Insurance Info Question

[HiddenMagic]

Divorced, two kids, custody fight.  ON paper we both have joint legal and physical custody - 50/50 time split.  IN reality, son goes back and forth weekly - daughter lives solely with me (mother) and has for three years.  Father had supervised visits with daughter, which the GAL revoked - no visits at all right now.

Kids carried under father's insurance.  The insurance companies won't speak to me because I'm not the policyholder - HIIPA rules and all that.  However, father refuses to take care of insurance/claims stuff.  We split unpaid medical/dental etc - and because I take the daughter for care, bills come to me to be paid in full when denied.

How do I get the insurance companies to share info with me - when he's the policyholder and uncooperative?  Got a form letter or anything?

[socrateaser]

Contempt is the willful and knowing failure to adhere to a valid court order. If the other parent is court ordered to provide insurance, and he intentionally does not provide you with the necessary info to utilize the policy, then he is willfully violating the order and therefore may be found in contempt.

I would send a letter to the other parent:

DATE

Re: Insurance benefits for DAUGHTERSNAME

Dear X,

On ??/??/??, I received a bill from a healthcare provider (copy attached) which requires me to pay for services rendered on behalf of our minor child, CHILDSNAME -- services which I believe should be covered under the health insurance that you are court-ordered to provide for her.

I have previously requested that you provide me the necessary information with which I can receive reimbursement from your healthcare insurance company for healthcare services, however, I have received no response from you.

My only concern is for the welfare of our daughter, and I would genuinely like to settle this matter amicably, howvever, if you do not provide me with an insurance card, or some other means by which I can utilize your insurance benefits for our daughter within 10 days of the date on this letter, then I will be forced to take legal action to enforce my rights.

If you have any questions or concerns, please do not hesitate to contact me immediately.

Sincerely,

YOURNAME

[Dr.Stepmom]

Re: the new HIPPA regulations...insurance companies need to share info with parents, but just must have proof first.

Contact the insurance company and ask them what they need.  In our case, Mom thought we were purposefully restricting her access to child's info.  As soon as we were made aware, we were able to fax a letter to the insurance company with the signature of the insurer and a copy of the applicable court order allowing Mom free access.  A simple fax and the problem was solved.

[socrateaser]

I'm afraid that I must disagree with your solution, not because the law may permit the non-custodial parent to gain access to the info, but rather because the problem here is that the other parent is failing to comply with the court order. Doing an "end run" around the other parent merely leads to more deception and acrimony. The custodial parent must be made to recognize that he/she has a legal obligation to perform, and that there are consequences that accompany willful violations of the court's orders.

Unless, the non-custodial parent gets tough now, then the existing pattern of control and manipulation will continue -- just in some new area. I suspect that this behavior was one of the reasons why these parents are now divorced.

[HiddenMagic]

ok, the problem is NOT that he won't provide the insurance - he does.  The problem is that they deny a claim and bill me for it - and when I call to find out why it has been denied and get it resolved - they won't talk to me - so it doesn't get resolved and then they come after me for the money.  I have an insurance card for the kids - and use the insurance.  The problem is unresolved/denied claims - he won't do any of the work to resolve them, I am unable to resolve them because they won't talk to me.  Yes - he could sign a release to allow them to talk to me -  but he won't because our relationship is hostile at best.

[HiddenMagic]

That assumes that the parent that provides the insurance is cooperative and wants to assist you in resolving the issue - he doesn't want to.

[HiddenMagic]

>Unless, the non-custodial parent gets tough now, then the
>existing pattern of control and manipulation will continue --
>just in some new area. I suspect that this behavior was one of
>the reasons why these parents are now divorced.

No, we got along for years after the divorce.  His supervised visits with daughter have been taken away by the GAL and we are currently battling over issues with our younger son and he continually loses (our son wins) - so he's in the mood to make as much trouble and as little peace and harmony as possible in my world.

