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  • Insurance benefits

    Strange question but...
    If Parent 1 has health insurance for their child and Parent 2 has none:
    Does that mean that Parent 1 keeps the money paid out by the insurance company and parent 2 does not?

    Parent 1 already pays 80% of the extra expenses.

    I did not care but one lawyer has been saying their client is entitled to things they are not on a regular basis and being ignorant of my rights isn't helping me. My lawyer isn't much of a help, they are all simply in it for themselves when it comes to money issues.

  • #2
    Technically the insurance is supposed to cover as much of the expense as possible which would then be split proportionate to income.

    Example: child had dental appt for $300. Insurance covers $200. Parents split $100 proportionate to income.

    Example 2: child had dental appointment for $300. Dentist direct billed insurance for $200. Parent 1 with insurance paid $100. Parent 2 reimburses Parent 1 for share of cost.

    I don’t see any scenario where one parent keeps insurance money. Unless they are getting reimbursed for more than than what they paid in which case it is insurance fraud and if you are the parent without insurance you should be reporting it to the other benefit provider.

    Comment


    • #3
      What was stated about splitting the insurance check 50/50 doesn't make sense to me. Also Parent 2 didn't pay insurance premiums.

      Parent 1 pays 90% of costs
      Parent 2 pays 10% of costs.

      $300 is paid to the doctor.
      Parent 1 pays $270
      Parent 2 pays $30.

      Insurance sends parents check for $100 as they pay a 1/3rd.

      Parent 2 ends up profiting $20.

      Comment


      • #4
        Did you know how much the insurance would cover? Because if you did (or they did if it wasn’t you) then the amount should have been subtracted and then split.

        No one should be “pocketing” insurance money.

        Which parent has the benefits and who paid the bill up front?

        Comment


        • #5
          Originally posted by pinkHouses View Post
          What was stated about splitting the insurance check 50/50 doesn't make sense to me. Also Parent 2 didn't pay insurance premiums.

          Parent 1 pays 90% of costs
          Parent 2 pays 10% of costs.

          $300 is paid to the doctor.
          Parent 1 pays $270
          Parent 2 pays $30.

          Insurance sends parents check for $100 as they pay a 1/3rd.

          Parent 2 ends up profiting $20.

          Actually, if Parent 1 gets the benefits and pays the most, why did they split the insurance cheque? Their share of the $200 is $170 so the $100 would have offset the $270 they paid?

          If Parent 1 is paying out the bulk and then submitting to insurance they shouldn’t be sending parent 2 anything but a request for their portion of the after coverage cost.

          Comment


          • #6
            Originally posted by rockscan View Post
            Actually, if Parent 1 gets the benefits and pays the most, why did they split the insurance cheque? Their share of the $200 is $170 so the $100 would have offset the $270 they paid?

            If Parent 1 is paying out the bulk and then submitting to insurance they shouldn’t be sending parent 2 anything but a request for their portion of the after coverage cost.
            I am merely pointing out that your reply does not seem like a legal stance because even on the surface it doesn't make logical sense.

            Comment


            • #7
              Insurance benefits

              The child goes for dental work at $300.

              The cost was split between the parents proportionate to income yes?

              Parent 1 paid $270
              Parent 2 paid $30

              Parent 1 submitted the receipt to their insurance and received $100 back.

              From what you said you took the cheque and split it between the parents 50/50 so they each got $50. This never should have happened. Here is why.

              Cost of the dental work AFTER benefits was $200. Therefore the split should have been parent 1 paying $180 and Parent 2 paying $20.

              You made the illogical argument. You never split insurance benefit reimbursement. You either direct bill to the insurance provider or pay the bill and submit and when you know how much the reimbursement is you then calculate the expense. Most benefits companies provide the coverage amount so before you go for the fee you calculate what parent 2 owes and request it.
              Last edited by rockscan; 07-03-2020, 10:10 PM.

              Comment


              • #8
                Originally posted by rockscan View Post
                The child goes for dental work at $300.

                The cost was split between the parents proportionate to income yes?

                Parent 1 paid $270
                Parent 2 paid $30

                Parent 1 submitted the receipt to their insurance and received $100 back.

