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Who should pay?

all4myfamily's picture

Quick question about my DH's ortho bill for his son . . .

His son had braces put on a year ago. At the time both bm and dh had orthdontics coverage with their insurance. The total bill was $3,000 and each insurance was to pay $1500 and cover the entire bill. Less than half way through, dhd changed insurance companies and the new insurance only covered $300 more of the total bill.

There is now a $780 balance. Does that balance need to be split by bm and dh or is it dh's responsibility because his insurance changed? In the divorce decree it states that they split all necessary expenses after insurance. Bm is claiming that because her insurance paid more, she does not have to pay the portion that insurance did not cover.

We have been threatened with court proceeding over a small amount of money. We are not planning on going to court if she files papers. We will just pay it, but don't want her getting away with stuff just because she bullies us with threats.

Any advice? Does she have a leg to stand on our is she just acting out again with her stupid threats?

Rags's picture

It depends on what your CO says. Ours required the Sperm Idiot to provide insurance which he never did during the entire 17+ year duration of the CO. Either I provided insurance for the Skid through my employer or his my bride provided it through her employer whichever had the best coverage.

The Sperm Idiot had half of the cost of covering the kid added to his CS (only about $15/mo) since he failed to provide coverage.

This is where the CO addressed your question. Our CO clearly states that any medical costs not covered by insurance will be split 50/50 by the CP and NCP. My guess is based on the information you shared in your OP that this is likely the case in your situation. The $780 is not covered by insurance so it shold be split 50/50 by your DH and the BM. No differentiation is made between who's insurance paid what.

She pays half. PERIOD!!! If she is so big of an idiot to make an issue out of this since her insurance is apparently the primary insurance for the Skid you can always leave her to pay it and then she can try to collect half from your DH. This is what the Sperm Clan would do if they had to take the Skid to the doc or hospital while he was on visitation. Since I was the primary on the insurance they would refuse to pay co-pays or anything else and name me as the responsible party. It used to piss me off to no end but in your case it is a very good strategy to follow if you can.

Good luck.

OrangeUGlad's picture

Yes, she is required to split that cost, whether she likes it or not.

The question is how much of a fight is that amount worth? You could send a certified letter, quoting the court order with a copy of the bill. You can have your lawyer write a letter.

I would totally let her take you to court if she wants to file over this!! The judge would rule in your favor.

Pay your portion right away and then forget about it. Does the bill come to dh or bm? If it goes to bm, write one response to her request explaining that you are required to pay half after insurance- then completely ignore the whole thing.

If the bill goes to dh, the problem is that they will pursue him for her balance. The only recourse then would maybe be taking it out of any child support payments he makes if that is even possible or allowed in your state.

weekendwidow's picture

Rickyticky has it correct. They pay 50% AFTER the ins covers it. So whatever is left AFTER insurance, needs to be split. Easy.

Hennypenny's picture

I can see where she is coming from. At the time the braces were put on there was the understanding between BM and DH that after insurance there would be no out of pocket expenses. DH altered the circumstances after the fact by changing his insurance company. BM shouldn't be penalized for that.

OrangeUGlad's picture

What?!? Insurance pays what it pays regardless of how long you have had it.

It doesn't matter what is "fair" what matter is ONLY what the law/court order require which is that bm & dh pay for any medical expenses after insurance.

Sports Fan's picture

While technically your agreement says after insurance, it is crappy to try to make BM pay half of the $780. It isn't her fault that DH's insurance changed and now his insurance isn't picking up as much. If there was only one insurance and it changed then that would be different. BM is paying the premium for her insurance and DH is paying his premium. You had an agreement at the beginning of the treatment and to change it now is not appropriate.

all4myfamily's picture

The bill goes to BM. We have paid our half of the $780. She is threatening court because her half is going to collections. Dh has communicated that the CO states they split the total after insurance. But she claims that her lawyer assured her it is not her's to pay. She has her lawyer on speed dial and emails him for everything. She likes to waste money but will drag this out and try to stress out my dh. She does this all the time. I just needed a little perspective from others in a divorce situation. Thanks so much!

hereiam's picture

Honestly, I don't think BM should have to pay half of what your DH's insurance didn't pay because it was changed half way through.

