BM won't use both insurance policies

[Apple]

BM is now receiving benefits at work and recently added SD's to her medical and dental policy.  Per the CO DH is to carry insurance for SD's and he does, and uncovered expenses are split 50/50.  As it stands with the insurance companies, DH's insurance is primary and BM's secondary.  Prior to BM adding them, the SD were covered by MA, so any uncovered costs were paid by the MA.

YSD is on Adderall (not a cheap drug).  BM decided that since the out of pocket is less using her insurance, she is going to use her insurance to get the meds.  Since DH's insurance is listed as primary, we can't go back to DH insurance and file a claim.  The primary has to be used first.

DH has explained this to BM but she doesn't care.  She refuses to use DH's insurance first (and then file a claim with her insurance for the extra benefit) and she refuses to change her insurance to primary (DH can't).  Her excuse is that she can't afford the out of pocket using DH insurance first.  DH tried explain the out of pocket may be higher, but the net cost will be less (because we can run it through both insurance companies).

This is the first month DH and BM had to pay for the meds, DH finally gave in and gave BM half of what she paid for the meds.  However, next month he wants to prorate the payment based on what the final cost would be if she used both insurances.   

This does not sound unreasonable to me.  Thoughts? 

Also, DH has also offered to get the meds, but BM refused that too.

[ocean]

Few options, we just went through this.

1. Call the dr office manager yourself, fax/send them the court order stating DH is required to carry insurance is primary and they must bill that way. They will redo the claims. Most offices will do BOTH before they ask for payment but there are some who will only deal with primary and then mom would send copy of EOB from DH to get the secondary to pay. They should do this if you are calm. polite, have DH call OR send a detailed letter with copies of the court orders with a copy of your medical ID.

2. File in family court modification papers. In the reason section:  "Mother is refusing to use father's medical insurance as primary as court ordered. Father requests that mother be required to use DH insurance as primary and XX as secondary. Father requests mother must use in-network doctors and send receipts with secondary EOB's attached to DH within 30 days of her payment".

Be careful, if you keep paying those bills, then you are agreeing to them. Send mom a letter/email stating: "As you know child has two insurances and XX insurance is court ordered as primary and your new insurance is secondary. If you choose not to use xx as primary, I will be forced to have the courts intervene as the out of pocket costs increase for both of us. I have offered to pick up meds if the out of pocket costs are too much to lay out each month. As stated above, I will only split medical costs when BOTH insurances are used. Please send me receipts and EOB's from your insurance of future payouts to show what the out of pocket costs are after BOTH insurances are used. Thank you".

Then ignore her response and wait for next receipt, see what dr office does too. If you have access to other insurance info, you can try to call them and tell them they are secondary for this child.

[MixedBag]

Bingo!

[Apple]

Thanks for the response.  Good advice for Dr appts. 

The issue DH is dealing with now is regarding a prescription being filled at a pharmacy.  They won't rerun it.  DH agreed to pay the higher amount for this one month and made that very clear to BM. 

Do you think DH is OK to prorate future payments and let BM go to a judge if she disagrees with what he's doing?

[MixedBag]

I would recommend not paying at all -- not reimbursing the parent who isn't following the rules ONE DIME.

Guess who has had to go down that road -- even across a long distance....Me.

Go to the pharmacy -- and do two things:

A.  Give them IN WRITING the correct  information.
B.   Complain UP their chain of command -- like take to the boss -- and the boss's boss....etc...Until they do re-run it.  I've never had that problem around here.

DO NOT reimburse the other parent squat until all the rules of insurance are followed.....

Actually, if you can get the right documentation, I used to have to manually submit the paperwork to the secondary insurance because for a long time the pharmacy would not process two insurances.  Could that be the real problem?

Good luck -- but learn to follow the rules as outlined in the decree AND by insurance companies before any reimbursement to the other parent happens.

[MixedBag]

Let me also ask you this.....who's birthday falls first within the calendar year?

[ocean]

Here, if it is court ordered, then that is the primary insurance regardless of birthday. That is what the judge DH.

Once you can get to the secondary insurance and they find out that they are not primary, they will put it in their system and everything will be denied until your insurance pays. BUT getting them to talk to you may be hard under HIPPA, depending on the phone operator.

I agree, go up the chain at the pharmacy and write that registered letter to ex stating you will not be paying anything until both insurances are used correctly. Depending on exactly what your court orders are, you may have to go back to family court and get exact wordings so the insurance companies can not argue who is primary.
Your letter to ex will be proof that you sent her communication about this. Courts will accept certified/registered letters as you can print out delivery confirmation to ex. You can have it delivered to her house or actually have her sign for it. For this, since you may go to court over it, have her sign for it so she can not argue she did not get it.

