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Insurance questions..

docco11docco11 member
in Blended Families

Per our CO, MH provides health insurance for his D. They are to split healthcare bills 50/50. His ExW has legal and physical custody. Long story short, ExW finally sought out treatment for D and she is staying in a facility to get help for her issues.  ExW chose what facility to put her in and, of course, it is not approved by our insurance.  Our insurance company gave her options on treatment facilities that are approved, she just chooses to use this place (close to her home so she can visit).

We got our first bill.  For 3 days of care, it was 11k.  She has been in treatment for 2 months now and is expected to stay through February at the soonest.  I shudder to think of the bill. Is my husband the "responsible party" for her bills since it is his insurance? We will do our best to pay but obviously, its going to end up in collections, that amount is unreal.    If so, I know the BM will not pay a dime and we will end up going to court over it later.  Do we have any rights here to get her mom to transfer her to a facility that is approved by the insurance company?  Or, does she get all the final say in the care and we just have to suck it up and somehow figure out how to pay the bill?  Our lawyer has been no help, he doesn't return our calls, which is a different story,

Thanks 

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Re: Insurance questions..

  • +just+j++just+j+ member

    You need to do all you can to find another facility closest to her that is covered.  If she refuses, you need to let her know that you will take the expense to court because it is not reasonable for her to deny the options you have provided.

    If you're paying it - you have a say. She does not just get to burn thru your money for her own personal convenience.

    And while I can't say any judge should see that, I would hope that they would take your side if you do your very best at working fairly with her and provide those options.

    "he offered her the world. she said she had her own" - poet Monique Duval
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  • docco11docco11 member

    Thanks J.  We have given her options, she just doesn't care.  Our insurance company has been great to work with, we went to arbitration with them and they tried to pay; they did an evaluation of the care/facility and they do not believe that the care she is receiving is consistent with her diagnosis and therefore will not pay. 

    We have all of our communications in writing, MH was smart enough to not try to work through all of this over to phone so he can prove that he is making a reasonable attempt.  We are just at a loss on what to do now.  Who can afford that?  We are thinking that she listed MH as the responsible party on all of the intake paperwork; knowing that they will go after him for payment, effect his credit, etc and not her. 

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  • +just+j++just+j+ member
    Then she is just being a bitch.  Take her to court.
    "he offered her the world. she said she had her own" - poet Monique Duval
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  • +just+j++just+j+ member
    edited November 2013

    BM's like this just pisses me off.

    I'm sorry, I have really good reason to fuck XH over financially.  Not on paper, but honor bound, he owes me and my parents so much money. tens of thousands.  But I would never do this.  I can joke about a car, or him spending money on toys, but that's just a joke. I would never manipulate the system or him and put him in a position like that out of spite.

    It's just not right.  And karma is a real bitch. 

    She is so trying to stick it to him.  I'd see if this is worth trying to get her to pay at least half.  Check with your lawyer.

    "he offered her the world. she said she had her own" - poet Monique Duval
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  • KTdiditKTdidit member
    I would think that, based on your statement that they are to split healthcare bills 50/50 and that your insurance won't cover any of it, that BM would be responsible for 50% of the bill. Just because your H is ordered to have insurance on her doesn't mean he is personally responsible for what insurance SHOULD pay, kwim? I also think with a bill like that, the fact that you have suggested alternate places, and the fact that you and your insurance evaluated the facility and found it to be insufficient - a judge would see ow reasonable you are being and how UN reasonable BM is being. And would order her to change facilities. Keep everything documented and go talk to the lawyer.
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  • docco11docco11 member

    We have called our lawyer multiple times, no return calls.  We have called the CS case worker who really can't give us an answer other than "you are both responsible 50/50 and outside of that, a judge will have to rule".

    I'll have him try to call the center and see if he is in fact listed as the responsible party. 

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  • docco11docco11 member

     

    +just+j+ said:

    BM's like this just pisses me off.

    I'm sorry, I have really good reason to fuck XH over financially.  Not on paper, but honor bound, he owes me and my parents so much money. tens of thousands.  But I would never do this.  I can joke about a car, or him spending money on toys, but that's just a joke. I would never manipulate the system or him and put him in a position like that out of spite.

    It's just not right.  And karma is a real bitch. 

    She is so trying to stick it to him.  I'd see if this is worth trying to get her to pay at least half.  Check with your lawyer.

     

    We filed a motion to withhold child support, beginning next month, as she isn't in her care and hasn't been. The facility provides EVERYTHING. Clothing, medical care is sent through our insurance still.  There literally is nothing to support.  She sent a nasty text about it of course.  It's apparent to us it's ALL about the money.


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  • docco11docco11 member

    I guess what I am saying is that even 50/50, it's an unreasonable amount for us (or anyone) to pay.  Just doing the math, if 3 days ran 11k, her being in the facility for 5-6 months will mean that our 50% is 300K.  We cannot afford that. And our insurance company is saying that it doesn't qualify for out of pocket coverage (I cannot remember why right off hand, I need to go back through the letter).