Technically, I guess she probably does owe half of it but I don't think it's right considering she thought the whole thing would be covered by the two insurance companies to begin with.

weekendwidow's picture

^^^I was just saying this out loud that she didn't cover half. Her insurance covered half and His insurance covered some. SO what's left over is split 50/50.

Rags's picture

This is purely a math problem with no right, wrong, fair, or unfair to it. The CO says that mom and dad split all medical costs not covered by insurance. Just math. There is no stipulation of anything regarding who provides the insurance just that anything not paid by insurance is split.

This is nothing more than a 5th grade math word problem.

Braces cost $3000.00. Mom's insurance pays 85% of the cost. Dad's insurance pays 15% of the cost. How much do each of them have to pay out of pocket?

Ex. $3000 X .95 = $2850. $3000 - $2850 = $150. $150/2 = $75. Mom pays $75 Dad pays $75.

Or in this case they each pay $390. Just a math problem. Nothing more, nothing less.

OrangeUGlad's picture

I am guessing they aren't even both required to carry insurance. Which one is- dh or bm? Maybe bm should be thankful that they have two plans and don't have to split the entire $1500!

It sucks for bm AND dh that the insurance doesn't cover what they thought it would- but such is life, it does not change the fact that they are BOTH responsible for expenses beyond insurance.

Hennypenny's picture

And DH should be thankful that BM's insurance covers an entire 1500 instead of sticking her with half of his half.

I dislike BM, but I wouldn't do it to her, even if legally I am in the right. Would she do it to us? Probably.

PokaDotty's picture

I agree. If BM decides to drop her insurance, y'all are suddenly going to need to start paying more in co-pays. This fight could end up costing you more.

Hennypenny's picture

Will she? Our agreement says out of pocket expenses are split, but that expenses over a certain amount need to be agreed to in advance for non-mandatory medical expenses. In our case, braces fall under cosmetic needs (some don't, I realize.) If, in our case, we went from not owing anything to owing 800.00, BM would not automatically have to pay for half- she would have to agree to it.

Hennypenny's picture

Why be snide? That seems unnecessary. I was using my CO as an example that the blanket statement "she will lose" may not be accurate. COs can't cover all situations and are open to interpretation based on the actual language, which is why people are asking specific questions about wording.

OrangeUGlad's picture

It is unlikely that she is allowed to drop her insurance- their court order must require one or the other.

If she is NOT required (IME typically the NCP is the one required to carry), yeah, she could. But she would be shooting herself in the foot.

I would feel the same whether it was bm or dh who had to change insurance. Sucks for everyone but the court order is clear.

Glassslipper's picture

Court order says 50/50....its 50/50.
And I don't know your BM, but if she is anything like my BM, if we let this one exception slip by, she would keep trying to use it to her advantage over and over and OVER!
I would just simply say, Sorry BM, crap happens, but its still 50/50 per the CO.

AllySkoo's picture

Legally it sounds like she'd be responsible for half (although I think that might not be as cut and dried as it sounds in this post - judges don't like this shit and sometimes do things you don't expect).

Morally I think your DH should pay it. When the expense was first agreed to, you each agreed to pay half through your insurance. It's morally wrong to make BM pay for your change in circumstances when she didn't agree to it.

Now, if the question were "We are ABOUT to get braces for the skid and this is the deal, should BM pay half of out of pocket expenses?" then I would say yes, absolutely. The problem in the scenario you've got though, is that BM made the decision to get braces based on the fact that insurance covered your "half". It's morally questionable in my opinion to demand she pay for what you lost.

AllySkoo's picture

"I should go suing someone anyone because I can't muster up a few hundred bucks for my kid's braces"

Sure, but your exact same logic applies to Dad. Shit happens, his insurance isn't as good as it once was, suck it up buttercup and just pay for it instead of going to BM and whining about your insurance.

(Just playing devil's advocate here.)

