Splitting health costs

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Associate of Daniel

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Splitting health costs
« on: September 12, 2018, 08:42:06 AM »
Here I am again trying to solve the unsolvable.

U/npd exH has a family health insurance policy that covers him, his Nwife and ds11.

His premium is no higher for having ds on the policy than if it was just u/npd exH and his Nwife.

The latest rule he has laid down is that I'm not allowed access to the policy to claim anything for ds.

He earns double my entire income and she probably earns more than him.

Ds is with me 64% of the time.

So I am currently paying for most of ds's medical appointments in full. Some are partly refunded by Medicare/concession but not all of them are.

We currently have a situation where I have paid for orthotics for ds to wear 24/7.

U/npd exH is refusing to pay half (all of $30), even though ds wears them when at his house.

Ds is about to start wearing contact lenses every day ($100s).

Let's pretend for a moment that u/npd exH is rational, normal and fair.

Who pays how much?

And I can't afford health insurance.

AOD

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HotCocoa

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Re: Splitting health costs
« Reply #1 on: September 12, 2018, 09:57:39 AM »
He is using finances as a weapon to abuse you.  If it trickles down to your son, he doesn't care.  The only way to fight this is through the court system.  In the US you would be able to take him to support court, file with the court then show up and hash out your finances with an officer of the court.  I have done it, I had an attorney, but you don't have to for something like this.  You would need proof of your expenses and income and tax returns.  The only way I got my ex to pay was through the courts.  At one point, he was ordered to pay 90% of all childcare costs.  That is the discrepancy between our income.  He was threatened with jail and having his professional licenses taken away if he didn't pay, as well as his driver's license. 
Trying to reason with him just didn't work.  He is unreasonable.  I would venture to say, so is your ex.  If by hurting your son he hurts you, then it is a win to him.
The courts have to hash that out, no matter how uncomfortable because your son deserves to be taken care of properly.  I would also say that I want access to his medical insurance including his medical card so when you take him to medical appt's you have what you need so they can properly bill the correct party. 
The smarter you become about narcissistic abuse, the crazier the narcissist will say you are.

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Stepping lightly

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Re: Splitting health costs
« Reply #2 on: September 12, 2018, 02:23:12 PM »
hi AoD,

I don't understand how you can't access the policy to claim anything for DS.  Is he preventing you from taking DS to the doctor?  I bet that would be interesting for a Judge to hear about.  What about the doctor filing the claims and then DH letting you know your cut?  You don't actually need to access the policy to be able to take advantage of the benefits of DS coverage.  There should be standard out of pocket and co-pays for their plan.

For us the split in responsibility for healthcare costs is specified in the CO.  The problem is, BM has forced a situation where DH really can't attend the kids doctor's appointments because she is so horrid to everyone when he does...and then twists it to be his fault (making nonstop ridiculous accusations).  So...basically she just extends her hand for reimbursement.  She refuses to provide the insurance explanation of benefits, which would detail what is owed after insurance pays (and she DEMANDED to hold the insurance and won't allow DH to hold it).  So, we suspect she is actually making money off DH the more she takes the kids to the doctor....lovely eh (even better that we suspected Munchhausen by proxy even before this setup)? But with everything, we have to determine how much of a battle we want to wage.  When she files for more child support, she'll have to show the EOBs for the past several years.....could be ugly for her.


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Associate of Daniel

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Re: Splitting health costs
« Reply #3 on: September 13, 2018, 07:32:53 AM »
Thanks, SL and HC.

I'll respond properly later. I just want to give you the latest.

He's refusing to pay me $30 for half the cost of the orthotics but is now saying he'll pay for a 2nd pair in full ($60+) himself for ds to wear when with him. Although it would probably cost him a bit less once claimed on insurance.

I'll check with ds's 2 podiatrists (yes 2. Don't ask. I'm sure it won't take long for you to work it out!) tomorrow whether having 2 pairs of orthotics is sensible.

