Some questions in regards to health insurance, sorry it's lengthy!
Hello. I posted in General as well, but realized it's definitely more appropriate here. Thank you to those who directed me here.
Our situation is complicated, because the child was born during our marriage (you can read my post in General or the Bio for more info). We currently have no contact with the child (who is an infant) or the BM for multiple reasons. This may change in the future.
My husband was ordered to provide medical insurance. Since I carry our family's plan thru my employer as it was MUCH cheaper than my husband's employer, the child will be put on my insurance. Currently the child is on state aid because BM doesn't and will not work.
Sorry if this post is more detailed than the post in General; I was posting before with 2 screaming kids in the background and now that 1 of them is asleep, the other one is almost asleep, I can take my time.
Chances are she is going to fight tooth and nail to get the child off of the insurance or to try and have the state cover him, although the judge already told her too bad so sad, if there is an option for private insurance then the state doesn't want him on their aid. Or she won't use the insurance.
A big problem is that WE do not know anything about her (yes, it is sad and embarrassing for both of us to admit this). From what we have learned so far is that she is a manipulative con artist who will lie to try and get her way.
1. I am incredibly concerned with BM having access to our insurance. The child will receive the card soon (I just submitted the paperwork last week). The insurance company and my employer have reassured me that unless I permit it, BM has zero access to the insurance, INCLUDING the child's info. She still has access to his medical records (which we do not as the courts gave her sole legal and physical custody). I do NOT want her to have access and will not permit it unless court ordered to do so; I have no problem mailing her any info such as the EOB as necessary. All claims come to me since I am the policy holder. She will be able to get general information, like which Dr.s are in network, copays, etc. The court order just states that my husband is to provide the insurance, not that we have to allow HER access. Anyone dealt with this?
2. Multi-part questions: She is responsible for the first $250 of "routine uncovered medical expenses" and I'm assuming that means copays for Dr./hospital visits, prescription drugs, etc. It IS her responsibility to keep detailed records, correct? Also, can we demand to see those records prior to paying anything? Finally, once she has paid the first $250, how do we go about paying the other half? My husband wants to directly pay the Dr., which could work; but what about pharmacy? We are incredibly hesitant to send her money that she may not pay the Dr. with, and then still be on the hook to pay.
3. If she chooses not to use the insurance, are we still responsible for medical expenses that could have been avoided if she had just used the insurance?
4. What happens if she is a no-show to an appointment and gets charged a fee for that? Example my Dr. office will charge a $50 no-show fee. Does that count under the "medical expenses"? We are concerned that she will make appts and just no show to try and be a pain in the ass. She made it VERY clear she did NOT want the insurance for the child.
5. If she does not follow directions and constantly goes out of network (this insurance is AMAZING and there are so many doctors there should really be no reason to go out of network) when she COULD go in network, how does that work out?
6. Finally, if she were to actually go and get a job and get insurance (unlikely, but hey you never know), but we were the ones ordered to cover the child and we are, would we be responsible to pay for it? Unfortunately there was no information about that in the order, which was amazingly short and left a lot of questions. Although we don't get a credit (I have a family plan which does not cost me anything extra to add the child) it IS cheaper in the long run for me to provide the plan. I just don't see it making sense if she tries to get insurance and then we get charged/have to pay 1/2 of it when this child will be on one of the best plans in the state at an incredibly affordable rate.
7. Will she have to put me down in the medical record as the policy holder--and if so will I have to provide the Dr./hospital with my SSN? We have taken great measures to make sure she does not get ahold of that information.
She told my husband that the child was sickly and she could not afford the constant paying of copays, however she refused to tell him what was wrong. I think that's why she doesn't want the insurance--we will be able to see which doctors he is going to. If there is something wrong with the child, what rights does he have to know? She has sole legal and physical.
Sorry for the lengthy novel; if you made it this far I just want to say thanks!!!