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Medical outrage!

Zaboomafoo3's picture

Ok...I have to ask. Does anyone have an ASO insurance plan?? How does it work? The mobster (aka SS10s so called mother) has taken this kid to the doctor numerous times for stupid stuff and is trying to stick it to DH. Well...the CO requires him to pay half of the uncovered medical IF she provides proper documentation within 30days of receipt of bill/payments made. Which she usually doesn't do and she has yet to send something that we don't have to send back and tell her to FIX if she wants to be reimbursed. We have requested several times for the kid to be added to our insurance on top of this other crap so he is well covered to which BM will refuse every time. Well....who in their right mind refuses better copays, coverage, etc....when you have racked up over $800.00 in medical in 3 months??? Yeah, urgent care 2 weekends in a row, 2 imaging appointments that were not discussed etc. They have joint custody and she neglects to tell DH anything but wants foot the bills. We think she is getting a kick back with this "ASO" insurance as it is something that her employer provides and from what we read on line she is covered fully by her employer then and doesn't come out of pocket. So therefore....we are confused as to how there are $800 in medical for the past 3 months if she doesn't have to pay anything.... Any help appreciated.


Last In Line's picture

I had to look up what you meant by an ASO plan. I have previously had that type of insurance, and DH currently does. It is administered by a regular health insurance company (Such as United or Humana) but the funds that pay claims are held separately instead of being paid by the health insurance company. Honestly, I don't see how kick-backs would be something that could happen, unless they have a very unusual situation where they are acting as their own administrator, but then their network would likely be teeny tiny as insurers negotiate with each provider to set rates and such.

She probably is using providers that are out of network, or having procedures/treatments that aren't part of covered services.

Zaboomafoo3's picture

The company that BM works for owns the insurance company. She works in the medical field. So all the doctors etc are in network as they are all part of this particular health care system. What we don't understand is why keep paying so much out of pocket when we have offered to add him to ours (it wouldn't cost us anything as we already have a family plan). I think she is up to something and it just is a matter of finding out what.

twoviewpoints's picture

"We think she is getting a kick back with this "ASO" insurance as it is something that her employer provides and from what we read on line she is covered fully by her employer then and doesn't come out of pocket. So therefore....we are confused as to how there are $800 in medical for the past 3 months if she doesn't have to pay anything."

That's not how a self-funded works. What it means is the place BM works (whether a large company, public service such as state employee, or whatnot), her employee healthcare benefits are self-funded by the employer aka the risk is on the actual employer and not a self pay insurance company . Not that the place hands it out all 'free' or that none of it, including premiums, deductibles, co-pays have no cost in the benefit service.

For example say BM pays $500 a month for her family plan her company offers. Now say her per person yearly deductible is $1500. Now say Junior goes to dr three times in three months grand total $800...ta-dah, BM owes $800, employer owes nothing. Thus if your CO says Dad pays 50/50 period of uncovered medical, Dad owes $400.

Some large employers may contract a insurance company for setting the standard coverage and administer the paper processing. The contracted company gets a fee for their work, but the cost of the actual medical care risk in the way of patients bills is on the actual employer. Not the contracted administration insurance company. Yes, employer may still do negotiations with providers for the medical services such is practice with preferred providers.

edit to add: I just read where you said BM works and who self-funds her benefit program. I imagine the bulk of cost she's seeing right now is her yearly per person deductible and her 'cost share' if deductible reached.

Instead of you sitting there guessing or trying to catch her, Dad needs to ask for specific information of exactly how BM's plan works. She should be able to show you her employee benefit healthcare program plan/s, whether online or a printed out summary.

Zaboomafoo3's picture

This is where the problems lie. 1. She REFUSES to co-parent and with them having joint custody but her being primary custodian she thinks DH has no parental rights. We have called her out on the communication skills that she lacks several times to which she just says how DH doesn't communicate either. (But the judge seen different). 2. She REFUSES to give us anything about the insurance period. We have asked for a copy of his insurance card...nothung. We asked for policy info....nothing. So we started asking about ss10 being put on our insurance and she says "he has insurance". So now we are left with legally going to take action because she REFUSES to comply with CO.
What we don't understand is if her insurance is " so bad" that she is coming out of pocket all this stuff...then why not let us cover him where it is CHEAPER. That's the catch. She is either not having to pay anything or is getting reimbursement from us as well as employer. From the way things read on that particular policy via the internet. But as I know not everything is "true" on the internet we are going to have our lawyer look into it.

Zaboomafoo3's picture

He could but with her NOT sending bills and only sending "patient payment receipts" he is questioning why there is NO bills. She says she gets billed and the other day says "oh we just got this and I will send them as I pay them." Funny, the bill she just supposedly paid was ALREADY sent to us TWICE with different dates of payment!!! She works in the offices where she can print out copies of payment receipts and all so we are going to have to figure out a way to make it where she has to send an actual bill not a "payment receipt" when that doesn't tell us who was seen where etc.

Zaboomafoo3's picture

That's the problem. We don't get ANYTHING from anyone but her. She doesn't have a bill mailed to us etc. We could put SS10 on our insurance and she refuses. DH is obligated to pay 50% of uncovered medical within 30 days of receipt of bill.. Well we aren't getting bills we are getting "patient payment receipts".