medical insurance

[luckymom]

Under my orders, my daughter is on my ex's insurance. It is a ppo and we divide uncovered expenses. Ex is supposed to provide me with insurance card and insurance information. My daughter has been seeing an out of network therapist, and I have been paying all of the uncovered portion. Ex was aware of this and has spoken with the therapist. Today, I contacted the insurance company because I had not received a reimbursement for the covered portion of visits from May and was told that since the deductable had jumped from 500 to 5000, no reimbursement would be forthcoming. I was NEVER informed of this change by me ex. His wife heads the company he works for and therefore according to insurance person would certainly have been informed.

Do I have any recourse here? I believe that ex is clearly in contempt of the order for not keeping me informed about changes in the insurance.

 

[fedupinIL]

I think the only way he would be held in contempt is if he wasn't carrying the insurance on her as was court ordered.

 

[SingleMom67]

It really depends on what the original order says. If the order doesn't specially address changes to existing medical coverage, then no, it wouldn't be contempt.

 

[GrowUp!]

Under my orders, my daughter is on my ex's insurance. It is a ppo and we divide uncovered expenses. Ex is supposed to provide me with insurance card and insurance information. My daughter has been seeing an out of network therapist, and I have been paying all of the uncovered portion. Ex was aware of this and has spoken with the therapist.

Quite honestly, you SHOULD be paying all of the uncovered expenses. I certainly wouldn't reimburse you. Why are you going to an out-of-network provider? You mean to tell me that there isn't an in-network provider within a 50-mile radius?

Today, I contacted the insurance company because I had not received a reimbursement for the covered portion of visits from May and was told that since the deductable had jumped from 500 to 5000, no reimbursement would be forthcoming. I was NEVER informed of this change by me ex.

And does this have anything to do with the fact that you are going to an out-of-network provider? Might it have been different if you were using an in-network provider (probably)? There's plenty of reasons why they are out-of-network.

 

[LdiJ]

Quite honestly, you SHOULD be paying all of the uncovered expenses. I certainly wouldn't reimburse you. Why are you going to an out-of-network provider? You mean to tell me that there isn't an in-network provider within a 50-mile radius?


And does this have anything to do with the fact that you are going to an out-of-network provider? Might it have been different if you were using an in-network provider (probably)? There's plenty of reasons why they are out-of-network.

You might be wrong here....many insurance plans don't have network providers that are not local....or even don't provide coverage at all outside of a local geographic area.

 

[nextwife]

And if THAT'S the case, CP really should be carrying the child's health insurance, rather than NC. It makes no sense to require NCP to carry insurance if their health plan has limited coverage and the NCP and CP don't live near each other.

 

[MrsK]

So do these things still stand (these are from other posts you have made...) ?


>>Since then I have kept paying for my daughter's insurance on my policy since the benefits are far better.

>>In any case, the new wrinkle, is that his insurance rejected the claim outright. It won't pay for any speech therapy unless the problem involved results from 1)brain injury or stroke resulting in aphasia, etc. 2) speech difficult relating to congenital birth defect such as cleft palate or the like. The good news is that my policy pays for 80%. I knew there was a reason why I was paying for the extra coverage.

>>Our court order states that I should use in network providers when possible and if I go out of network without good reason, ex doesn't have to pay. Non PPO coverage is 75% after the deductable, which works out to about $15 each per session.

And, did you ever call the insurance company & explain to them that it is either too hard to find an in network provider, or even impossible and see if they would cover someone in your area?

 

[MrsK]

And if THAT'S the case, CP really should be carrying the child's health insurance, rather than NC. It makes no sense to require NCP to carry insurance if their health plan has limited coverage and the NCP and CP don't live near each other.

Apparently CP *was* (and maybe still is?) carrying insurance on the child in her area.

https://forum.freeadvice.com/showthread.php?t=177009

If she isnt, I dont see why. That is downright dumb to be paying 100% rather than carrying her own insurance that would cover portions of it.

 

[nextwife]

How old is the child? We were very proactive with our daughter and obtained speech and other therapy services through the Birth to Three and Early Intervention programs available in most counties throughout the US. There was NO COST for much of it. And our daughter arrived severely speech and moderately hearing impaired (at 25 months she had NO language development and, being way past the babbling stage, had to be manually taught the speech production process. At nine her speech is now indistinguishable from her peers). Have you thoroughly checked out therapy provider options? These costs may not be necessary to obtain the needed services. What is the cause of the speech problems?

