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Author Topic: BM won't use both insurance policies  (Read 7329 times)

Apple

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BM won't use both insurance policies
« on: Jul 08, 2013, 04:01:44 PM »
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

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Re: BM won't use both insurance policies
« Reply #1 on: Jul 08, 2013, 04:23:08 PM »
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

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Re: BM won't use both insurance policies
« Reply #2 on: Jul 09, 2013, 06:45:23 AM »
Bingo!

Apple

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Re: BM won't use both insurance policies
« Reply #3 on: Jul 09, 2013, 10:21:40 AM »
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

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Re: BM won't use both insurance policies
« Reply #4 on: Jul 09, 2013, 11:28:16 AM »
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

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Re: BM won't use both insurance policies
« Reply #5 on: Jul 09, 2013, 11:29:14 AM »
Let me also ask you this.....who's birthday falls first within the calendar year?
 
 

ocean

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Re: BM won't use both insurance policies
« Reply #6 on: Jul 09, 2013, 01:28:47 PM »
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

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Re: BM won't use both insurance policies
« Reply #7 on: Jul 09, 2013, 02:47:47 PM »
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

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Re: BM won't use both insurance policies
« Reply #8 on: Jul 09, 2013, 02:54:59 PM »
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

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Re: BM won't use both insurance policies
« Reply #9 on: Jul 10, 2013, 06:37:07 AM »
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.
 

 

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