Medical Expenses & Insurance

[padad]

Good Morning!

Court order was entered in Az, Mother lives in Fl and father lives in PA. WE have split custody. Court order states in regards to medical
"expenses not covered by health insurance for the children will be paid 75% by petitioner and 25% by respondent" I am the petitioner in this court order.

1.If the child is under steparent insurance, can you still ask the NCP for their share of the expense?

2. Can it still be used to calculate support if i was to ask for modification?

3. How complicated would it get if i was to request a modification considering that neither one lives in AZ?

4. As stated in the CO, does that include premiums, copay and medical prescriptions?

THe biggest problem i am seeing right know is DENTAL, mother send me an estimate of work that was to be done to my daughter, the job was over $1200. I told mother to send me a completed bill showing what she paid and what the insurance paid. Which is the same way i send her bill when i need reimbursement. Apparently she has taking daughter 2x to the dentist and out of pocket she's had to pay over $400 each time. I can't believe that we try so hard to get good insurance for my kids and always very attentive to their "preventive care" yet the $$$ i save with the ones that live with me, i have to spend with the one that lives with Mother. My daughter is only 8 and there's always been something wrong with her teeth. At this point i am just a bit frustrated. Mother was shocked when i told her she had to pay 25% for the daughter that lives with me. Apparantely she thinks i have to pay for everything for the one that lives here  and 75% for the one  that lives with her, Great way of interpreting Court Order!!!

Thanks

[socrateaser]

>Good Morning!
>
>Court order was entered in Az, Mother lives in Fl and father
>lives in PA. WE have split custody. Court order states in
>regards to medical
>"expenses not covered by health insurance for the children
>will be paid 75% by petitioner and 25% by respondent" I am the
>petitioner in this court order.
>
>1.If the child is under steparent insurance, can you still ask
>the NCP for their share of the expense?

Insurance has nothing to do with it. The referenced text of your court order discusses amounts "not" covered by insurance. It doesn't discuss the reasons why an amount isn't covered, it just distributes the unreimbursed costs 75:25 and so that's what each parent must pay. Insurance premiums are not part of this split, and I don't know what your orders say about that. But, if there's a charge for actual healthcare services rendered, not covered by insurance you pay 75%, other parent pays 25%.

>
>2. Can it still be used to calculate support if i was to ask
>for modification?

If you choose to obtain insurance outside of the scope of the court ordered requirements, then the reasonable cost that you would have paid, had you obtained the insurance per the court orders should be available to calculate your support, because you could just switch the child to new insurance (which would likely be more costly to the other parent) and thereby force the issue.

>
>3. How complicated would it get if i was to request a
>modification considering that neither one lives in AZ?

What exactly do you want to modify, and for which child(ren)?
>
>4. As stated in the CO, does that include premiums, copay and
>medical prescriptions?

Premiums are not part of the reimbursement order. Copay/prescriptions/deductables/over-the-counter meds/prosthetics/medical equipment/orthodontics, glasses, etc. are part.

[padad]

So just so i understand this correctly, since the Court Order says nothing about the medical insurance. "expenses not covered by health insurance for the children will be paid 75% by petitioner and 25% by respondent"

1.Each parent has to have insurance for the child they have the custody of?

2. We can get reimbursement from the other parent for the copays, prescription and any amt due not paid by the insurance?

When i send mother a bill for our daughter that lives here, i send her the total bill showing what i paid and what the insurance paid.
3. Can i ask that she does the same when sending me a bill?

In re: to modification i was talking about Child Support for both kids, i am pretty certain mother is making more $$$ , we are probably at 60%/40% BUT b/c neither one of us lives in AZ, i am scared it would be a mess.

Thanks

[socrateaser]

>1.Each parent has to have insurance for the child they have
>the custody of?

No. I assumed (apparently incorrectly, from your response) that your court order instructs both parents to obtain insurance if available at reasonable cost from their respective employer. If this isn't in your order, then neither parent need obtain insurance.

I think you should post the entire text of your orders, because I don't want to give you a bad interpretation.

On the issue of filing a modification, if it's only for support, then I suggest you just open a case with your local child support enforcement agency and let them try to handle it. It will take longer than for you to file in the other parent's state, but it will be pretty much free, and the state is relentless if it thinks there's money to be had (because it receives federal matching funds for any collection obtained).

[padad]

"expenses not covered by health insurance for the children will be paid 75% by petitioner and 25% by respondent" This is the only part in the whole Court Order that even mentions health insurance.

Thanks

[socrateaser]

>"expenses not covered by health insurance for the children
>will be paid 75% by petitioner and 25% by respondent" This is
>the only part in the whole Court Order that even mentions
>health insurance.

OK, based on the way your order is written, my new interpretation is that any health care expense not covered by insurance is 75:25, and that would include the premiums to obtain health insurance, dental, vision, over-the-counter, medical equipment, orthodontia (if dentally necessary).

Some ortho/dental is cosmetic/discretionary, and the orthodontist will recommend it, but if actually asked whether it's "dentally necessary," the ortho will say, "no." If you can get a letter from him/her stating this, then you don't have to pay anything, unless the other parent demonstrates that the failure to get orthodontics would create a serious mental health problem for the child (self esteem, etc.).

It all gets very cloudy with dental work -- especially with young kids. Orthodontists love to tell you how the child's mouth is messed up, and that you shouldn't wait to see if the child's jaw will grow out. But, sometimes it does grow out, and more often than not, waiting doesn't damage the ability of the ortho to fix the problem later if the jaw doesn't grow out.

Anyway, if it's an issue of the kid's teeth not having room to come in, or being so crooked that the kid can't chew, then ortho is a necessary process. But, if it's just a question of whether the child has a perfect profile (i.e., according to the Ancient Greeks, a perfect profile means that a straigtedge should touch the tip of the nose, the top and bottom lip and the tip of the jaw), then that's really a discretionary issue, and you are entitled to weigh the benefit vs. cost before plunking down your money.

[padad]

Mother called and said she had to take daughter to the dentist a few times and to the ER. I told her send me completed bill so i can reimburse my share 75%.
She sent me the bill from the dentist showing her payment and she sent me the explanation of benefits the insurance sent her.

The explanation of benefits says she shouldve been charged $270 but she paid the dentist $450. Thats a big difference which one am i paying out of the bill or the insurance explanation of benefits?

Thanks!!

[4honor]

When an insurance carrier provides an Explanation of Benefits, they show what was charged, what was allowed, what was paid and what is owing.

The problem is when an "out of network" provider is used. Then the difference between the owing and the charged amounts are greater -- cause an out of network provider does not have to accept the amount the insurance company contracts with a network provider... so there could be MORE owing... some of the disallowed amounts.


Also, did the provider's bill show a previous balance owing? She could be paying on old bills.


You have to take all that into consideration when deciphering what is really owing and what was really paid, and was it all really due?  The dentist may be requiring the other parent to pay 100% of what is due and owing (per the EOB), plus any amount the insurance company disallows.

Run the numbers. Some of the disallowed amounts may still  be due and owing. If you are still unsure, most medical offices will forward billing information (only) without a public records request -- they will send information to anyone they think will pay their bills.

[padad]

there was a previous balance owing i went thru the EOB and the bill and checked off the services the charges where all the same amount. She also send a receipt showing she paid the hospital $100 but it doesnt show dates or what was done to my daugher. IT just says payment of 100 was received.

I hate this when i send a bill its a complete bill

[padad]

The dentist bill says she paid $417, she sent a note saying she paid $450 and the EOB says it should be $269. Which one is it??/?
the dentist is within the network..