Medical Bills / Problems spliting half

[heather2662]

Illinois Residence

Divorce was final Oct. 2003.

Marital Settlement Agreement states:
Wife shall maintain on behalf of the minor children of the parties medical insurance as long as it is available through her employment. Each of the parties agrees to pay one half (1/2) of all medical, dental, optical, pharmaceutical, orthodontial, and psychological expenses of the minor children of the parties not covered by that insurance.

As of Dec. 2004 Ex-wife is not employed. I believe that Ex-wife’s current husband may add or have added the kids to his insurance. I have not been informed of this by Ex-wife. This info came from a non related party familiar with both of us.

Problem:
From the moment the “one half” medical judgment became active,

1. Ex -wife has not provided medical billing information in a timely manner. She will hold on to bills that have only my portion due for several months before sending them to me. She has also waited until they are in collection.

2. She will bring the kids back to physicians for repeat visits before I am finished paying (my half) and will try to get me to pay half on the “total bill.” (That includes her unpaid portion)

3. She has provided me with bills (for my half) that the insurance has not finished paying on . She also has been reimbursed by the insurance and kept the check.

4. She will send me non-detailed bills with hand written notes on the pages or with post-its, with her calculations of what my half is.


Questions:
1. Is there a time limit on how long Ex-wife has to provide me with true and correct bills that reflect my portion?

2. Is there a time limit to provide me with bills, where after said time, I am not responsible to pay?

3. If  my Ex-Wife’s husband adds the kids to his insurance, does she have to notify me that the kids are covered again?    
(In this case, how can I defend myself from the Ex-wife providing me with basic bills that state the total and do not reflect the insurance “I am supposedly not aware of?” Example: She gives me a bill that shows a $200.00 total and says my portion is $100.00, but insurance paid on the bill making it $30.00 dollars we are suppose to split and she pockets the money.

In addition:
I have tried to work with physicians offices directly by informing them of the (one half) payment arrangement and it has been unsuccessful to date. They do not feel it is their responsibility to keep track of separate parent billing and make no efforts to aid the situation.

Thank you,
Mark

[reagantrooper]

Welcome to the nightmare that is ours! Sounds like your X likes to play games!

Remember that no matter what she throws at you never give up the fight. NEVER!

Simply make her send you copies of the insurance benifit before you pay a dime to her this way you will know what the insurance company pays and what they dont. Or make her pay the total uninsured portion then you can reimburse her based on her cancelled checks!

I prefer the latter.

How old is your child?

[joni]

You could take her back to court and state that the bills must be given to you within 30 days of the events.

I would only pay off of the EOB (Explanation of Benefits).  That'll show if she's keeping reimbursement checks or whatever.

Tell your Ex that you will only reimburse her once she gets the EOB.  Also, the doctor's office can provide you with a copy of this too.

[MixedBag]

We have several insurances that need "coordination" in our family.

I've had several doctorss and dentists offices tell me that they don't get an Explanation of Benefits (EOB) like the insured does.

They get a computer print out that includes everyone on it that the insurance company has paid with that transmission.  

But I do agree with your basic philosophy....don't pay until all applicable insurances have paid.

[MixedBag]

Lets first go according to your numbers.

1.  Time limit?  probably not.  Check your decree and IL state statutes if there is anything specified in either.  Probably not.  My state says reasonable....there's that magical word again.

2.  Time limit and NOT responsible?  Probably not.  BUT on this point, I would argue (and DH has won this argument), that if the insurance company hasn't paid because the claim wasn't submitted in a timely manner to them, then you shouldn't have to pay it either.  (For Tri-Care, that's 1 year beyond Oct 1st after the year during which the date of service happened....like for August 1, 2004, we have until Oct 1, 2005 to submit.)  Confusing -- but each insurance is unique and that's what I suggest you go by.  Everything that happened BEFORE Dec 04 can still be filed against her insurance even if she is no longer employed.  The kids were covered at the time of service.

3.  Legally, Step-dad not required to provide insurance for the kids.  I'm not 100% sure, but I think I read once where Soc said that a step-parents insurance is above and beyond everything and nope, they don't legally have to tell you about it.  It's there for THEIR benefit and you can't take advantage.  (not that I agree with that....) and I'd suggest you search his forum, but a lot of the older posts aren't there anymore.

From what I gather, you really have from Jan 1st to today to worry about.....19 days so far.

Lots of doctor's offices don't want to care (and they don't have to) about splitting bills 50/50 and basically keeping track of who paid what to whom.  I too am a parent that wants to pay the doctor directly so I can understand where you're coming from.  (6 kids -- tons of experience).


Here's what I think.....it's time to go back and renegotiate medical care coverage for your kids.

Why?  The divorce decree gives her a simple out -- if you've posted the words correctly.  She's not in violation at all...because it says she has to provide it as long as she can through her employer.

You need to find out if she got fired or quit to put the burden of having the insurance on the kids back on her like it was.

OR you need to pick them up under your insurance and then see if the courts will adjust your child support because of this.

Not giving you the bills in a timely manner....yep, do your bestest to keep track of that.

