Additional Health Insurance

[difficult3]

What is the name of your state? Missouri/Pennsylvania

My fiance and I live in Pennsylvania and through PA courts he was ordered to carry health insurance for his two kids who live in Missouri. We now suspect that his ex-wife has put the kid's under her new husband's insurance. (The kids' have gone to the doctor...yet there have been no claims)

1. Can she do this? Can anyone have two health insurance plans?
2. Is there anyway we can find out? Of course...she won't cooperate. She hides information form him all the time.

 

[cbg]

1.) It is perfectly legal to have two health plans and many people do it. It is not, however, always cost efficient. Contrary to what many people believe, the second policy is not necessarily going to automatically pick up anything that the first policy doesn't cover as they think. The second policy will look at the claim, and determine how much they would have paid IF they had been the primary carrier. If there's a difference, they'll pay it. For example, if the claim is for $100 and the primary carrier paid $80 and the secondary carrier WOULD HAVE, if primary, paid $90, they'll pay $10. But if they only would have paid $70, they won't pay anything at all.

So if she has put them on her new husband's plan, she's not violated any laws.

2.) Unless she chooses to tell you, it might be difficult. There's no data base you can look up and see if they're listed. IF she sends you any claims to submit, the insurance carrier will ask if there's any other coverage through the other parent, and you might find out that way.

 

[difficult3]

So how would one policy know if they are primary or not? That's how I figure she's getting away with it.

She's just screwing him by making him pay for insurance that she's not using. Just as she's still taking daycare money and pulled the kid's out of daycare. (We need to do a modification of child support over this)

Can we ask our current insurance company to search for additional coverage? Do they have that ability?

 

[cbg]

In the majority of cases, primary coverage goes by the "birthday rule". The parent who has the birthday earlier in the year, is primary for the kids. If both parents are covered on both policies, the husband's is primary for him and the wife's is primary for her. Very occasionally the policy that was in force first is primary, but at least in my part of the country that is very much the exception rather than the rule.

I understand your frustration and I understand what you say she is doing. But there still is no way you can search for another policy. Neither can your insurance company. There IS no data base that lists all the insurance policies and who is listed on them. Your insurance company doesn't have that ability either.

The only thing I can tell you is that if she is telling her insurance carrier that there is no other coverage, and they later find out that other coverage exists, she/they can be prosecuted fpr fraud. He can lose his job and have COBRA denied him.

Is it possible that you haven't received any bills because there haven't been any claims?

 

[difficult3]

It's possible. But not likely. This is totally something she would do. Unfortunately it is part of an ugly divorce.

That fraud thing is interesting. So...her new hubby would be legally obligated to list the insurance for the kids that my fiance is carrying? Can he also insure the children if he is only the stepfather?

 

[cbg]

Yes, he may legally list his stepchildren on his policy assuming that his policy considers stepchildren as eligible dependent. Most policies do.

IF HE IS ASKED whether or not other coverage exists, he is required to provide the information. He does not need to volunteer the information if he is not asked.

I will be extremely surprised, if he is not asked. But nonetheless, he only needs to inform his plan that other coverage exists, if they ask him.

 

[Subandera]

regarding a statement in a reply...

there was a reply to this question that stated "The only thing I can tell you is that if she is telling her insurance carrier that there is no other coverage, and they later find out that other coverage exists, she/they can be prosecuted fpr fraud. He can lose his job and have COBRA denied him"

I also am having to try to work with an ex. We have 3 kids. I carry the insurance on them. I do not know 100% if my ex has coverage on them also. I periodically get forms from my insurance co asking if there is any other insurance. To this question I reply not to my knowledge but I do not know if my ex has coverage on them. Is that an appropriate reply and IF he has coverage that will keep me out of trouble correct? I honestly do not know if he does or not, and i certainly am not attempting to defraud anyone

 

[cbg]

If you were covered by the company I used to work for and you answered the way you suggest, we would have said, thank you very much; how can we contact your ex to ask him? You would have given a perfectly appropriate answer and you would not have been held responsible if it turns out that he did. I imagine most companies would handle it the same way.

 

[ablessin]

court order

Yes, they usually say whichever paretn's birthday falls first in the year (month) that insurance is primary.



It's probably not financially feasable for the mom to cover the kids...... unless they frequent the doctors office and there are a lot of copay's due.



Chances are eventually one will find out about the other and someone will investigate..... you can call them......... to give them the heads up - I call when both pay (resulting in overpayment) and sometimes one doesn't know about the other, but with my "lead" they send letters to the subscriber to get the COB issue corrected.

 

[ablessin]

missed a sentence

Somehow I deleted half my post when I submitted it.

Part of it said that when there is a court order, that ALWAYS supercedes the birthday rule issue.

So, if dad is ordered to cover the kids, no matter whose birthday is first, HIS policy would be primary to moms.

As far as her covering them - feasable - if they don't frequent the doctor a lot, she's paying more in premiums that is probably worth it.

But hell, it's her $$ let her blow it

 

[cbg]

First of all, I said, in the majority of cases. Nowhere did I say that the birthday rule supercedes a court order.

Secondly, it is not necessarily true that the coverage on court-ordered insurance would ALWAYS be primary. It would depend on how the court order is worded.

 

[ablessin]

I know you didn't say that a court order didn't supercede a court rule.

I have seen plenty of cases of court orders and the other parent hold insurance also, and in 100% of the cases the court order is always first.....
and they have been worded slightly different.
Unless the court order specifically says both parents have to cover the kids - but usually that case the court falls back on the b-day rule of who is primary.

I work closely with people in COB departments of various carriers so I feel comfortable with my answer.
When I am not sure I say so. I feel confident.... I also read a lot of posts from you, cbg - I feel that you're respected and trusted..... and I know a lot we differ in what we think.

 

[cbg]

And I have been working with health insurance policies and employer-sponsored group benefits my entire working life - 25 years.

You yourself say, "Unless the court order specifically says both parents have to cover the kids - but usually that case the court falls back on the b-day rule of who is primary." " which means you recognize that a court order is not necessarily going to dictate the primary or secondary level of a coverage. In other words, now that your mistake has been pointed out, you're backtracking to cover yourself.

You may feel comfortable with your answer, but that doesn't make it correct.

 

[somarco]

Birthday rules and court orders aside, some group plans refuse to cover dependents of a non-custodial parent, especially if they do not live in the home of the covered plan participant.

 

[ablessin]

what I meant was if the court order says both parents have to cover the kids, it would most likely be the birthday rule to determine 1st and 2nd payer - although I have seen court orders say the fathers is primary to the mothers - even if the mom's birthday is first in the year.

It can work either way, and I am not backtracking to cover myself. The majority of the cases I have seen have been a court order for one parent and that is the primary carrier..... the other parent can cover if he/she chooses to and they are second.

The only times I have seen a court order for both parents to cover is when the child has a chronic illness, such as diabetes or renal failure because there are generally a lot of doctors visits and hospitalizations in cases like those.

I too, have been in the health care industry a long time and I have taken classes and I attend numerous seminars directed by the payers and that is the information discussed from the COB department..... they discuss that issue for offices who run into two insurances for patients in effort to help the offices determine what carrier should be billed first.