interesting development

[littleman]

years ago my ex said that he would not take our child to the dentist anymore whereas was in wrong end of town (happens to be end of town where my child & I reside) .......so I put him on my insurance and told him to forget about it
I just happened to notice the other day when I took our child to dentist that it is also being submitted to the exes insurance as well and he is receiving cheque for this also
I pay up front and get my refund in hours from insurance and he also gets a refund for the same amount........I let his insurance company know about this this morning and without thinking about the ramifications this may have......I dont think this will have bearing on myself because I was honest about this and told his insurance to stop payment on it......also found out I was still on exes insurance also
now what do I do.......I have opened serious can of worms here and dont know how to stop the bleeding

 

[KeepSmiling]

WOW ??!!??

Sounds like the dentist might be the one in trouble - submitting the same claim to 2 insurance companies?

Maybe you should inform you ex what you have discovered and done. See what he says?

 

[littleman]

dentist didnt submit to two insurance companies
I was unaware that they were submitting to exes insurance when I submitted to mine
after being told by ex that he removed our child from his insurance I naturally got insurance for our child and have been taking care of all medical costs for our child without his financial support

 

[dadtotheend]

It may be that your ex's insurance company is paying out any uncovered portion not paid by your insurance company.

You calling his insurance company definitely was not cool. You should have first asked the dentist what was going on and I bet you will hear the answer above.

 

[littleman]

its not unpaid portion at all
the appointment was for 158$ and I paid it and got back 155$ and his insurance company issued cheque for 158$ to him

how do I fix this
I dont want to see ex arrested and trhown in jail for it.....then again he should have been forth coming to the insurance when he received a refund cheque for something he never paid out
I just really want to fix this without the ex getting into fraud charges or anything like that

 

[blinkandimgone]

It's normal to be submitted to two insurance companies if both parents are insured and pay for their eligible dependants to be insured as well. Typically what happens is the claim will be submitted to the insurance company of the parent whose b-day falls earlier in the year, the remainder of the claim will be processed through the other parent's insurance. Any remaining balance would be paid by the parents, % split proportionally to their income. Any insurance payouts should go to the person who paid up front but it is up to the owner of the insurance plan to submit information for re-payment. My ex pays all of the remaining balance (not a whole lot after it goes through both our insurance companies) because he can put it on his credit card, I simply provided my insurance company with his banking information to deposit the money to rather than me getting it and transferring it to him.

The issue here isn't that there are two insurance companies involved, that's quite normal. The issue here would be is he recieving re-payment for monies you paid when he should not be. If his insurance is covering part of the costs not covered by your insurance then that's great for you, reduces what either of you would have to pay for medical/dental costs, just be sure the correct person is being reimbursed for the costs not covered.. In order for his insurance to pay for anything he would have to submit receipts to them, if he is not then there's an issue with the insurance company.

If both companies are covering the full cost then there was a mistake made, sounds like both of your insurance companies are unaware there is another company involved. You should inform them you now have your own insurance. The dentist did the right thing by submitting it to both companies, you and the ex didn't communicate the proper information to each other, the dentist and the insurance companies.

 

[littleman]

I just talked to the dental office and they are faxing me all claims submitted to his insurance so I can compare against mine. Im wondering about the legal implications this may have on the ex.....I opened a can of worms that I need to be closed without anyone getting arrested or charged with fraud.......will his insurance give him opportunity to pay back what he got from them as a refund

 

[blinkandimgone]

I think you may be overstepping confidentiality boundaries by requesting information about HIS insurance without speaking with him. This is his issue, why not let him sort it out. It's not any kind of fraud if he's paying insurance through work.

If you got your reimbursements and everything is fine then you should really leave it alone. Definately let him know about the insurance situation that there was a mistake made in both companies processing the entire amount but let him sort it out. It may turn out you both owe a bit back to the insurance companies as neither should be covering the full amount with both policies available.

You sort out yours and let him sort out his. Not sure why it's such a huge issue, it sounds like an honest mistake.

 

[littleman]

It is a big deal
its not a mistake on my insurance company part nor on mine
he told me that our child was no longer insured under his plan
I put our child on mine and just seemed right whereas I have sole custody
our child been on my plan for years
ex has been accepting cheques from insurance that are clearly stating refund for child dental appointment
I never even thought about it before calling the insurance company how much legal trouble this could cause........I never meant for that to happen.....sure we have our moments but this is wayyyyy beyond everything or anything I could ever have done on purpose
I just want to fix it......Im not being vendictive at all

 

[blinkandimgone]

ex has been accepting cheques from insurance that are clearly stating refund for child dental appointment

You confirmed that with him?