AllySkoo's picture

I believe the OP said they were debating the fairness of asking BM to pay half the remaining balance - from the sounds of it, they haven't even brought it to her attention, much less to court.

In any case, a bit further on she says insurance changed when he changed jobs. Now, going forward I think you're correct - they split out of pocket expenses on future bills. However, for the braces I think DH should be on the hook. He made the decision to change jobs KNOWING this bill was coming, he should pay for it. It was COMPLETELY within his control, and generally people change jobs to better their financial position. It's unfair to better your own financial position and then use that rationale to make someone else pay out. Legal, maybe, but unethical.

all4myfamily's picture

There was not an agreement verbal or otherwise. BM took ss in for ortho appt and then everything was just submitted to each insurance. Their CO states that they each have to have kids covered. Bm had that changed because the original order stated the my dh had to carry them and she did not want to have to pay him monthly for the ins. premium so she took us to court to have that changed. So now that they both carry ins. the bill was submitted to both. The insurance changed due to a job change. Not saying that is was her fault but yes insurance companies change and policies change. Life happens. I am not saying that we should stick it to her, we always end up giving in and doing the right thing. But this time I am not sure what the right thing is. Bm is a selfish bitch but that does not mean that we have to stoop to her level. I just want to do what is fair.

AllySkoo's picture

Uhhhh.... what? Do you know this chick personally or something? Because you're attributing an awful lot of negative motivation to BM (and an awful lot of "pure as the driven snow" attributes to Dad)....

AllySkoo's picture

Actually, that brings up a good point - the way it was phrased "he changed insurance" rather than "his insurance changed" - seems to indicate that HE took the action to change is insurance. It's inference, certainly, but grammatically solid. And if it was his actions which resulted in poorer insurance, then I definitely think he should pay the balance.

moeilijk's picture

Every EMPLOYED person never has to worry about that. In Ontario.

I can't speak for provinces other than Ontario and BC, but when I moved from ON to BC and went from employed to self-employed, I was surprised with the insurance premium hit from the gov't. Healthcare is NOT as good in BC as in ON, not many of the extras are covered even via employment.

Sports Fan's picture

I'm with you. He changed jobs thus changing the amount of coverage. When BM took the child to the orthodontist, neither of them was going to pay anything out of pocket. Their cost was going to be what they each paid for their insurance since the insurance was covering the treatment. Their cost was their insurance premiums. Now, down the road DH changed jobs and changed his insurance and the amount it covered. HE owes this amount, not BM. His premiums for this new insurance is probably less than the other policy since it covers less. How is it fair that he is probably paying less for his premium now and he also expects BM to pay more.

sickofitall's picture

My DH's CO says just that he has to carry medical and dental and all unreimbursed costs are to be split 50/50. My DH did call his lawyer and ask when we were switching and they said it doesnt matter the level of insurance. Just that there is a plan in place covering SD. And BM never argued abot covering her half. She complained but didnt try to fight it.

Sports Fan's picture

Ortho treatments work like this. You submit for it at the beginning of the treatment and payments are made by the insurance company throughout the course of treatment. If for some reason, you no longer have the insurance anymore, the payments stop and you or the new insurance is on the hook for the remaining amount. We just looked into this since DH is changing dental insurances in 6 months. We didn't want to start SD's ortho until after the change because of losing benefits. The second company doesn't pick up the total amount that is left on an in-process treatment.

aggravated1's picture

Foreverstacey, i don't think you understand how insurance works in the US.

And as someone who works with insurance companies, you can never be sure how much they will pay on anything. In fact, most dental secondaries won't pay as much as they would as a primary because they expect the primary insurance to pay more. The way to determine in most cases whose comes first is whose birthday falls first in the year. So using some of this (crazy) logic I am seeing here, the OP'S DH would have to pay more because he was born in August and his ex was born in June? Sigh. Rarely does it work out to a 50/50 split-and employers change insurance and coverage on us at least once a year in a lot of cases.