May be worth paying a lawyer for an hour, to look at your papers, make sure you are right and send her a nice letter demanding she follow the court order. Tell lawyer you only want to hire them for meeting and one letter. If you need to go to family court, you will consider hiring them. NO RETAINER, just one letter. Keeps costs way down.

[Apple]

There are no rules outlined in the CO except that DH has to cover the SD with employer's insurance.  However, we have an email from BM recognizing that her insurance is secondary.  With this being said, do you still recommend not paying BM at all until she runs it through both? 

Another issue, is we have a high deductible policy.  By her not using DH's policy, we're not getting credit for our annual deductible. 

DH contacted secondary insurance to alter them, but the prescriptions are processed by another company and they won't talk to him.  But I may suggest he try again.

Thanks for the responses!   

[ocean]

If they won't talk to him, get their address and send them copies of paperwork and your card to say they are secondary.

Yes, no payments until both insurance companies have been put through with proof the correct way.

What if you put the meds receipts into yours and told them to process as primary and send other insurance notice? Your insurance should be denying any pharmacy payments since they know they are primary right?

We had that happen and the insurance asked for reimbursement as they are now secondary and paid out primary.

Should talk to lawyer though, the birthday rule may come into play if it is not spelled out in the court order and that would take a trip to court to fix.

[MixedBag]

That birthday rule -- since the question wasn't answered.

See in the "insurance industry" (IMHO) if Mom's birthday is in January, and Dad's birthday is in March, then Mom's is primary, and Dad's is secondary.

In the Family court world, it's who ever was ordered to pay and carry insurance for the child.

So....blend the two and you have conflicting rules of engagement many times.

Here, I was ordered to carry insurance.  (Birthday in Oct, Insurance was Tricare)
Dad picked up insurance (Birthday in May, Insurace was BC/BS of IN)
Step-Dad picked up insurance (Birthday in February, Insurance was BC/BS of AL)

So.....here we go for confusion?

I was ordered, BUT Tri-Care is federal and says all other insurances must pay first by federal law.
DAD wanted to be primary because he was custodial and argued that point with his BC/BS of IN.  They agreed.
I wanted Step-Dad to be primary because I was ordered to carry the insurance AND because of the birthday rule AND because DAD didn't share medical/dental/perscription/ANY information with me.  (See I'd atleast get to see the EOBs soon after to get the clue SOMETHING happened......long distance, so it's not like I'd get any update by seeing my son EOW or something....)  BC/BS of AL agreed with me.

So two BC/BS companies -- gave conflicting decisions.

THEN there was the hurdle of having TWO BC/BS policies -- got told at one point that this wasn't allowed.
THEN there was the hurdle of paying for BC/BS and getting credit in the child support formula.
The WV judge allowed DAD a credit even though DAD wasn't ordered to pick up any insurance.  (I thought this wasn't fair -- and Dad was never ever ordered to pick up insurance -- I always had Tri-Care (free) and it provides excellent coverage (while active duty) and when I retired, we picked up BC/BS of AL to cover the gap for ourselves and son (and 5 other children).....) 

So there's a lot of aspects to this insurance thing.

[MixedBag]

Medical Insurance, Dental Insurance, Perscription Insurance, Vision Insurance -- all separate companies, but in terms of "insurance" -- handle them all the same way.

And NOPE, do not reimburse the other parent until properly processed.

And YEP, start a letter writing campaign to all individuals/companies involved and send it in a way that you can track the other side received it.
I'm not in favor of "certified"mail -- when there's first class delivery confirmation available now a days.  And even priority confirmed delivery....

THEN use certified to send a stronger message when they continue to play the GAME of "Geez, I didn't get that memo"

[MixedBag]

another thought that just came to mind.

You're talking Pharmacy and medicine -- but also talking medical deductibles (I think)....

IMHO -- that's mixing apples and oranges -- both "medical" issues (like that's both fruit), but one is the medical insurance (visit to the doctor where there is a high deductible), and the other is pharmacy/perscription insurance (for the Adderal/medicine).
The "high cost" of the medicine is not going to be applied to the medical deductible side of the house (IMHO).

I shared the complicated situation of my past above......and never was the true cost or any cost of my medications applied towards my deductible on the medical policy.

For example.....annual physical OB/GYN exams are medical.  I have $150 deductible then 80/20.  Then, every month I go get my BCP....that's separate and about $5 a month.  The two don't blend......because they are handled under separate programs.  So the annual cost to me of $5 x 12 of $60 does not go toward the $150.