But I can't help thinking, what happens if ds needs braces for his teeth?

By u/npd exH's logic, he would pay ALL of the $1000s if they are appied during his time, I would buy a 2nd set to be swapped every few days at changeovers....  :stars:

Ds doesn't have sneakers at u/npd exH's place so uses the ones I buy ($160). He only has sports boots, thongs and dress shoes.

Should I bother replying?

AOD


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Rose1

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Re: Splitting health costs
« Reply #4 on: September 13, 2018, 10:48:33 AM »
No. Its probably his wife having the tantrum anyway. It's stupid. Maybe he will figure out the orthotics won't work with thongs. I would record it and add it to the mountain of evidence when it comes time for him to take you to court. Make sure you mark them with texta so that as they wear you won't get his mixed up with yours. Could cause ww3
« Last Edit: September 13, 2018, 10:50:57 AM by Rose1 »

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Associate of Daniel

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Re: Splitting health costs
« Reply #5 on: September 13, 2018, 07:15:33 PM »
I'm in Australia, where the health system and insurance policies seem to work differently from America.

Basically, to make any claims on u/npd exH's insurance  I need access to the policy number and to be listed as a limited authority on  the policy.

He won't allow that.

The practioners who have the policy number - that only happens if u/npd exH has paid for any appointments, which is rare since I"m the one who takes ds to most appointments - can't give me the policy details due to the insane privacy laws in our country. 

Our situation regarding Ds's health costs and who takes ds to appointments really has been one 6 year circular conversation.   We need the slate wiped clean and someone in authority to say who does and pays what.

It would be great if there was a set formula which takes into account our respective incomes, the percentages of time ds is with each of us and the child support amount that u/npd exH is already paying me.

And that that formula could cover other expenses such as school costs.

AOD

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sonto92

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Re: Splitting health costs
« Reply #6 on: September 13, 2018, 11:53:42 PM »
I know that with PDs you have to pick and choose your battles - this one to me looks like a battle you should take. I donít think it makes a difference who has the insurance, if the kids are covered it doesnít make a difference if itís your policy or not. The kids should be able to go on your exís Insurance. Where it gets complicated is the reimbursement if you are on a deductible plan. Uggh- itís never in the interest of the kids

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Penny Lane

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Re: Splitting health costs
« Reply #7 on: September 14, 2018, 01:44:34 PM »
I know that with PDs you have to pick and choose your battles - this one to me looks like a battle you should take.

 :yeahthat:

AOD, you've been going around and around on this, and I really think you're only going to get it resolved with the help of a lawyer. My hope for you would be to get a more detailed order in place or having legal help in making sure the child support office's rules are enforced. It sounds to me like you're doing everything right and you're just getting nowhere with an ex who simply won't be reasonable. I know you don't want to go to court and you don't have the money - but it sounds like you're headed to court either way, either over this or over the school thing. I think you'll be in a better position once you're there if you're assertively addressing issues rather than waiting for your ex to file the motion. I really hope you can find a way to make that work because it sounds like your ex is putting you in an impossible situation. The two pairs of orthotics thing is ridiculous. Your ex's position seems to in no way be about what your son needs (but I don't have to tell you that!)

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elly87

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Re: Splitting health costs
« Reply #8 on: September 17, 2018, 06:57:54 PM »
his position is completely ridiculous.

It makes no difference WHERE or WHEN your son uses his medical equipment/items. what matters is that these are medical needs that your son has. period. even if he only wore orthotics at your house.  it makes zero difference.

I'm a little confused..if these items you mention are covered under your ex's insurance plan, how can he keep your son from using the benefits? or, if these items are not covered by insurance, do you have an agreement for health care out of pocket expenses. usually, each parent pays a percentage pro rata for the costs. if you have an agreement for that and he isnt paying his pro rata share, you need to document it and bring him to court so he will learn that you are not just letting him financially abuse you and violate your contract and you will seek justice. this may deter him from violating the contract in the future.