2bornot2b
New
Reged: 06/22/08
Posts: 10
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My husbands divorce papers state that he and his ex pay 50/50 on non covered medical bills. We have reason to believe that after the ex gives my husband a copy of the medical bills and gets reimbursed for half from him, then she is filing a claim with the insurance company for reimbursement. Is any one else dealing with this problem? Also, is this a form of fraud? HELP!
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melanie14
Platinum
Reged: 03/11/06
Posts: 3058
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you stated that it was non covered. so the insurance won't cover it. Did I read that wrong? And doesn't the doctor's office directly bill the insurance?
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2bornot2b
New
Reged: 06/22/08
Posts: 10
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The red flag came when my husband called about a high dental bill and they told him that the ex should have been mailed a check from the insurance. Also the prescription drugs that he has been paying for show that the insurance did not pay. We think she might be filing online for reimbursements after getting money from us. If that were the case, could it be considered fraud?
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Sarah1014
Platinum
Reged: 04/12/07
Posts: 2348
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Who carries the insurance?
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2bornot2b
New
Reged: 06/22/08
Posts: 10
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The ex wife got the insurance during the divorce because she had dental at the time, when my husband did not.
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KGrow
Platinum
Reged: 01/27/06
Posts: 3153
Loc: Colorado
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If reimbursement is for uncovered medical expenses, before reimbursing he should ask to see 1/ statement from the provider, 2/ proof of payment by her and 3/ documentation from the insurance company of any required copays or uncovered services.
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EZmark
Platinum
Reged: 06/04/07
Posts: 292
Loc: Florida
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Excellent advice, and I would add why not contact the provider and pay them directly? If the order does not say re-imburse don't do it. Keep the receipts and tell the judge why if she files a motion. Forget fraud, the prosecutor has bigger fish to fry.
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gigi
Platinum
Reged: 11/06/06
Posts: 5138
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This is reminding me of something I heard about recently... maybe here or maybe another group... let me think... One parent was paying the doctors first and seeking reimbursement for half from the other. The other parent would then pay the doctors and the insurer would reimburse her (because she carried the insurance) for the overpayment. She went to the child support people and showed proof that she had paid so the child support people refused to make her reimburse the father. He ended up paying 100% of the bills and she would pay 50%, get a receipt, then get reimbursed for the overpayment. Yep, this WAS fraud.
It took a really long time for the father to figure out what she'd been doing and I don't remember how it all turned out... but...
I'd be careful about making direct payments of more than half of the unreimbursed expenses... I think KGrow's suggestion of getting information about what insurance covered and proof that she paid and proof that she pursued insurance reimbursement first, it might help...
This type of stuff is such a tangle, unless the medical costs are huge, it might not be worth spending lots of time questioning it. And if the medical costs ARE huge, it would suggest to me tht the kids' medical needs are big enough that the father should be more involved, closely enough that this type of mix-up should not occur quite as easily.
Good luck and let us know how this works out.
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chatter box
Platinum
Reged: 11/09/07
Posts: 1300
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[quote]This is reminding me of something I heard about recently... maybe here or maybe another group... let me think... [/quote]
Gigi that was me your talking about and it took me for ever to get it straight with the hospital. Still working on the doctors offices. Kgrow is right. You need copies of all that stuff and copies of check. Everything. Set down and make a spread sheet and go over everything line by line. If you can't explain something then call and ask someone.
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2bornot2b
New
Reged: 06/22/08
Posts: 10
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Thanks for the responses. It's not as simple as just seeing the paperwork. She only produces what she wants, we have no idea if she is lying or not. My husband tried to talk to the insurance company but they would not talk to him even though the divorce papers state he has rights to all information about his child. Very complicated! The ex is on her 5th marriage, yes that was 5, and we are really hoping she is giving us ammunition without knowing it.
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