[HiddenMagic]

Dear (ex-husband):
Re: Insurance benefits for (daughter name) and  (son name)

Dear (ex-husband) ,

I have been receiving bills and phone calls regarding payment of claims from various healthcare providers which requires me to pay for services rendered on behalf of our minor children, (daughter name) and (son name),  -- services which I know are covered under the health insurance that you are court-ordered to provide for them.
Some require a letter regarding coordination of benefits and declaration that no other benefits exist; some require discussion of the actual treatment.  All of this is event specific and not covered in the generic benefits book and website.  Because I am not the subscriber, they will not accept any declarations from me nor will they speak to me regarding specific claims so that I may resolve them.  Based on recent legislation regarding length of time allowed for claims, this is a time sensitive issue.  After the cutoff, the insurance company does not have to pay on the claim whether it was a legitimately covered expense or not.

I have previously requested that you provide me the necessary information and assistance with which I can resolve these issues with your healthcare insurance company for healthcare and mental health care services, however, I have received no response from you that actually assists in doing so.  In essence, you are thwarting my attempts to garner the highest level of payment from the insurance company – which is quite illogical when you are required to pay 73% of uncovered medical expenses.  Since you are, and have been, aware of this issue (previous emails) – the excuse "she didn't adhere to the plan, therefore I don't have to pay" will not stand up as you yourself are keeping me from resolving the claims issues.  My claim to the court will be that you barred me from resolving the issue; therefore you are responsible for 100% of all unpaid claims.  

My only concern is for the welfare of our children, and I would genuinely like to settle this matter amicably, however, if you do not provide me with a release to allow your insurance provider and mental health benefits provider to speak to me regarding the claims on (daughter name) and (son name), and provide me with copies of the Statement of Benefits mailed to you after an event - within 10 days of the date on this letter, then I will be forced to inform all providers that you are now solely responsible for all claims that were denied, or denied and passed the timeline cutoff, and all future treatment.  I will have to approach the Guardian ad Litem if providers begin to refuse the children treatment or are dropped from the provider's care due to unpaid claims.  I will be forced to ask the court for an order that all medical bills for the children are to be your responsibility to pay and resolve.  If you have any questions or concerns, please do not hesitate to contact me immediately.

Sincerely,

me

[socrateaser]

There's no point in giving him your legal theory or using any adversarial language. There's always a possibility that what you write will get in front of the judge's nose, and you want to appear squeeky clean -- not antagonistic. Your letter is edited below.



>Re: Insurance benefits for (daughter name) and  (son name)
>
>Dear (ex-husband) ,
>
>I have been receiving bills and phone calls regarding payment
>of claims from various healthcare providers which requires me
>to pay for services rendered on behalf of our minor children,
>(daughter name) and (son name),  -- services which I know are
>covered under the health insurance that you are court-ordered
>to provide for them.
>Some require a letter regarding coordination of benefits and
>declaration that no other benefits exist; some require
>discussion of the actual treatment.  All of this is event
>specific and not covered in the generic benefits book and
>website.  Because I am not the subscriber, they will not
>accept any declarations from me nor will they speak to me
>regarding specific claims so that I may resolve them.  Based
>on recent legislation regarding length of time allowed for
>claims, this is a time sensitive issue.  After the cutoff, the
>insurance company does not have to pay on the claim whether it
>was a legitimately covered expense or not.
>
>I have previously requested that you provide me the necessary
>information and assistance with which I can resolve these
>issues with your healthcare insurance company for healthcare
>and mental health care services, however, I have received no
>response from you that actually assists in doing so.  


>My only concern is for the welfare of our children, and I
>would genuinely like to settle this matter amicably, however,
>if you do not provide me with a release to allow your
>insurance provider and mental health benefits provider to
>speak to me regarding the claims on (daughter name) and (son
>name), and provide me with copies of the Statement of Benefits
>mailed to you after an event - within 10 days of the date on
>this letter, then I will be forced to take appropriate legal action, which will almost certainly result in your being ordered to pay, not only the insurance bills, but my costs of suit and attorney fees, as well.

>If you have any questions or concerns, please do
>not hesitate to contact me immediately.
>
>Sincerely,
>
>me
>

[HiddenMagic]

I will use the edited one you provided.  I put in what  his claim would be because I know that is what his thought process is and his  hope to lay the full cost on me.

Thanks!