I have no idea why on earth you'd think it was ok to speak with HIS insurance company before speaking with him about it. If he has the child insured then he's paying into it - which is both his right and responsibility as a parent. I re-read your original post and I find it odd that because he didn't want to drive to the dentist you decided that meant his insurance should stop as well. The insurance will cover the child regardless of who will take them. It doesn't make any sense that you'd play around with the insurance policies based on who is physically transporting them.

Either way, I doubt there will be much effect in you calling the insurance company. His insurance information is confidential and they should not have given you any information, as well they should not have allowed you to make any changes to his information or policies.

Either way, he did nothing wrong by maintaining an inurance policy for the child. A lot of companies will expressly tell you (if you read the forms) that it is not possible to opt out of insurance for eligible dependants if you have any. The issue is with the communication of the information.

You should be speaking with him about this instead of his insurance company or a bunch of strangers on the internet. Why throw everything into panic mode before even talking to him about it - just COMMUNICATE with him and let him take care of it. Problem solved.

 

[dadtotheend]

It's not your place, or even your right to be interfering with his insurance company. His contract with his insurance is his deal, nothing to do with you.

What you should do is making an inquiry with your insurer about what the policy is when two separated parties have a child on each policy.

Furthermore, the dentist would appear to be a bit sloppy here as they probably have a mechanism to be properly submitting the claims. It's the dentisit who is submitting double-dipped claims. There must be a "bucket" that is or isn't being checked on the claim submissions.

 

[littleman]

I think you guys are misunderstanding this situation
I am sole custodial parent of our child
I live at one end of the city and he at the other ( at the time insurance was discussed he lived over 100kms away) he CLAIMED he REMOVED child from insurance - I never once suggested for him to do so - that was him saying that
I do have access to his insurance whereas apparently I am still on it as well!!!!! The insurance company did nothing wrong by discussing with me whereas my name is listed there as insured. - that puts that to rest - I advised them that I shouldnt be listed on his insurance anymore whereas we were divorced years ago
I have made the claim solely to MY insurance and I have been reimbursed solely by MY insurance company........Im not trying to make waves for him but the cat is out of the bag so to speak and now I have to fix it
this is not a situation where one insurance pays x amount and the other makes up the difference

I DID NOT KNOW TIL YESTERDAY THAT HE WAS ALSO RECEIVING REFUNDS FOR SAME THING I WAS......I CALLED HIS INSURANCE TO TELL THEM TO STOP PAYMENT ON THE LAST CHEQUE AND GAVE THEM THE REASON WHY......
how is that trying to cause trouble for anyone
I was the honest one and didnt think about ramifications to him til afterwards.
I do not talk to my ex whereas it is easier on our child if we keep our distance
so telling him is NOT an option --there is no double dipping by dentist when visit is paid for up front then submitted to insurance on my own - I receive my money back and the ex receives money back for an appointment that he didnt pay for nor did he even KNOW about

how can I be wrong with being up front with insurance

 

[today]

I think the point that everyone has tried to point out is that you have no business in what he is getting from the insurance co. so long as you are properly paid by your own insurance then that is that...period, the "fact" that he may be getting reimbursed as well does not concern you at all. Although that is very strange and normally can only happen if a duplicate cliam is filed with his insurance co. as well. If there is a discrepency then he will have to deal with it through his insurance co. Has nothing to do with you, the confusing part is how the dentist can file two claims for one visit, that is rather strange, my children their Mom and I all attend the same dentist and it has never happened in years that a duplicate claim was filed it goes back and forth in no particular order and reaaly doesn't matter who's insurance they use, hers, mine no difference but only one claim. They is no way for the other parent to be reimbursed if a claim has not be filed. At the end of the day it has nothing at all to do with you, although it is odd, you recieved yours so why interfere.

 

[NBDad]

there is no double dipping by dentist when visit is paid for up front then submitted to insurance on my own - I receive my money back and the ex receives money back for an appointment that he didnt pay for nor did he even KNOW about

How did his insurance company get notified about the visit then? How is YOUR EX getting money back from an upfront visit without submitting a claim? Here is what you don't seem to understand....

YOUR DENTIST screwed up and submitted the claim to HIS COMPANY in error, as well as accepted payment FROM YOU, so basically their system is not working properly and allowing a double dip.

They ARE allowed to submit a claim for any amount that is not going to be covered by YOUR insurance IF your insurance company allows direct billing. That is actually a common practice.

The fault lies with YOUR DENTIST and THEIR BILLING SYSTEM, it's their mess and THEIR responsibility to fix. THEY should be contacting the insurance company to advise them of THEIR error, NOT you. YOU are unnecessarily involving yourself in the matter and causing unnecessary strife.