Just trying to share and help.....k?  sometimes understanding outside influences help make things clearer and stuff starts to settle down.

[Apple]

Good point on the meds not going towards deductible.  I'm sure you're correct.

BM's birthday is in May, DH in December.  But the order is for DH to carry insurance, I'm guessing BM is carrying it too because it's free or very inexpensive, not sure.

Twist to this now...   BM is suggesting they remove the clause that DH must cover SD and just use BM's policy.  DH asked her for copies of the coverage her employer offers and a recent paycheck.  We want to calculate to see if DH dropping policy on SD would be enough to increase his CS obligation and what kind of coverage she actually has. 

Waiting for the documents from BM...
 

[MixedBag]

Seee....BM using Birthday rule -- and potential increase in CS.

Dad using court order....

As for the CS, ask the Family Court Clerk for a copy of the last CS calculation work sheet.

It might already be on there so you can see how it overall effects that part of the equation.

Personally (since at one time there were 3 insurances on some of the kids), I'd carry the child until BM files a motion etc.

Then I'd STILL carry the child....just to be safe.

Chances are that the policy is single and then family.  So if you two are married -- and "drop" his child, there won't be a savings.
Chances are that the court will include Mom's premiums into the calculations similarly to whatever they did for Dad's...

WV court did it one way, NV court another....AL court a third (different cases, but same subject), so there is no ONE WAY -- except how it was handled in the past by Dad's judge.

[Apple]

Trust me, BM knows nothing about any rules!   

Yep, we have access to the on line CS calculator for our state and will run the numbers every which way when we see how much BM pays for insurance and how much she makes. 

Actually, if we didn't cover the SD we'd each go single on our respective employers plan and save over $250 each  month.  In our case, singe + single is WAY less than 1 +. 

BUT this is all dependent on BM getting us the paperwork.  Until then, we'll keep the SD covered and require insurance to be used as it should before we pay her.

[ocean]

Keep insurance until you go to court. He is court ordered to keep it, so he can not stop until he gets to court.

Sounds like child is on monthly meds, how much would it be out of pocket with her insurance each month? if is a small amount then not worth spending it on your insurance.

Make a deal with her, You will give her xx ($150?) more a month BUT she pays copays. Some people have that they split medical/prescriptions IF it goes over a certain amount.

Does BM have a family plan now? Does she have other children? If she has other children then when you figure her cost, figure in the other children or you can make the argument that since there are other children on the plan it does not cost her anything for this child.

[MixedBag]

That's if you trust mom to keep the insurance going....how stable is she in that area?

I can see Ocean's point....sorta...

And fortunately, if BM drops insurance on SD, that should be an event where either Dad or SM can pick her up within 30 days even if it is outside the open enrollment period.
PROVIDED BM tells either one of you that she dropped the insurance.

[Kitty C.]

Why couldn't he just go to the pharmacy with his ins. and CO and tell them to register his insurance and it MUST be used first, per the CO?

[MixedBag]

Kitty -- because of the birthday rule...

That confuses "people" in general because Dad has a court order saying one thing, and "industry standard" says Mom's birthday falls first.

I would agree to give it a try....but honestly, I'm not sure where it would get anybody as more and more information from this poster gets shared.

I think the poster was wanting the pharmacy medication to count towards medical deductible -- because she mentions how expensive it is...  Well, that ain't gonna happen no matter what.

Then, I would think it's smart to use who ever's perscription co-pay is cheaper -- and that could be BM. 

HOWEVER, even with perscriptions, both insurances can be used -- and maybe the together will cover 100% maybe not.....

What about Dad approaching his insurance and saying "Hey I'm secondary now using the birthday rule, so here please process this perscription against my insurance too?"

This case for these people -- goes back and forth.

[Apple]

DH insurance is primary and can't be changed to secondary without a CO.  This is according to the insurance company.


My biggest concern is the net cost of medical expenses.  Because BM is only using her insurance neither is getting the benefit DH insurance.  And net out of pocket is more than it should be for both parents.


BM has now presented DH with bills from several months ago asking for 50%.  SD were covered under DH insurance and Medical Assistance at the time.  One bill is for glasses for OSD.  DH asked BM why MA didn't cover the portion insurance didn't.  Her response was that OSD prescription didn't change so MA would not cover new glasses.  So is DH responsible for 50% of glasses that weren't necessary?   SD had perfectly good glasses.  What's to stop any parent from taking advantage? 


Since SD were on MA DH has never had to deal with these issues. 

[MixedBag]

In my experience -- vision isn't necessarly a "health insurance" item.

There's medical, dental, vision, perscription,.....

Any time Mom presents a bill, go back and re-file it with Dad's insurance.