                From what you said you took the cheque and split it between the parents 50/50 so they each got $50. This never should have happened. Here is why.

                Cost of the dental work AFTER benefits was $200. Therefore the split should have been parent 1 paying $180 and Parent 2 paying $20.

                You made the illogical argument. You never split insurance benefit reimbursement. You either direct bill to the insurance provider or pay the bill and submit and when you know how much the reimbursement is you then calculate the expense. Most benefits companies provide the coverage amount so before you go for the fee you calculate what parent 2 owes and request it.
                OK...will wait for other replies. thanks.

                Comment


                • #9
                  The bottom line is you shouldnt be splitting the insurance cheque. You should be calculating the amount owing by both parties after the insurance is calculated.

                  Parent 2 should never be getting a chunk of the insurance reimbursement. If this was written into the agreement it was a stupid clause especially since the payment of expenses is not 50/50.

                  Comment


                  • #10
                    This sounds like that old math riddle about the hotel room that costs $10 each for 3 people, where the owner refunds $5 and the bellhop keeps some of it and somehow some of the money disappears. Essentially, the "paradox" comes from poorly defined terms.

                    I think that Pinkhouse is mixing up terms here.

                    Parent 1 pays 90% of costs
                    Parent 2 pays 10% of costs.
                    As rockscan pointed out, parent 1 would pay 90% of net costs, not gross costs. That matters. I'm going to assume that parent 1 does not pay extra to obtain insurance and as such is not compensated for it in the split.

                    $300 is paid to the doctor.
                    Parent 1 pays $270
                    Parent 2 pays $30.
                    This part is mostly irrelevent. Parent 2 could have paid $220 and Parent 1 could have paid $80. What matters is that the final split is 90% parent 1 and 10% parent 2.

                    Insurance sends parents check for $100 as they pay a 1/3rd.
                    In this case, parent 1 would have received the check since they have the insurance.

                    So let's figure this out!

                    Amount paid
                    Parent 1: $270 (paid to dentist) - $100 (received from insurance) = $170
                    Parent 2: $30

                    Amount that should have been paid
                    Parent 1: $180 (90% of the $200 net cost)
                    Parent 2: $20 (10% of the $200 net cost)

                    Result
                    Parent 2 overpaid by $10. Parent 1 needs to make a payment of $10 to parent 2.

                    Comment


                    • #11
                      Alternatively, if each parent received $50 from insurance (not sure how that would happen, since parent 2 has no relationship with insurance company) calculations become:

                      Amount paid
                      Parent 1: $270 (paid to dentist) - $50 (received from insurance) = $220
                      Parent 2: $30 (paid to dentist) - $50 (received from insurance) = $-20

                      Amount that should have been paid
                      Parent 1: $180 (90% of the $200 net cost)
                      Parent 2: $20 (10% of the $200 net cost)

                      Result
                      Parent 2 underpaid by $40, and needs to pay parent 1 $40.

                      Comment


                      • #12
                        Originally posted by pinkHouses View Post
                        OK...will wait for other replies. thanks.

                        It’s not really that hard of math... the costs are split AFTER insurance deductions... not before. NET costs are split... not gross.

                        If an appointment in $300 and insurance pays 1/3, then it’s $200 to be split by the parents. Parent 2 pays 10%, so $20, Parent 1 pays 90% so $180.

                        If insurance doesn’t pay the provider directly then the one who will be receiving the insurance cheque pays the cost up front. So parent 1 may pay $280 up front but once insurance pays they still only paid $180...


                        Sent from my iPhone using Tapatalk

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                        • #13
                          Thank you Janus and Berner_Faith. Your answers made sense.

                          I didn't go through that little bit of math for no reason. Rockscan said to split the cheque and that did not sound right at all. Next time I will use the quote feature when making responses.

                          BTW: I am the only one paying for the premiums, I think I also have to pay taxes on some of the benefit I receive.

                          thank you.

                          Comment


                          • #14
                            I never said to split the cheque. You shouldn’t be splitting it. And if you read Janus’ comment, he pointed out that I was correct.

                            Comment


                            • #15
                              OP's question has been answered thoroughly and accurately, so closing this thread.
                              Ottawa Divorce

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