2bornot2b
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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
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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
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Reged: 04/12/07
Posts: 2348
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Who carries the insurance?
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2bornot2b
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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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germangirl631
Platinum
Reged: 04/04/08
Posts: 1259
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If she wants a reimbursement, she should provide the insurance explanation of benefits to you. That shows you exactly what they did and didn't reimburse. The Dr bill is not the thing to go by. If she won't provide that explanation of benefits, don't pay. My flex spending plan won't reimburse me without it.
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chatter box
Platinum
Reged: 11/09/07
Posts: 1300
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I know how frustrating it is. You might talk to the insurance company again and be nice very nice. Let them know that you have a court oder and ask to talk to someone in there legal department if you have to. They may not be able to still help but at least you tried that angle. The only other thing you can do is get a lawer and have them ask for the insurance forms. I forget what they are called but he will know. My X owes me thousands and it has taken a long time to figure out how she has been getting away with it.
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alizzie007
New
Reged: 04/29/08
Posts: 15
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We also have a similar problem... my SS's mother was given a packet of information with all of his medical insurance cards, EOB's etc. She went a year and a half and then claimed that it was never given to her. *sigh* We're worried because we both were there when it was given, but it wasn't sent certified or anything.
Insurance stuff is really sticky. We have to pay our "allotted proportion" of medical stuff but always keep all of our receipts and we will not pay anything unless we see all of her documentation and can verify it with SS's medical provider.
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"I am not afraid. I was born to do this..."
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KGrow
Platinum
Reged: 01/27/06
Posts: 3153
Loc: Colorado
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"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."
She's the one requesting reimbursement. If she refuses to provide adequate documentation, you refuse to reimburse. It's not complicated at all.
Keep insurance companies and providers out of the middle of it. He has a right to medical information about his children. He does not have a right to billing information. That information has to come through her, the policy holder.
Edited by KGrow (06/24/08 01:10 AM)
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gigi
Platinum
Reged: 11/06/06
Posts: 5138
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Check with teh laws. Somewhere (I think it's FEDERAL law, but I might be confused again) it says that both parents have the absolute right to have everything. If you are trying to do this on your husband's behalf, the insurers might not let you... but otherwise, have him send them a copy of the law that requires them to give him this information. Or simply don't pay until she gives him a release of infomration form for him to get all this information from them so that he can be assured that what she's chargign him for is fair and that she's actually paid it. And if she has not paid it herself, he should be paying the insurer or doctor directly.
We watched ChatterBox go through something like this not too long ago and it just sounds like a real mess... do what you can to see tha tit doesn't get that far as to create such a mess that will be as impossible to get out of. Good luck.
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gigi
Platinum
Reged: 11/06/06
Posts: 5138
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Ah... I didn't see KGrow's response... he's right... it's the medical information you're entitled to... not necessarily the insurance information. If you're concerned about the reimbursement, getting her to give a release of information form might be the way to resolve that one... Geez what a scary mess this could be. I'm glad as heck that my stepkids are physically healthy.
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