when he keeps the insurance reimbursement.....

K

KoratCat

New member
I have a question maybe someone can help with.

My child's dental surgery cost $2500, and I paid this on the credit card.
I submitted to my insurance, and got $1200 back.
As per the agreement, STBX submitted the invoice to his insurance.
I have texted him asking if the insurance has paid, how much and when I am going to be given it to pay for the credit card bill?
He has denied receiving anything.
I called the insurance, and was informed that $500 was deposited in his account mid November ( almost a month ago).
I texted him and told him I know he was paid, how much he was paid,when he was paid , and that I need it to pay the credit card bill.
He has ignored me.
My lawyer is well aware, and will contact his lawyer.
We go to trial in the fall, and it just amazes me he would do something like this when it can be used against him.
He is dishonest and a thief.
I am sure there is a way to have his insurance company deal directly with me...
does anyone know anything about this?
Thanks
 
OP....What exactly is the question you are posing to the forum?

In order to better answer any question you might have regarding this dental matter, it might help if you provided a bit more detail on top of what you already posted. For example...

1. What is the access / custody arrangement?
2. Does the dental office have both parents names on their system?

This obviously is a Special Expense under the Child Support Guidelines. Did
you and the other parent ever agree on how to divide payment for special expenses?


To use my own personal case as an example...our child had a dental appointment 2 months ago, and although it was not on my day, the dental office already gave us (both parents) an estimate of the fee for the procedure, and sent the quote off to my (first on the list, then ex) insurance company, who later sent me a letter to notify me of the deductible.

On the day of the procedure, I went in after work to pay the dental office, and a week later I got a cheque from the insurance company.
 
I have custody..the child is 17.
Both parents are on file at the dental office..
we are to divide the extraordinary expenses 50 50.

we have to submit to my insurance company first as my month of birth is first..then he submits the claim after mine has paid ( he has to include an explanation of my benefits to his company).

His insurance company direct deposits into his account the amount that they reimburse.

I have no access to this money..and have to rely on the STBX being honest and handing over the money ( which I have already spent on my credit card).

I know he received money..and is ignoring my texts .

He has kept money that the insurance company paid as his own..like some free money.

Maybe I don't have a question, and maybe I am just venting.

Something is wrong with the STBX when my lawyer has to send a Letter of Demand to his lawyer regarding this.

There has to be some other kind of arrangement with the insurance company so that this does not happen again and again...STBX keeping money that is not his.

Curious to know if anyone has such arrangement, to avoid being ripped off.
 
You're lucky you are already going to court. Just have your lawyer add it to the file.

Once you get out of court with an order, he will do the same thing. Then you will be in a position where you have to decide whether to go to court for $500. My ex pulls stuff like this all the time.
 
KoratCat said:
I called the insurance, and was informed that $500 was deposited in his account mid November ( almost a month ago).
Click to expand...

Is it just me or does anyone else think it's strange that his insurance company gave her information? What about the Privacy Act? I'd be a tad upset if my ex could call my insurance company and find out if/when money was deposited into my account.
 
I know that I called exs insurance once and all they told me (claim was for me personally) that they received the paperwork and the check had been mailed. They didn't tell me when or what amount.
 
arabian said:
Is it just me or does anyone else think it's strange that his insurance company gave her information? What about the Privacy Act? I'd be a tad upset if my ex could call my insurance company and find out if/when money was deposited into my account.
Click to expand...

You can see why I asked for more details in my previous post.....This supposedly issue can be easily resolved with better communication. Op said she has sole custody(?), but their section 7 and special expenses are 50/50 (?)

She followed up in another post saying this "Maybe I don't have a question, and maybe I am just venting."

I know if my EX called my extended health insurance company that is there for our son, she will be told to get me to call instead. Reason....her name is not on file.
 
I had money deposited into my bank from MEP. The amount was an odd amount so I contacted MEP to ask them where the money came from. To this day they absolutely refuse to give me any information. I was just told that their job is to collect money for me and that, due to the Privacy Act, they can't disclose the source of the money.
 