Its a court order. Split after insurance pays. Its not rocket surgery, people.

onebright1's picture

This is similar to a situation I have at the moment. BD10 is going on a Washington DC trip with her class in 2016 which will be 7th grade. Her school starts the kids fundraising for it in 5th grade which is now. At this moment she(I) am selling wreaths, coupon books, trash bags, pizza, and have finished with the bake sale and catalog sale, and will be doing more this year and all again next year.
The cost of the trip is 900$
Her dad agreed to split the cost with me.
Whatever is raised comes off the 900$
Since I am the one doing all the fundraising with BD10 should I get it all off my half?
NO!
My SO thinks so, but I disagree.
Whatever the end result is owed at the time of the trip is what we will split.

Sports Fan's picture

This is what I said. He's paying less for lesser insurance and now trying to stick BM with part of the costs. Not fair and not cool.

Hennypenny's picture

Except that he may not be paying less for inferior coverage, he just may have different coverage- for example, worse dental coverage but lower copay or deductible or something. He could be paying the same or more depending on the policy and how much the employer covers.

But this change was after the fact. Future care can take these changes into consideration. I think costs associated with procedures that were carried out under the previous arrangement should be paid for based on the previous arrangement. Which means BM pays zero, like she thought she was paying a year ago.

OrangeUGlad's picture

"If he changed insurance companies and that company pays less, then that means that insurance doesn't have as much coverage and his previous company or as much as BM's company. And.....that also means DH pays less for that insurance"

Uh... no it doesn't. Thinking of all the insurance plans available to me and spouses over the years through work- 1. you often have no choice in the plan or at least limited choices. 2. Cost to the employee and level of coverage are not correlated between employers.

I have pretty good coverage and a moderate premium. I could pay more for a higher level of coverage. But dad in this case did not voluntarily choose a different plan with a lower premium and lower coverage- he got a different job.

If I change employers though- it is a whole new ball game! My last employer I would be paying 3x what I am now for much less coverage. My ex paid more, but got better coverage; bm pays less and gets better coverage. My Dh doesn't have any available at work!

People change jobs, it is a part of life! When people change jobs, sometimes their insurance plans and income change. The courts understand those changes are a part of life.

aggravated1's picture

What if his premium is more than ex wifes's? Does he get a credit for paying more for his insurance?

I can't see a judge even bothering with this miniscule crap. Insurance changes all the time. People have to take other jobs. I havent changed jobs and our insurance this year that we are being offered is more expensive yet crappier than the year before.

Calypso1977's picture

here's my take on this.

they BOTH made a decision on the braces based on certain information. that information was that they were each responsible for $1500 and at the time it was agreed to, insurance was in place for both thus no cash out of pocket.

i dont think BM should be responsible and here's why. had she known this initially, she may have decided not to agree to the braces if she couldn't afford half the cash amount.

aggravated1's picture

What if BM had no insurance and OP's DH had insurance? Who should have split the balance after insurance paid?
I would really like to hear the answer to this.

Hennypenny's picture

I hope she shares her decision. This reminded me of the mock trials we used to have in high school English class (did Hester deserve to wear a Scarlett A?) Next time I am hoping to be on the prosecution side instead of the BM defense team. I hate having to publicly take her feelings into consideration.

moeilijk's picture

It's unfortunate that the DH's insurance coverage is less now than expected, but the CO was clear at the beginning, middle and end of orthodontic treatment. There can be no reasonable expectation that insurance will pay a certain amount nor that insurance will continue to pay, unless the insurance company provided a letter confirming payment - in which case I suggest DH hold the former insurance company to their commitment. But that's pretty darn unlikely.

The BM has the same right to change (or is subject to the same whim of employers/ins. companies to change) insurance coverage as DH. Perhaps when the next big expense hits, her coverage won't be so generous. Let's say, eye-glasses.

It's unfortunate, and if she were a half-way decent co-parent, I'd probably try to insulate her from the unexpected expense at least somewhat. But if she's difficult and contentious, I wouldn't - because I couldn't expect cooperation when something unfairly affected me negatively. I would just follow the CO 100%.

QueenBeau's picture

I could see this agreement changing if they go back to court, which is why I would just pay & keep quiet.

