Medical insurance
Hi all! divorced father of 5 going on 10+ years. Children have been on my medical insurance plan through my company. At one point, many years ago during a disagreement with my ex, she mentioned she was going to put my oldes two "on xxx's policy anyway". Tried to understand the logic off and on, but never really gave it any serious thought. A situation has arose that makes me think of this, as I am sure my youngest two are probably now also on my ex's husband's medical policy.
It doesn't make sense to me why they would be on the ex's husband policy. I am sure their cost is deducted from his salary yet my ex uses my policy for all the doctor and specialty and medical treatments. Doesn't make sense unless there is a chance she is "double dipping"...meaning using my insurance for the visits and copay, then then collecting from her husband's policy? Wouldn't the court frown on that? My insurance sends me a standard letter and form, probably once a year, asking me if anyone on my policy has coverage through another policy.
Any insight, advice, and experiences would be appreciated!
Thanks!
I'm fairly certain that your
I'm fairly certain that your insurance would be the primary insurance coverage.. since you are the bio parent.. and if there is another policy.. (you are assuming).. it would be the policy for your Exwife's new husband.
I don't know that there is a concern for your Ins company whether it has primary coverage.. given you are a bio parent and the other policy is not bio parent.. then yours would be primary.
Have you thought about asking your EX whether your kids are covered by her new husband? Then you could answer your own ins that yes.. they have 2ndary ins via a stepfather.
Yours would still be primary.. and they technically would go against yours first.. and anything uncovered that might be covered under the other policywould be sent to the 2nd.
I think what you are concerned about is that your insurance is being used as primary.. but is your EX sending medical bills through her new husband's to get coverage for them there too?
I guess that's possible.. but in that scenario.. your wife would be the one (and her husband) to be in trouble for not being honest about the kids being primary covered under your policy.
It may be that her new husband has kids too.. and his employer cost is the same whether he has 1 kid or 12 on his policy.. so added your kids because it was no additional cost.. and perhaps there would be some marginal benefit for coverage under his plan that yours didn't cover.
Thanks Esmond. I realize EX
Thanks Esmond. I realize EX would be the one to get it trouble if she submitted full claims to her husband's policy after using my insurance at the actual doctor. My main concern is am I at risk with my insurance company if they know the children are covered under another policy. I suspect no, but haven't wanted to roll the perverbial dice.
What prompted me to post is the scenario you mention, only because of a large cost issue. Without notifying me, EX went out of network for an expensive imaging procedure for my daughter. The doc is in network, but actual imaging is capitated to a certain location based on who the PCP is. So...instead of flat copay, it was applied to my family deductible after being billed for 1/2 the cost. Then, when EX got the invoice for the balance, she paid it full, again without notifying me. Now, this cost shows up in her unreimbursed medical for 2024. I am a bit mad that 1. EX didn't tell me about the procedure. 2. EX went out of network instead of going to the capitated site (can't determine yet if knowingly or unknowingly). 3. paying the balance when they mailed her the bill...again without questioning it or notifying me.
So...aside from all the above, I can't help but be a bit disturbed if EX is "making" my unreimbursed medical of $1,500 on said procedure when she may have submitted the bill to her husband's insurance after the fact. There is a chance this may go to a hearing if I call her out on this and don't reimburse her for that. So I don't know if bringing up the dual insurance during the hearing benefits the case or not.
The only way I could see
The only way I could see “double dipping” is if she were paying the deductibles and asking you for half knowing her spouse’s insurance will cover what your insurance doesn’t. If that isn’t happening, there really isn’t anyway to double dip with insurance. Having dual coverage is legal and not really an issue, unless as I said she’s having you pay for things out of pocket that are being dual covered and she’s pocketing what you paid.
Thanks. I agree and don't
Thanks. I agree and don't see why dual coverage would be illegal. It just doesn't seem to make sense EX's husband may pay more for family insurance that wouldn't be used since EX uses mine. Unless...as someone mentioned...his policy is family oriented where cost is capped at a number of beneficiaries.
The scenaio you describe may be happening. My previous post describes an actual happening with an out of network imaging procedure in 2024 for may daughter.
My 2 cents
There was a year where my ex and i both had the kids on our workplaces' insurance. The rule for which was "primary", as explained to me by both companies, was that the person whose birth date is first is the "primary." My ex is a year older than me so his was primary, mine was secondary. I do remember having to fill out the form saying they were also covered by another policy. If i hadn't done that, i'm not sure what the consequences would have been.
I've read the birthday rule
I've read the birthday rule too.. but I am thinking because the other policy belongs to the new stepfather.. then this poster's policy would be considered primary. if it was his exwife's policy.. then yes.. birthday rule it would be.
Dual coverage is not illegal. But insurance fraud is.
If she is doubling on reimbursement from your insurance and her DH's, that is fraud. Insurance is designed to return the insured to their pre loss financial condition due to a covered peril. If she is profiting by failing to disclose dual or supplemental coverage to both insurance companies and they are both paying in full, then she is going after you to reimburse her for half of the invoice, that is fraud. Big time. Perpetrated against you, and potentially both insurance companies.
Contact your lawyer to confirm and clarify.
In one of my past lives I was a licensed all lines insurance adjuster and consulting insurance fraud investigator. If she is committing fraud it could void coverage by the insurance companies she is defrauding. Not to mention expose her to criminal charges.