     

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  • logansmom3212logansmom3212 member
    I think it's time for you to find a new lawyer or two. One that can help you fight things with the insurance company (have you filed appeals? Based on the language in your policy, they may have to cover her at least in part. im no expert, but you need to find one) and one to help with how the out of pocket stuff gets split based on BM's choices.

    I'm thinking that there is a lot of back story here that I am missing, but you need better representation. I'm also surprised that the facility has only billed for a few days if she has been there for 2 months... What is their response to the insurance company refusing to pay?
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  • docco11docco11 member
    logansmom3212 said:
    I think it's time for you to find a new lawyer or two. One that can help you fight things with the insurance company (have you filed appeals? Based on the language in your policy, they may have to cover her at least in part. im no expert, but you need to find one) and one to help with how the out of pocket stuff gets split based on BM's choices. I'm thinking that there is a lot of back story here that I am missing, but you need better representation. I'm also surprised that the facility has only billed for a few days if she has been there for 2 months... What is their response to the insurance company refusing to pay?
     
    Tons of backstory that some of the "oldies" may remember.  I don't want to hash it all out today.
     
    We are just now getting the bills as the insurance company just completed their arbitration review.  They let us know upfront, that they wouldn't be paying instead of billing us and then going through arbitration.  The 3 days were for the last 3 days in August that she was there.  We will be getting more bills very soon they said.
     
    We are long distance and they live in a very small town.  There are 2 attorneys in the town, his ex has one, we have the other.  We are open to getting a new attorney in a new town, we just need to do it.
     
    The facility can't release much information to us , they basically just acknowledged that it was up to her mom to move her if she wished to do so.

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  • +just+j++just+j+ member
    I agree. Time for a new lawyer and if its that kind of money it would be worth it to fight it in court. That could send anyone into bankruptcy and she does not have the rite to do that to you.
    "he offered her the world. she said she had her own" - poet Monique Duval
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  • logansmom3212logansmom3212 member
    Oh wow... The fact that she has joint legal and physical custody is the root of your problem, especially since he is on the hook financially. What a mess!

    I hope that the treatment that she is receiving will help her, but I also hope it won't bankrupt you in the process. I really think you need a great lawyer to help you through all of this and of your current lawyer isn't even returning your calls, you need to find someone else.
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  • dannie2011dannie2011 member
    Maybe the place she is at doesn't know she has no coverage, maybe telling them that you are not going to pay  for a choice her mother made. Which is pretty much what is the issue if your insurance won't pay she has no coverage. Would they want someone racking up a bill who won't pay.

    Sorry if that's not how things work, I still haven't figured out US insurance. Never thought of insurance before being Canadian.

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  • twister22twister22 member
    wendilea said:
    Did you bring this up to the facility when you first got the bill for 3 days?  Most inpatient facilities will make a parent sign a payment schedule.  The first bill may have included intake/screening so it may be higher than just the per diem.  Were you consulted at all prior to the admission?  Was it considered an emergent situation? 
    DH needs to:

    1) Call the facility. State that he does not agree to DD being in their care because; he cannot afford it, his insurance will not cover it, etc. Also, find out what the estimated cost will be when all is said and done.
    2) Email the lawyer that you have contacted x number of times with no response, and if you do not receive a response by y date that you will be terminating the contract, suing him/her, and contacting the bar.
    3) Find a new lawyer if need be.

    Holy crap this whole thing must suck. T&Ps your way.
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  • docco11docco11 member
    wendilea said:
    Did you bring this up to the facility when you first got the bill for 3 days?  Most inpatient facilities will make a parent sign a payment schedule.  The first bill may have included intake/screening so it may be higher than just the per diem.  Were you consulted at all prior to the admission?  Was it considered an emergent situation? 

    Yes we called thrm right away. They pretty much refuse to talk to MH but we can call back with those questions. 

    She sent MH a text that morning informing him of what she was doing. She did not consult him but we had been pressing her to get her help for some time.

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  • +just+j++just+j+ member

    not to hijack but Logansmom, Logan is a DOLL!

    "he offered her the world. she said she had her own" - poet Monique Duval
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  • NineoceansNineoceans member
    wendilea said:

    Did you bring this up to the facility when you first got the bill for 3 days?  Most inpatient facilities will make a parent sign a payment schedule.  The first bill may have included intake/screening so it may be higher than just the per diem.  Were you consulted at all prior to the admission?  Was it considered an emergent situation? 

    Exactly this. Usually they will get a copy of the insurance card too to have on file. If Bm signed as the guarantor then this will go on her credit too so she's absolutely crazy to wrack up these bills with no concer
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  • SigirSigir member
    it seems that since exw has sole legal custody, she gets to decide where the child is put. It's f-ed up that your dh has to pay 50 % when he has no say, but since that is the current CO, that is the reality. I cant see how you're going to get anywhere because she has all the power right now. I think all you can do it get back to court asap to try to fix it. why does she have sole legal and physical custody?
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