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Author Topic: follow up on reimbursement from NCP heatl insurance  (Read 1794 times)

Tana

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follow up on reimbursement from NCP heatl insurance
« on: May 19, 2015, 10:11:07 AM »
I posted before about not being able to get reimbursements from NCP health insurance for medical services (out of network) that my son needed. So far, about $800 were reimbursed but they never reached me. Health insurance said they are following what the garnishment department has sent them.We are in California but the reimbursements aRE going to a POBOX in Florida and I just found out that they are going to QMCSO (qualified MEDICAL CHILD SUPPORT ORDERS.
has anyone dealt with something like this?
the child support agency has no clue why and they are receiving EOBs but not the money. The state desimbursement unit has no clue why. Father has being reluctant to call HR and garnishment department to figure things out.He has been given plenty of notices.
Court facilitator thinks he either has a child support order in Florida (that's where ther POBOX is) ir someone is committing fraud in the insurance department.
Facilitair also asked me to bring all receipts and file to make NCP pay his 50 % of all those bills. It might make him follow up and call each department.
anyway, anyone knows why QMCSO is involved? or why they are not sending the money?
I did find a file online that says they the health insurance should send the money to the CP that paid those expenses
thanks


MixedBag

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Re: follow up on reimbursement from NCP heatl insurance
« Reply #1 on: May 20, 2015, 06:10:24 AM »
I hope you have names and dates behind who said what.

I'm also -- and I know this is a PITA -- but did you ever file something with the family court directly about this situation to put the responsibility clearly back on Dad to reimburse you as the order states?

I dealt with three major health insurances as the kids and step-kids were growing up and I'd always get different answers as to whom they would reimburse directly -- one said "Policy holder" the other said "Paying parent" and oh was it a goat rope because I didn't get ONE answer.

The bottom line is that it's dad's responsibility to reimburse you -- the family court order is between you and dad -- and doesn't bind anyone else.

I've heard of QDRO (Qualified Domestic Relations Orders) -- mainly in terms of splitting a retirement.  I'm not an attorney, but in mediation class, we were advised to definitely ask an attorney to draw up that part because it had to contain certain elements (like verbage) for it to be considered a QDRO.  For example, a military retirement has to have a QDRO or else DFAS acts stupid and says it doesn't know how much to disperse to the retiree and how much to disperse to the spouse. 

I'm GUESSING a Qualified Domestic Relations Medical Order is gonna be extremely similar -- it probably spells out in details who pays for what, who covers with what, and how reimbursements are processed and who gets paid. I'm also GUESSING that this is sorta "new" on a scale of 1-10 with family courts -- so "older" orders might not have enough detail to be considered COMPLETELY clear.  I'm also GUESSING that different states are being more progressive or proactive about this -- like some are gonna be "behind the times" and other on the cutting edge.


Tana

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Re: follow up on reimbursement from NCP heatl insurance
« Reply #2 on: May 20, 2015, 09:49:51 AM »
I sent letters and email asking FATHEr to cooperate and  make calls. The last letter stated that my next option was to file in court. he said he was going to call but it seems that he never followed up,
So I saw the facilitator this week and she has no idea why they are sending reimbursements there and she drafted a motion to ask him to pay his 50 % plus interest.
We have a court date for july.

MixedBag

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Re: follow up on reimbursement from NCP heatl insurance
« Reply #3 on: May 20, 2015, 10:14:57 AM »
good luck....July is not that far away.

Sounds like you've asked the right questions.....just that the left hand isn't talking to the right hand....and it's dad's responsibility to make that happen....so you are doing the right thing.

MixedBag

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Re: follow up on reimbursement from NCP heatl insurance
« Reply #4 on: May 20, 2015, 10:16:48 AM »
I remember going to court once....because the other side needed to reimburse me and they never responded to anything I sent and the insurance company wasn't cooperating either.

In court....they said "Well, my insurance should pay."  And the judge said "You're right, but YOU need to make sure they talk to her and pay OR you pay yourself."

Yes....insurance paid....but geez, WHY did they sit back and wait for court instead of answering me or getting the insurance to answer me?


 

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