All your ex has to do is claim he had no idea, didn't pay that close of attention, his insurance is setup for direct debit, etc.

 

[dadtotheend]

I think you guys are misunderstanding this situation
I am sole custodial parent of our child
I live at one end of the city and he at the other ( at the time insurance was discussed he lived over 100kms away) he CLAIMED he REMOVED child from insurance - I never once suggested for him to do so - that was him saying that
I do have access to his insurance whereas apparently I am still on it as well!!!!! The insurance company did nothing wrong by discussing with me whereas my name is listed there as insured. - that puts that to rest - I advised them that I shouldnt be listed on his insurance anymore whereas we were divorced years ago
I have made the claim solely to MY insurance and I have been reimbursed solely by MY insurance company........Im not trying to make waves for him but the cat is out of the bag so to speak and now I have to fix it
this is not a situation where one insurance pays x amount and the other makes up the difference

I DID NOT KNOW TIL YESTERDAY THAT HE WAS ALSO RECEIVING REFUNDS FOR SAME THING I WAS......I CALLED HIS INSURANCE TO TELL THEM TO STOP PAYMENT ON THE LAST CHEQUE AND GAVE THEM THE REASON WHY......
how is that trying to cause trouble for anyone
I was the honest one and didnt think about ramifications to him til afterwards.
I do not talk to my ex whereas it is easier on our child if we keep our distance
so telling him is NOT an option --there is no double dipping by dentist when visit is paid for up front then submitted to insurance on my own - I receive my money back and the ex receives money back for an appointment that he didnt pay for nor did he even KNOW about

how can I be wrong with being up front with insurance

Everyone here BUT YOU understands the situation quite clearly. Your sole custodial status means jack shit vis a vis this issue, as does the distance between you and what he told you about removing your child, or not, from his policy. You are interfering in his insurance policy - PERIOD. If he is wrongly being compensated, it is not your responsibility or business to poke your nose into it.

As NBDad, myself and others have repeatedly told you, tell your dentist to fix the problem whereby insurance is being billed twice for the same service.

And stay the fuck out of his insurance policy. Too much drama!

 

[blinkandimgone]

I think you guys are misunderstanding this situation
I am sole custodial parent of our child

It doesn't matter who has custody of the child when it comes to insurance.

I live at one end of the city and he at the other ( at the time insurance was discussed he lived over 100kms away) he CLAIMED he REMOVED child from insurance - I never once suggested for him to do so - that was him saying that

Perhaps he was unable to do so, some insurance companies don't allow you to opt out of providing insurance for eligible dependants - Manulife is one for example.

I do have access to his insurance whereas apparently I am still on it as well!!!!! The insurance company did nothing wrong by discussing with me whereas my name is listed there as insured. - that puts that to rest - I advised them that I shouldnt be listed on his insurance anymore whereas we were divorced years ago

Again, it's irrelevant if you are divorced, if he is still paying benefits for you to have benefits then good on him for being a good provider. Too bad you haven't been taking advantage of the benefits he's paying for, could have been saving money all this time.

I have made the claim solely to MY insurance and I have been reimbursed solely by MY insurance company........Im not trying to make waves for him but the cat is out of the bag so to speak and now I have to fix it
this is not a situation where one insurance pays x amount and the other makes up the difference

Sounds like what happened was the dentist had his insurance info on file, he never took it off, then you provided them with yours and they went ahead and submitted it to both companies as they normally would. Neither company was made aware there was another policy that came into play and that it should be processed through both and the differences applied.

I DID NOT KNOW TIL YESTERDAY THAT HE WAS ALSO RECEIVING REFUNDS FOR SAME THING I WAS......I CALLED HIS INSURANCE TO TELL THEM TO STOP PAYMENT ON THE LAST CHEQUE AND GAVE THEM THE REASON WHY......

Yelling is rude. You also have no right to call his insurance company and make any demands for payment - for yourself or him. Let him sort out his own issues with them. Are you really so worked up because he recieved a few extra bucks that you feel he wasn't entitled to? It's quite possible that he gets his refunds direct deposited into his account and didn't even notice them. You're jumping to a LOT of conclusions in accusing him of cashing in on your refunds. Perhaps you should talk to him about it

how is that trying to cause trouble for anyone
I was the honest one and didnt think about ramifications to him til afterwards.

Common sense dictates that if it's not YOUR insurance company then you don't call them. Most people also have enough common sense to call and make anonymous inquiries about such things with insurance companies knowing that they can and quite often do flag your account as suspicious and can even hike your rates for simply asking questions.