My ex does stuff like this all the time without consequence. His insurance company disclosed nothing to me. He also refuses to pay service providers directly when he has agreed to the expense and they Bill his portion directly. The only mitigating thing I have been able to do is to reverse the order that our benefits are applied (his birth month comes before mine) for one of our two kids. For some reason that ex would not help rectify, his insurance would deny the one kid thus sticking me with a big bill every month for meds that otherwise would be fully covered.

Unfortunately my lawyer/the legal system was no help for me.
 
I think the access/custody is irrelevant to this issue, and it also doesn't matter what names the dental office has on file.

She took the kid to the dentist, and the bill was $2500. She paid it in its entirety since she was the parent there. She submitted it to her insurance first based on birth date and was reimbursed $1200. The remaining $1300 went to his insurance and he was reimbursed $500. So the parents are out of pocket only $800 after both insurance plans, which should be divided $400 to her and $400 to him as they share these expenses 50-50. Presumably their incomes are similar, or this is the ratio that was agreed on for whatever reason.

Except that he kept his $500 refund and she is still out $1300 for the dental bill. So he owes her $900 and is refusing to pay it. Depending on her financial situation, she may not even be able to pay the credit card bill and is accumulating interest.

Fortunately, they have court coming up, and she can address this $900 owing to her there, and hopefully get a system in place to avoid this behaviour from him in the future. So the question for the forum is what is the best way to get this money from him, and prevent future similar shenanigans?

As far as I know, insurance only pays out to the person who has the benefit, not the person who incurs the expense. Even if they DID pay you, you would still have to figure out how to get the remaining $400 from your ex. I think all you can do is hope that your ex pays some expenses and asks for reimbursement from you, then you can deduct what he owes you when you settle up.
 
If this has been going on for sometime, are you able to estimate the yearly amount you spend on Section 7 expenses? If so, at your next court date, ask the Judge to award a monthly amount for Section 7, that way it can be enforced by FRO.

However, I am pretty sure you can get his benefits to pay you directly. This happens with my partner and his ex. His ex is able to submit right to the insurance company and it all gets covered. Now it may be different as this has been for dental and between the two of them it has been 100% covered, however I am certain there was at least one poster on here who mentioned they were able to get their ex's insurance company to reimburse them directly.

Do most dental offices not submit their bills to the insurance companies and get reimbursed automatically? I know everyone we have dealt with, was able to submit a quote, so we would know if we would owe any money and when the bill came, the office submitted it right to the insurance company?
 
Do most dental offices not submit their bills to the insurance companies and get reimbursed automatically?
Click to expand...
Hence my question about the names the dental office has on file (which can be used to send claim to insurance company(ies).... Apparently not....I have had two dental offices in the past in two different cities bill the insurance company directly, as opposed to asking you to pay upfront.

I know some offices just want their money right away, instead of dealing with 3rd parties
 
arabian said:
Is it just me or does anyone else think it's strange that his insurance company gave her information? What about the Privacy Act? I'd be a tad upset if my ex could call my insurance company and find out if/when money was deposited into my account.
Click to expand...

You would not have information about the ex's claims made for himself, however because the claim is made for a minor child, and the insurance company is aware of both parents, either parent can inquire and expect information.

FWB said:
You can see why I asked for more details in my previous post.....This supposedly issue can be easily resolved with better communication. Op said she has sole custody(?), but their section 7 and special expenses are 50/50 (?)

They may have made their own agreement, away from the guidelines, or the child may have made the decision to live solely with one parent, as they can do at that age. Either way, it's really not relevant to the question at hand.

As for dental offices billing directly to the insurance company, it's my understanding through my own experiences dealing with special expenses through OHIP and a few other insurance companies, that many dental offices will no longer direct bill certain companies (Like OHIP, and one of the previous HC providers for the federal gov) because it is too hard and too long to collect.

It may be possible to have the dental office split the bill and send an invoice to each parent, that way they can submit their own and not have to worry about collecting from the other parent.
Click to expand...
 
I know with my dental I have to pay up front and then they submit it electronically so I have my money within 3 days. Then I have to fill out the paperwork for the COB and mail that in myself.
 
@Rioe thanks..you understand completely.