Credit reporting or collections?  Do a search under the Fair Debt Collections Act on this site.  USE that to get your name off the bills at the doctor's offices because YOU didn't take the child into the office, period.  There's a divorce here and fight back.  There was a similar thread in another section (where I responded)....check that discussion out.

As for figuring out what the insurance actually paid -- getting back to my "slight" disagreement with the other person here.... On the statement that the doctor provides you, you should see what the insurance paid to the doctor and what their adjustment was.  That actually suffices as a replacement for the EOB.  If the insurance company pays the beneficiary directly, I'd refuse to reimburse the other parent until she provides the corresponding Explanation of Benefits to each date of service in question.

You might have to run or keep track of all this stuff in a separate spread sheet or something -- good luck in keeping yourself straight.  Make sure HER bills and step-dad's bills are not in this mess.

That's probably part of the goal too -- to confuse you into paying more than your fair share.

Above all good luck and don't let her walk all over you!

[heather2662]

There are 3 kids: 13, 16 and the oldest will be 18 in 2 weeks.

[heather2662]

I know for a fact she was fired, on the spot, without notice.

[joni]

Not true, otherwise how would the doctor know what to bill?  

I checked with our medical biller to confirm various insurance carriers and there's always some sort of reconciliation provided to the doctors from the gross amount billed down to the net amount paid.  As well as telling you when the patient got the money instead of the doc.  It's true that there may be more than one patient on the doctor's version of the EOB but it still shows this reconcilation.  Otherwise, the doc wouldn't know the contracted amount and what to write off because of in excess.  This is VERY important because it's against the law for a doc to bill a patient more than the contracted amount.

[FLMom]

One idea previously mentioned was to go back to court and clarify the insurance coverage. This did WONDERS for us!

In my case ex had allowed his wife to add our kids to her insurance. Because her insurance through her employer covered her and dependants at one set cost, ex got out of paying ANYTHING for insurance coverage for our children. He then announced that because her insurance had specific physicians listed, that he had, without my knowledge, changed their pediatrician and dentist. I went through the roof.

When we went back to modify I opted to take over the insurance coverage myself. If you are in a position to do so I would say that's the best bet.

Another option is to call the step dad's human resources office and ask them if they're aware that they're covering children's insurance where the step is NOT the guardian. They don't like that too much, cause it costs them reams of money when they don't have to.

Also, in the case of my insurance provider, if both a parent and a step parent have the same children listed as under their coverage the company will use the birthdate that's earliest in the year as who is the main provider, and the other as secondary. If you can afford insurance, get the same company as the step dad does. You can call his employers human resource department and find out what company takes care of their employees. A lot of prospective employees do this, so it's not out of the norm. If it turns out that your birthday is before his in the year, you could be their main and he's could be the secondary. Even if you're secondary you'll still get the explanation of benefits that you aren't getting now.

Yeah, it's convoluted, but when you're tired of living under the thumb of a person that is not playing by the rules and his wife, you draw a line. I now carry all of our children's insurance and ex is responsible for 50% of costs not covered. They're back with their regular physicians, also.
Plus, some states take this into account in factoring CS, so it may be more cost effective for you to take charge of the insurance!

Good Luck,
FLMom

PS-No, I'm not a lawyer, but I've BTDT.

[LizaLou1]

I also posted this to you on Soc's board. He always has the best advice, so listen to him. But, I wanted to share our experiences...

DH had similar problems until he took the position that he was not financially responsible for debts made by his ex. He is responsible for paying 1/2 TO the ex - not directly to the doctor. She selects the doctor and she takes the kids in alone (we live in a different state). Therefore, she is responsible party directly to the Doctor. She used to tell the Doctor to send the billings directly to DH because she wanted him to pay all up front. He never did he'd only pay 1/2 and they stopped after he provided the divorce papers and a letter referencing Fair Debt Collections Practices Act.

I agree with the doctor that he should not be responsible for the 50/50 payment issues. Below is part of the letter DH sent to the doctors. They quickly saw the light and stopped billing him directly. Or it could be the EX was so embarrased she accepted their billings. Needless to say she was furious that her crap was opened to view of a third party.

"I am not responsible for debts or obligations incurred by EX. This is not a refusal to pay, but a notice that your claim is disputed. Under the Fair Debt Collections Practices Act (FDCPA), I have the right to request validation of the contractual obligation, which you suggest is binding on me to pay this debt. You should also be aware that reporting such invalidated information to major credit bureaus might constitute defamation of character, as the negative marks on my credit report harm my credit and prevent me from enjoying all the benefits of good credit."

Now DH doesn't pay his ex's demands unless and until he get the doctor's billing records FROM the ex that shows insurance payments AND the insurance company's explanation of benefits that shows what they paid. It's important that you get the doctor's statement AFTER insurance pays because they often write-off a portion of the remaining balance. We usually call the doctors for a 2nd copy just to compare with what the EX sent.

Currently the ex has no sent billings in almost 2 years and we know there have been medical issues. She loves to tell people and the kids dad doesn't pay. We send her a letter every couple of months asking for documentation. But, no documentation - no money. Our attorney is cool with this approach. It would make his day if she'd sue us over this issue.

LizaLou