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BM/Medical Part II- advice requested!

MJL2010's picture

So the other day I nutshelled about SS7, who had fallen while ice skating and hit his head. I observed, kept checking him, and finally took him to Urgent Care as he seemed pretty tired. They told me that if I suspected a concussion, I should take him immediately to ER. He vomited on the way and off to ER we went. After a long afternoon, he is absolutely fine, thank goodness- they didn't even order a CT scan.

Of course this has become an issue with BM. Here's the latest:

She sent an email to DH telling him what he'd *have* to pay. She refused to provide bills. So of course we called the insurance company. (SSs are on her health policy.) Insurance company gave us the claim information with no problem; we have their policy number and, duh, didn't ask any questions about her health- asked about the status of these claims.

All three ER-related claims have been paid for with money that her company kicks in as a "health fund". (Read: not money that she paid from her own pocket, not money that she will get back if she doesn't use; money that her company sets aside to supplement employees' benefits.) She didn't tell us that the claims had been paid for- she told DH that he owes her in order to pay the ER bills. So basically she would pocket the money that she didn't pay in the first place.

It seems really shady to us. If skids are going to be on her health care, yet the money that her company kicks in is only for her use (she doesn't want to pay for her own children with that money), we may as well have separate insurance for them while they're on our watch. And like most people, there is no way in hell that we could afford that luxury! (And it's probably fraudulent anyway- are any people, minors or adults, allowed to be covered under multiple health policies?)

We have no problem paying the co-pays when the co-pay bills arrive- in the percentage specified by their CO- and would even consider, as this was an unexpected, unfortunate incident brought on not by anyone's negligence, reimbursing her in that same percentage going forward (but for how long, to what amount? Probably will be decided when/if this goes to small claims court) for costs that she now has to pay for her coverage out-of-pocket because the health fund has had a large chunk taken out of it due to SS. My questions to you are:

1. Has anyone dealt with a similar situation?
2. Is it pretty shady of BM to want us to give her money to pocket that was never hers to begin with?
3. Are there any solutions to health coverage between households when one of the bio parents is a lunatic?
4. Or am I completely off-base here?

Thank you in advance, Steptalkers! Have a great day!


Justwantsomepeace's picture

Some of the counties also have info about marriage licenses granted on the county website. Look for a register of deeds search. If it isn't there, it will tell you contact info to find out.

B22S22's picture

1) Yes, people can be covered by more than one policy. The DOB of the policy holder determines which one is considered primary, then the other is considered secondary (unless, of course, there is a CO, which could change that)

2) My opinion would be "No EOB (explanation of benefits - an accounting from the insurance company showing what is paid by insurance, what portion policyholder is responsible for), No Money" If I were you, I'd send BM an email (document, document) requesting a copy of the EOB from the insurance company for ALL VISITS. If she complies and the EOB's show Zero account balance, then your DH owes NOTHING.

My DH's insurance had some crazy policy that it would cover only SIX doctor visits a year. That policy covers him, me, my kids (2), and his kids (2). BM "conveniently" takes her kids to the doctor constantly at the beginning of the year and sucks up all the benefits, leaving us to be 100% responsible for any MD visits after the first 6 (including any my kids have). She doesn't worry because her DH also covers the skids so she never has to pay anything. Thank goodness that rule is changing on 1/1/12.

VioletsareBlue's picture

I agree.... ask for every EOB. Don't pay a dime if she didn't pay anything. What does the CO say about health care costs? Our BM has to pay 35% of anything out of pocket.

giveitago's picture

Our idiot BM thinks we are the bank of BM! She asked for extra money on the CS check for school supplies...erm...not happening! One time she demanded it and DH left the money (usual amount) for one of her minions to collect..oh and we expected SD's medicine too! What is wrong with these folks? Anyhow, she asks me if the extra is there and I tell her it's not. She demands to know where DH is and to have his work cell #. I tell her I have no idea where he is, true I didn't...he left for work and he could be anywhere on call at any given point, besides, I did not need to know his whereabouts!
She cusses at me, tells me I cannot find my ass with both hands in my pockets. She calms down, asks again if I can call him and ask him to put extra money there for her. I tell her no. She goes off again, she demands to know where he is..DEMANDS! I tell her he crawled up my ass and I can find neither it nor him (click).