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ExH trying to pull a fast one on me

EvilWickedSM's picture

Our daughter is getting some orthodontics work done. Her dental insurance covers half of all ortho costs. The orthodontist’s office filed a claim. I asked them about the claim status, and they checked for me. They let me know that the claim had been accepted in the beginning of December and that the check will go to the enrollee, in this case my exH. He hasn’t said a word to me about it, hasn’t submitted payment to the ortho for the portion the insurance covered. So, what it appears he is going to do is pocket that money and use it to pay his half of the costs, leaving nothing coming out of his pocket, and leave me to pay the uncovered portion. I am giving him the benefit of the doubt though and am going to ask him about it. Our agreement is that I pay the first $250 of uncovered medical expenses, which includes co-pays, etc, and then we split 50/50 of whatever insurance doesn't cover. I had already hit my $250 this year, so the entire uncovered ortho bill should be split 50/50.

Calypso1977's picture

does he know a check was mailed and that he should be on the lookout?

i work in benefits, and i cant tell you how many times our insurance companies mail things to our employees that go for weeks or even months without being opened or more often than not, thrown in the trash. ive even had people throw away their insurance cards thinking it was junk mail!

EvilWickedSM's picture

Oh gosh, that would be terrible if he accidentally threw it away! I don't know if he has received it or knows it's coming. I'm sure that he would have received it by now though, so it is possible that he doesn't know it came. I sent him an email asking him if he'd rec'd or heard anything and that I had talked to the ortho and that the claim had been accepted. I really think (because things are so crappy between us right now) that he has no intention of me even knowing that insurance covered half of it, because he kept saying that he didn't think they did. But, who knows.

twoviewpoints's picture

Call back and ask when the check was cut and actually mailed (released). Your wording above was 'accepted' and 'will go to'. The check may not have been released yet, even though the claim was accepted.

If it's not been actually mailed out yet, you're now alerted the ex it will be coming, what it is and to watch for it. You should also put a bug on his buns as to what he is expected to do with the check and the terms per the CO share of cost.

Currently some of my providers receive their insurance payouts 3wks after company 'accepts' claim and agrees to pay. You won't know if ex is lying or being a greedy jerk until you know exactly when check was released. I hope he's not shorting you. No matter how well or not well an ex and the opposite parent get along, it's just silly to short the one parent...all it ends up doing in the end is taking money out of the kids pocket.

Calypso1977's picture

thats just odd that the insurance even mails a check to the enrollee rather than just processing the claim and paying the provider.

if he did throw it away, they can easily stop payment and issue a new check, but of course that may delay things with the doctor.

EvilWickedSM's picture

I thought that was odd too. I would have thought that they would send the check to the person/company filing the claim, so that they are guaranteeing the doctor is getting paid for their services.

EvilWickedSM's picture

I did check back with the ortho yesterday and they sent me the paperwork from the insurance company, showing the check amount, number and it states that it was sent to the "enrollee", which would be exH. The check was for the total half of the work that she is getting at this time. I am still shocked that they wouldn't send that directly to the orthodontist. He said yesterday that he hadn't heard anything back from them. I'm going to email him today and let him know that a check was supposedly sent to him, according to the insurance company.

IAMGOOD's picture

Why don't you stop speculating and follow up on the e-mail. I understand not all co-parents work together well but at some point in time it is so much easier if business becomes business. Not emotions. I am shocked they would send any check to him - and if they did it should be made out to the orthodontist. I actually doubt the check went to him. Sounds like dental provider messing up. Has he stolen money in the past from you?

EvilWickedSM's picture

No, he hasn't stolen money in the past. However, we are currently in a fight regarding CS. Basically, he agreed to me moving, and when I went to finalize details to get it in writing, he is holding his agreement to me moving (but not so far that it would affect him and his visitation) "hostage" in exchange for me to cut CS in half (this is after I had already agreed to a lower amount a few months ago). We don't, yet, have a court order for CS, but I do have an appointment with an attorney to get the ball rolling. The last check he sent was half of what it should been, and he said he is not paying me any more than that because he can't afford it, and if I can't afford to take care of our daughter then he will take her. So, basically, in a nutshell, everything is always about the $ with him, so I don't doubt for a minute that he would take the check, give it to the orthodontist as payment for his half, and tell me that the insurance didn't cover anything so that I continue to pay my half, which will end up being the entire uncovered amount. As I dig deeper into this today, I found out from the orthodontist that they filed a claim with the insurance for our initial x-rays back in the summer, and that the insurance cut a check to the enrollee for half of that. I was never told about it from exH, so he pocketed the money, again, leaving me to pay the entire uncovered portion. I haven't talked to him about it yet as he hasn't responded to my most recent email. Yesterday when he responded he said that he hadn't heard anything from the insurance company. The insurance company may have messed up, but since it's been two checks now, I doubt that is the case. Unfortunately, I can't call them because it's his insurance, and I doubt they will give me info, but I do have the printouts that the orthodontist's office gave me with the info they got from the insurance company when they checked the status of the most recent claim.

EvilWickedSM's picture

Well, I ended up calling the insurance company to verify what information the doctor had been given. It was all automated, so I was able to access the information with the information from the insurance card and my daughter's date of birth. They are indicating that the check was mailed on December 13th to "the member", which would be my exH. I'm going to let him know in the off chance that he didn't recieve it.

IAMGOOD's picture

sounds frustrating!!! With all you have said then maybe he is pulling a fast one. My x husband signed a paper so that I can call for both health and dental and get information about my kids. He can do that! Sounds like he may not let you - but in order to manage their healthcare the best you should have that legal authority with the plans.

If he suddenly cut in half what he is paying you then he is in contempt. I am not even sure you need a lawyer for that one - I know here the state attaches their wages with the filling out of a form.