Medical Insurance and going to a non-provider

[mbensoni]

What is the name of your state? Minnesota

I am the step parent providing medical/dental/vision for my step daughter. My insurance is better than her fathers and therefore the state allowed me to put her on my plans.

Here is my question - the dental plan is a bit messed up. She is covered but the closest dentist in the network is 20 minutes from her dad and I and a good 55 minutes from the mother. The mother is the custodial parent. Yesterday - the mother calls the father and wants my social security number as she was bringing her daughter to the dentist in the town where we live....long story short - I called to speak to her informing her that the person she was going to see was not in the network. I told her that her daughter is covered but only when using the dentist in the network.... Mom said I will not traumatize my daughter by bringing my daughter to someone she does not know.... The person who cleaned her daughters teeth is a friend of the mother apparently. SO - I am wondering - since she took her daughter to someone who is not a provider for my insurance - does this constitute a medical expense that should be reimbursed to the mother. I am under the understanding that since she choose not to go to the provider than she is on her own for paying that cost. Am I correct? Her dad told the mother he would take his daughter to the dentist that was 20 minutes away from him if she would just ask and would want him to. She claims she does not want a stranger looking at her daughters teeth.

The child support order states that both parents pay 50% of non covered expenses - BUT - there would never have been a non covered expense as my insurance covers 100% of the visit with no co-pay.

Please help. Am I wrong for being upset that she expects him to pay for the uncovered dental visit?

Thank you.

 

[Gracie3787]

What is the name of your state? Minnesota

I am the step parent providing medical/dental/vision for my step daughter. My insurance is better than her fathers and therefore the state allowed me to put her on my plans.

Here is my question - the dental plan is a bit messed up. She is covered but the closest dentist in the network is 20 minutes from her dad and I and a good 55 minutes from the mother. The mother is the custodial parent. Yesterday - the mother calls the father and wants my social security number as she was bringing her daughter to the dentist in the town where we live....long story short - I called to speak to her informing her that the person she was going to see was not in the network. I told her that her daughter is covered but only when using the dentist in the network.... Mom said I will not traumatize my daughter by bringing my daughter to someone she does not know.... The person who cleaned her daughters teeth is a friend of the mother apparently. SO - I am wondering - since she took her daughter to someone who is not a provider for my insurance - does this constitute a medical expense that should be reimbursed to the mother. I am under the understanding that since she choose not to go to the provider than she is on her own for paying that cost. Am I correct? Her dad told the mother he would take his daughter to the dentist that was 20 minutes away from him if she would just ask and would want him to. She claims she does not want a stranger looking at her daughters teeth.

The child support order states that both parents pay 50% of non covered expenses - BUT - there would never have been a non covered expense as my insurance covers 100% of the visit with no co-pay.

Please help. Am I wrong for being upset that she expects him to pay for the uncovered dental visit?

Thank you.

I may be wrong about this, if so hopefully someone will correct me. I believe that if the CP (or NCP for that matter) CHOOSES to take the child to a Dr. , dentist, etc. that isn't a covered provider, that parent is responsible for the expense (as long as it wasn't an emergency situation). This is what a friend was told in a similar situation.

I don't think that teeth cleaning is considered an emergency situation, so there may not be any problem.

It sounds like the mother is just being a pain in the a$$, with her attitude of not wanting a stranger to look at her daughter's teeth. My God, what would this woman do if her daughter were playing sports and got hit in the mouth- would she say- oh wait, don't take her to the ER, I don't want a stranger looking at her mouth? LOL

The situation may be different however, if that dentist is the ONLY dentist that your step-daughter has CONSISTANTLY gone to (regular check-ups, etc). In a case like that, your husband may have to pay half.

 

[mbensoni]

I may be wrong about this, if so hopefully someone will correct me. I believe that if the CP (or NCP for that matter) CHOOSES to take the child to a Dr. , dentist, etc. that isn't a covered provider, that parent is responsible for the expense (as long as it wasn't an emergency situation). This is what a friend was told in a similar situation.

I don't think that teeth cleaning is considered an emergency situation, so there may not be any problem.

It sounds like the mother is just being a pain in the a$$, with her attitude of not wanting a stranger to look at her daughter's teeth. My God, what would this woman do if her daughter were playing sports and got hit in the mouth- would she say- oh wait, don't take her to the ER, I don't want a stranger looking at her mouth? LOL

The situation may be different however, if that dentist is the ONLY dentist that your step-daughter has CONSISTANTLY gone to (regular check-ups, etc). In a case like that, your husband may have to pay half.

Thank you! - I just didn't to think I was being anal about it - and it was the child's first dental appointment. She's four.

 

[NotSoNew]

if she chooses to go out of network and coverage is available to her, she will be responsible for the costs.

 

[LdiJ]

if she chooses to go out of network and coverage is available to her, she will be responsible for the costs.

The only thing that might throw that off is the fact that the closest dentist to mom's area (that accepts the insurance) is an hour away from mom. I judge might find that distance to be far enough to not be reasonable. In that case, dad might have to pay half.

 

[nextwife]

The only thing that might throw that off is the fact that the closest dentist to mom's area (that accepts the insurance) is an hour away from mom. I judge might find that distance to be far enough to not be reasonable. In that case, dad might have to pay half.

It might also be responisble to ask FIRST ask Dad to make an arrangment to take daughter to the dentist near him when he has daughter, as it IS NOT an emergancy. Maybe dad was perfectly happy to take daughter to dentist himself- and the distance would not have ben a problem for mom?

FIRST the option of having the child see an in-network provider should be eliminated BEFORE mom decides to go to one OUTSIDE network. She never even inquired whether dad would take daughter to the in-network provider close to him that he could easily access.

I have an eight year old. She has seen many new providers over the years for eyes, ears, what-all. Her pediatrician retired after a stroke, so she had a new pediatrician, his colleague, who then himself left private practice to teach. So she had yet another pediatrician. Big deal, so she saw a new doctor, and a different dentist when I changed employers - and my plan changed to a different insurer. There is nothing "traumatic" about seeing a different provider, people do it all the time.