Insurance question

wwnbw

We have never had insurance like this so i'm clueless...hopefully someone can help me.

We don't have a copay we just have to meet our deductible and after that we pay 10%. CO says DH has to cover SS but they split everything else 50/50. I understand that BM would pay the deductible minus DH's part divided by 4 (# of kids we have) divided by 2. And then she would pay 5% after we meet the deductible.

None of the other 3 kids ever get sick or DH ever get sick and they never go to the doctor. The only time anyone goes is for preventive care and that is covered 100%. It seems like BM takes SS to the doctor for every little thing. So my question is does all she have to pay is 1/2 of SS's part of the deductible and then her 5 % or does she have to pay 50% of all his bills until the deductible is met?

Sorry if that is confusing... 

Schrodinger

We have similar wording in our CO.  Our lawyer explained to us that we are responsible for our share of the OOP expense.  Take whatever the bill was after the insurance paid, then divide.  If you haven't met your deductible, then its still 50% of the total bill.

I'm a little confused by the "deductible minus DH's part . . . "  Insurance is paid for by your DH and that cost should be factored into CS.  Trying to assign the deductible on a per-person basis just complicates things.

Schrodinger

Also, we pay for insurance as well.  BM also likes to use urgent care/ER instead of regular doctor.  Its frustrating because she doesn't have to pay as much for health care.  I try to move past it by reminding myself that she is helping me meet my deductible sooner.

Ginlyn0

When someone is ordered to cover insurance plus 50% of charges, it means 50% of that person's bills. So if that child is the one that has all the charges and no one else does that could even mean up to 50% of the entire deductible. You would just divide any bills for SS in half whether the deductible was met or not.

Ilumine

gin9874:

When someone is ordered to cover insurance plus 50% of charges, it means 50% of that person's bills. So if that child is the one that has all the charges and no one else does that could even mean up to 50% of the entire deductible. You would just divide any bills for SS in half whether the deductible was met or not.

Sorry, but this is true. A deductible is not a yearly enrollment fee.  There are thousands of HMO/PPO plans that have YEF and Deductibles. 

The deductible is only being reached due to your StepChild's care.  Therefor it should be split according to the CO.  So if you start this next fiscal year off at $0.00 and your SC goes to the doctor for an ear infection and it costs $200, then BM must pay %50 of that bill - $100. 

Wahoo

I think it's mean spirited for you to begrudge BM her choice to take SS to the doctor when he is not feeling well. 

wwnbw

Thanks everyone. I was hoping that it would work out that way! I was afraid it would be where she didn't have to pay the 50% until the deductible was met.

  

fellesferie

We have a similar plan--no copays, and we just pay until we hit the deductible. After that, I think it's like an 80/20 split. All well care & preventive care is free, too. 

In our situation, we decided that we would pay for DS's doctors visits for two reason:

1. DH did have another medical plan available to him that would just be regular copays. The plan we chose is cheaper for us--but if we billed XH for his 50% of visits, it would be more expensive for XH. Does that make sense? It makes sense in my head, but I don't know how well I'm explaining, lol. Anyway, it just struck us as unfair that we would unilaterally choose something cheaper for us and more expensive for XH.

2. I do not have any desire to consult XH every time I want to take DS to the doctor. And I felt like if XH was going to be responsible for $125 or so every time I took DS to the doctor, I'd start feeling like I needed to ask before taking him.

If I were you, and you intend to stick with the plan, I might try to suggest that whoever takes him to the doctor pays the fees. But given the wording of your current CO, I would expect her to pay for half. And I'd file contempt charges if she didn't. 

daymisty84

Hi - I'm new to this board and am dealing with the same issues.  It really depends on how the custody paperwork is worded.  My DH is to provide health insurance and BM pays the first $250 per child per year of any uncovered medical.  After that it was based on income regarding what percentage they had to pay.  BM is responsible for 40% of uncovered medical after the first $250 per child and DH is responsible for 60%.

Unfortunately, BM put DH's name down as the person responsible for all uncovered medical bills with the Dr office they go to.  About 2 years ago we received a Final Notice that we had medical bills for SSs that would be going to collection.  We never received any other bills prior to that.  Since they are in DH's name we started paying on them and BM had made no attempt to pay anything.  We went to our lawyer and she figured out that BM was paying for medicine and that met the first $250 per kid per year but we were still paying more than our share.  She sent BM a notice saying she needed to reimburse us and start putting the medical bills in her name and that we would reimburse her for DH's share in the future - this was about 6 months ago and we are still the only ones paying with no end in site.  DH has a $1,500 deductible per kid per year and they go to the dr so much that we have accumulated $3000 worth of medical bills each year for the past 3 years with the 1st year going towards DH's bad credit because we never received any of the bills.  Unfortunately our lawyer is too busy to take her to court and DH is too stubborn to find another lawyer so we'll be paying on medical bills forever. 

mmmmmriley

OMG us too! my DH pays for the insurance, deductible, and all the copays even though the CO says she's supposed to pay 1/2 the deductible and 1/2 the copays. She always take them to the ER for every little trip and fall, then she leaves w/o paying a co-pay and has us listed as the ones responsible for the bill! We get the bill later and just pay it. They money hurts because we have a $1500 deductible that she's responsible for half of, and we just pay the bills she has sent to us for co-pays, but I'm getting really frustrated with it. DH doesn't want to bother with trying to fix it because we're taking her back to court to try to get full custody, and figures asking her to pay the half she's obligated to pay makes us look petty to the court. Oh well, she's cost us about a grand so far this year, but we do what we have to for the kids. With the amount of school they miss (20 days each this last school year with her, 0 with us) you'd think they had a terminal disease.

mmmmmriley

I forgot to reply to the OP

Think of it this way, she's responsible for half the deductible and co-pays no matter what- what if it were the other way around? If she was taking them to doc all the time and it cost her money, you'd still have to pay half as well.  If DH is responsible for obtaining the policy and paying the premiums, whatever percent BM has to pay for the deductible according to the CO should be settled up at the same point every year. if she is supposed to pay 1/2 of the deductible, whether she uses any of it or not, she's still responsible for it. It's insurance that you have to pay for no matter whether you use it or not, such is the nature of insurance. You pay your car insurance all the time whether you use it or not.