Here, we carry SD's medical insurance. BM pays the first $250 out of pocket expenses & then costs are split 60/40. BM pays more out of pocket because DH carries insurance & she doesn't.

If BM picked up coverage, this would change. But our plan is a 90/10. If BM went & got a 70/30, she would be responsible for more out of pocket expenses than we would. If this goes back to court & DH's plan is a lower plan than BM's, he would be responsible for a higher % of the out of pocket expenses. So yes BM would have to pay some, but maybe only 30% & then DH pay 70%.

If I were BM, I would take him back to court either way since his new coverage doesn't cover as much and have it modified so he paid more of the out of pocket expenses. I actually wouldn't be surprised if she did that.

Sports Fan's picture

They already made their decision. OP said that they paid half and the other half is in collections. They have already "stuck it" to BM by allowing it to get to collections. She said BM gets the bills so it is effecting BM's credit already.

QueenBeau's picture

I do think she could fight this & win it in court if she's in a state like ours. They calculate how much of the medical expenses you have to pay based on how much your insurance covers. So if DH's insurance covers 90% of expenses (like ours) he doesn't pay anything out of pocket until BM hits a certain amount, then they split 60/40. If BM had a 90/10 they would split out of pockets 50/50 the whole time. If BM had say a 70/30 & DH had a 90/10, she would pay a higher % of out of pockets.

She may not be 'sticking it to herself' as much as going to take it back to court & have it modified because OP's DH's plan changed.

Willow2010's picture

IMHO...CO says they are each to pay half after insurance pays. Unless it says that each must have insurance to cover half every time, there is nothing BM can do. It is her responsibility to pay half of what is left over after insurance pays per CO.

I think a judge would see it that way also.

But due to the circumstances and the fact that OP said it was a small amount of money, I would probably go ahead and pay if I was DH.

twoviewpoints's picture

I'm curious (not that it matter, just curious)what if any deductible OP's DH's dental insurance charged DH before his new provider ever kicked in? . The company paid a very lousy 10% of $3000...appears to be pretty poor insurance which would hardly be worth paying premiums monthly for.

Did his insurance company pay so little on this submitted bill perhaps because say DH has a large deductible yearly on dental before it is activated? Example, say his provider has a $750 family deductible a year before they pay a dime. If that is the case, DH paying the first $750 of submitted bill would not leave a 50/50 spilt with the BM after insurance is paid. The $750 would be before insurance is paid on his part and would not count towards what's left after insurance pays. They both have to provide insurance per the CO. They do both carry the mandated insurance. However BM is not responsible for whatever cost it takes to actually activate OP's DH's policy benefits.

sickofitall's picture

We have actually had this scenario happen to us. My DH had great dental insurancr and we moved out of state and had pretty bad dental insurance. My DH has been at his job now for 7 years and dental has changed about 3 times. Some times better sometimes worse. Medical has stayed the same and is excellent. Our BM is extremely greedy and court crazy and tries to get every dime out of us.

She complained about our dental being horrible and DH agreed but it is what it is. She has paid half of whatever hasnt been covered all along.Before we voluntarily changed insurance because of moving nothing was ever needed to be paid out of pocket. Now most everything does need money out of pocket.

She has never threatened not to pay her half and trust me if she had a leg to stand on she would.She sis try to open a Carecredit card in my DH's name illegally and the dentists office shut her down and called us. But thats another story...

So I would say this is one of those things in life that can happen whether divorced or not. If they were together and insurance changed it would just be an unfortunate blip in the scheme of things.It should be able to worked out like reasonable adults and the fair thing would be to split it. Its both of their child.

It just seems petty to me on the BM's side. Shit happens. Things change. Its not thousands were talking here.

Irene H.'s picture

I think if there'd been no change in the insurance, and there was a balance at the beginning, it should be split. But an added charge after things were underway, caused by a change in someone's insurance, should be covered by whomever's insurance changed. The other person wasn't the cause of the change in charges, and didn't get a chance to commit or veto. 
Bur my DH says you're right so...I guess it's a judgment call.