Announcement

Collapse
No announcement yet.

Children covered under multiple employer benefits

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #16
    Originally posted by Ange71727 View Post
    Beware of this scenario:

    Parent 1 is primary insurance
    Parent 2 is covered under spouse’s plan (step-parent) and does not have their own plan
    Children are covered under Parent 1 and step-parent (4 on this list).


    Coverage of the child must proceed through the “coordination of benefits” between any plans. At the time of making a claim, most plans ask the question “are there any other plans covering this child?” and prompt you to indicate additional policies. If Parent 2 & step parent pays for anything out of their own pocket, all reimbursements will still go to Parent 1 because that is the primary plan (in my experience). Parent 2 or their spouse could have an earlier birthdate than Parent 1 even, but it doesn’t matter. Parent 1 is primary and gets the reimbursements.

    I am out $1000 currently because of this rule. Ex just pocketed my money even though I paid for the services (for our child) I made the claim for.


    Sent from my iPhone using Tapatalk

    Then he committed insurance fraud and you need to reach out to his spouse’s insurance company and report it. He should also be paying his share of the expense over and above what was covered by his wife’s plan.

    But then again, your ex is a super ass who pulls these stunts. Add it to your list of abuses for the next time he cries foul.


    Sent from my iPhone using Tapatalk

    Comment


    • #17
      Rockscan is right. If you have paid for an expense and their insurance plans paid anything toward it they need to reimburse you right away.

      Comment


      • #18
        Sorry it’s not super clear now that I read it.

        Child gets some medical services.
        Both parents pay towards this service.
        We both have insurance coverage for the child - my ex through his own plan, and through my spouse’s plan (stepdad) on my end.
        Receipts issued even state explicitly who paid what. We each submit through our plans.
        Insurance company will only issue the reimbursement through the Primary parent’s plan (my ex).
        This means he receives back his reimbursement, for funds paid out of his pocket AND my reimbursement for funds paid out of my pocket.
        Insurance company considers it a done deal at this point because they’ve paid out what they’re reimbursing and don’t care to who.
        At this point, a reasonable human would return the money to the party who actually paid it out.
        My ex is not a reasonable human. He actually has accused ME of insurance fraud, saying I had no business “using” his benefits to cover our child. He clearly does not understand how it works.
        Therefore I am currently out $1000 for two separate claims.
        At one point he said he would just mail the money back to the insurance provider, but that hasn’t happened. The insurance company also told me that unless he mails it back with specific instructions to reimburse it to my husband’s policy number, that they’d not be sending me any money as it’s considered “his” right now.
        This is going to just keep occurring as well.
        It’s on the list of items we are hoping to address at the upcoming trial.
        I am surprised I don’t hear others talking about this matter - it must occur to other people in similar situations to me.
        And yes Rockscan, I know you know this would be typical of him.
        As infuriating as it is though, my husband seems to think it’s going to hurt him in front of a judge to have been so uncooperative.


        Sent from my iPhone using Tapatalk

        Comment


        • #19
          It has been discussed in other threads.

          In your case what should have happened is this:

          You pay the money up front and submit to your benefits company. You send him the receipt and he submits to his company. You can also submit to the new spouses companies on both sides. Insurance reimbursements go back to you IN FULL and any remaining amounts are split according to section 7.

          Namely, expense is $1000. Your company pays $300, his company pays $300, other companies don’t exist. You pay out the $1000 up front, he pays you the $300 and then you split the remaining $400 proportionate to income (say it’s 50/50 so he pays you $200).

          I wonder if you can just get the insurance info and have the medical provider bill direct?


          Sent from my iPhone using Tapatalk

          Comment


          • #20
            So what happened is we both agreed to pay our share and each submit through our own insurance. He didn’t want to have to deal with me, and frankly I didn’t want to deal with him either. We divided up the cost proportionately and knew the full amount was going to be covered. It seemed like a win-win....
            Except that when I submitted my portion through my husband’s account, I was forced to indicate there was an additional policy covering the child (ex and current husband are both with the same company). That’s fine, because it’s insurance fraud to not indicate that, but it meant that the reimbursement went through the one plan only - the primary insurance ie. ex husband’s.
            He should have simply just e-transferred the amount over to me. But he chose to power trip and keep my money.
            The dentist is never a problem because they direct bill and we don’t pay out first.
            Any time an agency expects payment first (which is the case for many places), I am going to run into this problem.


            Sent from my iPhone using Tapatalk

            Comment


            • #21
              There are a couple of things I noticed. I think that if coordination is very straightforward, for example there are only 2 plans and each plan pays 50% then it makes sense to just submit under your own plan.

              However your situation very complex, from what I can see there are at least 3 benefit plans. I would send a letter to the insurance company indicating there is a complex order of benefits that needs to be followed for each claim for your shared children. That the first plan it goes through is the biological father, then your plan, the biological mother then your partners plan. Be sure to include the group numbers, etc. The insurance company will add a note to your files, so that it gets coordinated in the correct order. Hopefully this helps.

              Comment


              • #22
                Originally posted by Alpinist View Post
                There are a couple of things I noticed. I think that if coordination is very straightforward, for example there are only 2 plans and each plan pays 50% then it makes sense to just submit under your own plan.

                However your situation very complex, from what I can see there are at least 3 benefit plans. I would send a letter to the insurance company indicating there is a complex order of benefits that needs to be followed for each claim for your shared children. That the first plan it goes through is the biological father, then your plan, the biological mother then your partners plan. Be sure to include the group numbers, etc. The insurance company will add a note to your files, so that it gets coordinated in the correct order. Hopefully this helps.

                Ange’s problem isn’t coordination of benefits. It’s her ex paying her the money that was paid to him but owed to her.


                Sent from my iPhone using Tapatalk

                Comment


                • #23
                  I agree. He's not being honest and needs to pay her back. However figuring it out on the insurance side might prevent future insurance payments to the wrong person. Adding a note/letter when she submits the claims under her husbands policy could prevent the insurance company from paying it under her exs policy by mistake. Sounds like that is what is happening.

                  Comment


                  • #24
                    Originally posted by Alpinist View Post
                    I agree. He's not being honest and needs to pay her back. However figuring it out on the insurance side might prevent future insurance payments to the wrong person. Adding a note/letter when she submits the claims under her husbands policy could prevent the insurance company from paying it under her exs policy by mistake. Sounds like that is what is happening.

                    I have been over it with this insurance company a thousand times. They won’t break policy - primary insurance has to be reimbursed no matter who pays out. They have notes on file, they have evidence of who paid it out (it’s on the receipts), they’ve sympathized with me....but they don’t consider it a “mistake” at all that they would reimburse his plan only. I guess they assume that reasonable and moral people wouldn’t try to collect money they didn’t actually pay out. They told me the only way to have any of it changed involves the bio dad’s cooperation - and that’s why I have this huge problem. It sucks for the parents who are dealing with a high-conflict ex.


                    Sent from my iPhone using Tapatalk

                    Comment


                    • #25
                      That really sucks that he is being so dishonest. Could he pay all the expenses (100% of the total bill) going forward? Since his plan is first. Then you submit to your plans and reimburse him afterward.

                      Comment

                      Our Divorce Forums
                      Forums dedicated to helping people all across Canada get through the separation and divorce process, with discussions about legal issues, parenting issues, financial issues and more.
                      Working...
                      X