK benefits are provided each must insure the children, but states nothing regarding third party benefits.

                        Comment


                        • #13
                          I completely understand your situation. However I will offer you this:

                          Look up BATNA and WATNA as somethings are in your control and some things aren't. Personally, you under no obligation to advise your ex how you deal with your finances with regards to the insurance you use. So he would not be aware you are putting it through your husband's insurance.

                          Comment


                          • #14
                            Originally posted by Serene View Post
                            I completely understand your situation. However I will offer you this:

                            Look up BATNA and WATNA as somethings are in your control and some things aren't. Personally, you under no obligation to advise your ex how you deal with your finances with regards to the insurance you use. So he would not be aware you are putting it through your husband's insurance.
                            All I've ever wanted ex to do is follow the agreement he made - both in his actions with daughter and financially. It's been an ongoing struggle to get him to stick to anything he says. I've been of the opinion (perhaps deluded opinion?) that if I don't honour it, I can't expect him to. The last agreement, which was substantially successful on his part (more access, etc.) was thrown away by him within two weeks of making the agreement.

                            But now that he has cancelled the insurance (or it was cancelled on him due to the move), I've started making inquiries about putting her on my current husband's plan. My ex stated that he didn't change companies, just locations, which is why the judge wants proof that she cannot be insured even though he works for the same organization.

                            I'm in SC next month, so I plan on bringing it up - if the judge doesn't already. She definitely wasn't impressed with his excuse-making tactics at CC, so we'll see what happens there.

                            I've also asked for S7 in this round at court (S7 that is agreed to in our existing agreement, yet he still won't pay up), and instead of proportionate share of those medical expenses, I've asked for the whole amount. With a sport she's involved in I've also asked for a set amount of S7 per month. His answer to that, ironically, was if my husband can afford it then he can pay for it, but the ex will not. Hmmm..... you see the bass-ackwards idiot I have to deal with?

                            Comment


                            • #15
                              Originally posted by Berner_Faith View Post
                              As unfair as it is for you and your daughter not to be covered, did your agreement state that as long as he has work benefits he must cover or just cover in general? The reason I am asking is because if he moved South and his benefits no longer covered in Canada, he may be off the hook, however if it states he must provide third party insurance, he should be paying for coverage in Canada for her.

                              My partners agreement states that as long as WORK benefits are provided each must insure the children, but states nothing regarding third party benefits.
                              Yes, it states that he must have insurance for her. But, that doesn't matter to him or his lawyer. Nothing he previously agreed to matters to him unless he can now use it to get out of something or accuse me of something.

                              He's the person that will quote part of an agreement to you to get his own way, and then ignore everything else that doesn't suit him today.

                              Comment

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