I

do not talk to my ex whereas it is easier on our child if we keep our distance
so telling him is NOT an option....

Which explains a lot of the communication issues.

--there is no double dipping by dentist when visit is paid for up front then submitted to insurance on my own - I receive my money back and the ex receives money back for an appointment that he didnt pay for nor did he even KNOW about

How exactly is it you came to know for sure that he is even recieving anything from his insurance company at all? For soeone who doesn't communicate with him you seem to know an awful lot about his affairs, either that or you have a very small amount of information and are jumping to a lot of conclusions without being fully informed.

 

[rustedinnocence]

I have not read all the posts so perhaps this is already answered correctly...

I work within the insurance industry.... the law in Ontario is as follows:

1 - IF the parents of the children live together and both have insurance on the child, the parent with the birthdate earliest in the year is the primary insurance holder and submits the claim..... then the parent with the later birthday holds the secondary insurance and submits for the balance of the bill that the was not covered by the primary insurance holder.

2 - IF the parents are seperated, it has nothing to do with birthdays. The primary insurance would be the parent with which the child lives or spends more than 50% of their time with. Then submission of the unpaid portion of the claim then falls to the secondary insurance holder which would be the parent that does not live with the child. (50-50 joint custody would revert back to rule #1 above).

3 - IF the parents are seperated and the child lives with a parent that is remarried or has a partner that has put the child on their benefits as well, then the claim gets submitted as follows.
1- The plan of the parent with custody of the child
2- The plan of the spouse of the parent with custody of the child
3- The plan of the parent without custody of the child
4- The plan of the spouse of the parent without custody of the child

So from what I have read in your post...if it was completely paid out twice, there has been an error somewhere. Maybe his insurance company still has him set up as the primary payor.... and since you have seperated your insurance company has you as the primary payor.... either way, it is insurance fraud to have TWO companies being the primary payor... your dental office should have caught that.
No harm no foul if it was an error along the way... they will readjust the payout order...
But you need to let the dentist know you are seperated so you lawfully are the primary insurance holder and your ex is the secondary.... the dental office will seti it up correctly for the claims... something is definately not set up properly.... You SHOULD recieve the main claim portion back and your ex will recieve all amounts remaining uncovered by your primary insurance... good luck getting the secondary cheques from him... (maybe you could work something out with your dental office that you pay them what your insurance company would pay you, and then the remainder that your ex's insurance will cover can be directly mailed to the dentist office....

 

[KeepSmiling]

Hi - I have a question ....

How were the claims submitted to YOUR insurance company? Did the dentist electronically submit it at the end of your appointment? Or, did you mail it in to them with the paid receipt after the appointment?

And ... Is your ex getting re-imbursed for your dental appointments too?

Just curious really, cause it isn't your problem. You have already informed ex's insurance carrier, so can't undo that, and the dentist now aware of the situation and won't be doing it again. Stay out of it now.

 

[littleman]

i started this reply with the defensive notion howeer I feel its of no use.
Facts remain the same.
I pay for my childs appointment - I electronically submit to my insurance - I receive my refund electronically
noticed that my ex was also receiving a refund cheque for the amount I paid for the dental appointment
I jumped the gun and called his insurance company and regret doing so
I do not talk to my ex whereas there are bigger issues than him just receiving extra money in his pocket for something I paid for - issues that have no business being on here - I may have bad feeling with him but Im not into slandering anyone
I have since talked to my insurance company and his and sent him an email with the situation and HIS insurance company has eased my mind by letting me know that he will not be charged with anything and the easiest thing to resolve this situation is he has to pay the moeny back that he received in error

blinkandimgone - just as an aside I was well within my rights to call his insurance and they didnt do anything wrong by talking to me whereas I stated before my name was still on the insurance ......it has subsequently been removed whereas we are divorced and that will lower his payments - so maybe I was wrong by putting money (all be it about 3$ a month) back in his pocket but I guess in your world

 

[blinkandimgone]

You've no right to make changes to his insurance policy, and the insurance company should NOT be speaking to you about it because it isn't your policy, it's his - especially if it comes from his paycheck. Regardless of whether or not you're divorced, many people maintain insurance for their former spouses - for some it's even a condition of their seperation agreement so the fact that you're divorced is - again - irrelevant.

You still have not said how you came to know for sure that he is recieving any type of reimbursement from the insurance company for your appointments? Earlier you said the dentist submitted the claims but now you say you submit them electronically. Do you have access to his bank accounts or mail to know that he is recieving these reimbursements?

You need to stop sticking your nose into his business and interfering with his insurance company. Stop calling, emailing and writing them, own up to your interference so that he doesn't get any suprises and stop messing around in his financial affairs.