I have to pay the dental bill upfront. The dentist does not submit directly to the insurance companies.

His insurance company provides information, as I am named on the policy. However, the reimbursement is paid only to his account.
No privacy violations.

@Blinkandimgone...exactly. The child made the decision to remain with me..
extraordinary expenses are supposed to be shared..
 
I actually can say I feel for you , understand your plight and legally there is a solution. To those who believe there is a privacy concern - I can only say this:

This is just a copy/paste of the last paragraph to allow you to see where this post is headed:
The end - Your ex's benefits provider will now put your name directly into the plan in as much that all issues dealing with you will allow the insurer to contact you direct and expect any shortfalls in any service provided to you; it will also permit them to reimburse direct to you, cheques in your name, mailed direct to home thus bypassing your ex 100%.

THE POST:
My ex is "beside herself" in how I manage to keep on getting this sort of info, that I know and understand her entire work benefit plan from her pension to the dentist to everything between. She won't help/ disclose so it left me no choice but to make the effort on my own behalf as the spouse of a "crazy woman". All employer benefit providers have experienced every compilation of BS from their employees and in the end..... they get tired of the BS stupidity just as much as we are!!!!

1. For ease of understanding the following: let us assume your ex is crazy, vindictive, wants to cause you as much pain as they are able now that the hold they once had over you is being stripped away (Thank God!!)

2. you are a named beneficiary to the benefits (otherwise they would not cover squat, if you are not but your child is, then you become the official guardian in the eyes of the benefit provider so without requiring any real proof - I would lay a guess in their paperwork you are named as the spouse at one time or another and the benefits provider is assuming #1 at this point as well.

3. I have found that the benefits person on the other side of the phone is generally sympathetic to the victim (you) and (please refer to #1)

4. I clearly state each time I am the Stbx, that my circumstance has left me with no other recourse than to get the info I seek help and I have never been refused. When I asked for help to understand how to do "????" or a way around "????" the benefit provider person has , at least in my case, gone way over their mandate every single time I politely asked for help.

As a good example of this: (her pension provider actually helped me understand the technical steps in how her first pension dollar amounts were determined from a different employer back in the 1980's and 90's - including the split before we married (belongs to my ex 100%) and the value of during the marriage using the methods laid out in the paperwork of that pension provider (my ex gave it all to me at the onset - may be stupid now that I know what I know today but my ex just said she didn't understand all this gobblyguck one bit when it came to creating our net family property - and eventual equalization payment that would need to happen "one day".

So direct to the OP's inquiry!!! And to solve it 100%
I assume you are still covered under your ex's benefit plan? Like myself her provider explained to me that with a simple request and judicial endorsement for your ex to provide your full benefits by signing the request to have your name entered into your ex's benefit plan - signed by your ex right then and there in front of the judge, while still in the courtroom not later.

(call your ex's provider in advance and request in writing to you if possible exactly what they will require on this document - you shall use this to pre-prepare the document with a place to have your ex sign and a place for the court to stamp it's endorsement right then and there. This must be done before your session is ended because once the judge leaves the room - your ex will not sign squat.)

This document signed by your ex (your ex could just write a simple request on his own but I have a feeling, just like my ex which garbage can it will all end up in!!). The document basically is wording the request to his benefits provider (make sure you identify them all as my ex has three separate providers and they each must be named specifically). The judge's endorsement stamped "by the family court" now provides the benefits provider the legal back up they must have to side step your ex.

The end - Your ex's benefits provider will now put your name directly into the plan in as much that all issues dealing with you will allow the insurer to contact you direct and expect any shortfalls in any service provided to you; it will also permit them to reimburse direct to you, cheques in your name, mailed direct to home thus bypassing your ex 100%.

Your ex is doing this to maintain the hold on you, to keep on or in control over you and lastly the assumption of causing you as much heart ache and pain and financial hardship for your no longer accepting the crap that has been dished to you for how many years????
 
^great advice^

I took a quick look at some of the major insurance company websites to see if they had a standardized form and I didn't see any (which would be useful for those who want to see the claim payment history as well as be able to file/receive reimbursement directly).

I agree that having forms signed in the presence of a judge is excellent.
 
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