Children covered under multiple employer benefits

[Alpinist]

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.

 

[rockscan]

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.


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[Alpinist]

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.

 

[Ange71727]

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.


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[Alpinist]

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.