Additionally, if there is any universities nearby with a Speech Path program, they often offer clinics.

 

[MrsK]

Under my orders, my daughter is on my ex's insurance. It is a ppo and we divide uncovered expenses. Ex is supposed to provide me with insurance card and insurance information. My daughter has been seeing an out of network therapist, and I have been paying all of the uncovered portion. Ex was aware of this and has spoken with the therapist. Today, I contacted the insurance company because I had not received a reimbursement for the covered portion of visits from May and was told that since the deductable had jumped from 500 to 5000, no reimbursement would be forthcoming. I was NEVER informed of this change by me ex. His wife heads the company he works for and therefore according to insurance person would certainly have been informed.

Do I have any recourse here? I believe that ex is clearly in contempt of the order for not keeping me informed about changes in the insurance.

One more thing, OP.

Why does it matter if it is contempt? Do you plan on filing charges? Then what? Maybe it'll go back to court, at which point your ex could EASILY argue that since you cant find providers who accept that insurance, that YOU should carry the insurance, OR that you should carry additional coverage (like you were, and maybe still are...) and after YOUR insurance pays, then uncovered costs will be split. I imagine the judge will think its RIDICULOUS that you wouldnt get some coverage to help with these costs, rather than use a OONP and then expect your ex to cover 50% of that, esp if your order apparently states (according to your own posts...) that your order says if you dont use an INP, YOU must pay the costs.

Honestly, from reading all your posts, you sound like you are just trying to find a way to be controlling & stick it to your ex.

First you want him to pay 50% of uncovered medical expenses even though you have another insurance and think that the benefits of the secondary coverage should only benefit YOU (heaven forbid you be fair...), then you are bitching about how he put her on a late night flight because the one she was supposed to be on got cancelled (like that was his fault or something...), then you arent happy b/c he isnt taking his 6 wks in the summer all at one time (never mind that YOU moved her away from her father, gee, thats fair to him and your daughter...only getting to see each other once a month...nice), then you are mad b/c he wont take her to the dentist while he has her, even though since she is with you the large majority of the time (a direct quote from your post : And I don't think it is fair to say that if you get more time, that means you have to do the "grunt" work of parenting.), then you are bitching that b/c of his SIX WEEKS in the summer (hello, lady, YOU moved her away from her father...) dont allow for your THREE weeks per the order but ummm you have her the rest of the year, but heaven forbid you worry abour your child spending time with her father because THEN you move her out of the country temporarily...

And in between all of that, you've been bitching LOTS AND LOTS about the insurance, and SURPRISE, here you are again...

Christ on a cracker. WTF is with you????

 

[MrsK]

How old is the child? We were very proactive with our daughter and obtained speech and other therapy services through the Birth to Three and Early Intervention programs available in most counties throughout the US. There was NO COST for much of it. And our daughter arrived severely speech and moderately hearing impaired (at 25 months she had NO language development and, being way past the babbling stage, had to be manually taught the speech production process. At nine her speech is now indistinguishable from her peers). Have you thoroughly checked out therapy provider options? These costs may not be necessary to obtain the needed services. What is the cause of the speech problems?

Additionally, if there is any universities nearby with a Speech Path program, they often offer clinics.

Pretty sure you suggested this to her in yet another thread she made about this, NW. She had lots and lots of excuses as to why all the very good suggestions ppl made for her wouldnt work.

 

[GrowUp!]

You might be wrong here....many insurance plans don't have network providers that are not local....or even don't provide coverage at all outside of a local geographic area.

Unless you're living in a suburb of BFE, then bull. I am still waiting for the OP to answer the question.

 

[LdiJ]

Unless you're living in a suburb of BFE, then bull. I am still waiting for the OP to answer the question.

Its not bull at all GrowUp. Do some research before you call something "bull". There are MANY employer plans out there that do not provide for network coverage outside of their local area or region.

 

[haiku]

Unless you're living in a suburb of BFE, then bull. I am still waiting for the OP to answer the question.

It is true....my husbands kids really do live in BFE LOL, and thier mother has to provide the coverage because we cannot.

 

[MrsK]

Unless you're living in a suburb of BFE, then bull. I am still waiting for the OP to answer the question.

Actually, it can be true. Not usually as often, but it can be true.

But mom couldve solved this a few ways...

a) not moved her kid away from dad a bunch of times, across the country and then OUT of the country no less

b) kept insurance for kid through her employer so she wasnt paying high OOP expenses for non covered therapy. its just that simple. and if she does still have that coverage, then she is an idiot...because she should be using it.