Health insurance use- is this wrong

by cardinal2012 » Mon Jan 14, 2013 02:46 pm

I have health insurance for my child. My ex went out last year and got insurance also. When she takes the child to hospital, Dr, etc.. they normally bill both carriers. Mine always pays first so when her insurance pays it shows an overpayment made on account so hospital sends it back to insurance company and they refund the ex. I could be guessing but I think they think she over paid her amount and don't realize that another insurance company pays. My court order says I have to pay 50 percent what insurance doesn't cover so not only does she get paid from her insurance company I pay her 50 percent of what my insurance doesn't pay. So I think my ex benefits by taking my child to hospital or Dr's. She's making money. The reason I know is I checked child's records and seen that hospital sent $1100 back to insurance company saying the account was paid. I've noticed my kid has been to Dr's alot in last year for minor things such as ER visit with a 98.4 temp. I suspect foul play so is there anything I can do or should do? Or is this legal what she is doing? Oh hospital bills both as primary which I think is weird.

Total Comments: 11

Posted: Thu Jan 17, 2013 06:12 am Post Subject:

I am agree with this above reviews.

Posted: Thu Jan 17, 2013 09:52 am Post Subject:

What's there to agree ! :roll:

Posted: Thu Jan 17, 2013 02:42 pm Post Subject:

I suspect foul play so is there anything I can do or should do? Or is this legal what she is doing? Oh hospital bills both as primary which I think is weird.


Have you tried talking to the hospital billing department? That's where you should start. It doesn't sound like your ex- is making a profit here, if money is being refunded to her insurance company for a claim that was overpaid by it.

You should also speak to her insurance company and ask them what's going on.

If your ex- is turning in fraudulent claims, you can report that to the Dept of Insurance for investigation.

Posted: Fri Jan 18, 2013 05:37 am Post Subject:

Approach to your insurance agent they give you complete Information about your insurance.

Posted: Wed Jan 30, 2013 04:02 pm Post Subject:

it sounds like it could be as simple as her informing her insruance company that they are secondary to your policy, as long as that is infact correct. you said the court states you have insurance so I would assume that would trump the birthday rule. so since your insurance is primary she needs to tell her insurance they should be paying as secondary to your policy. I don't understand though why she would be receiving the money that is refunded back to the insurance company for overpayments, that part doesn't make sense to me and if that is infact happening you might want to talk to the billing department.

Posted: Wed Jan 30, 2013 06:41 pm Post Subject:

I would assume that would trump the birthday rule


Wrong. Although the court may require divorced parents to EACH carry all available health insurance on the children, nothing upsets the application of the gender or birthday rule as it applies to children as dependents under their parents' policies. One will be primary and the other secondary. The court does not determine that, state law does.

If an individual is receiving refunds due to an insurance company, that becomes their responsibility to turn the money over to the insurance company. I doubt that is happening here. What might, possibly, be happening, is that someone paid expenses out of pocket, and those were later paid for by insurance. If so, the money is refunded to the payee, not the insurance company.

We don't have enough information here to know exactly what is going on.

Posted: Wed Mar 06, 2013 08:23 pm Post Subject: Health insurance

Yes i agree with you insurance agent give you better information about you also check online by this site [Link removed per TOU]


Take Care
Robin James

Posted: Mon Mar 11, 2013 11:06 am Post Subject:

It is not logic that if parents not living together now and insurance company is not liable to pay for children health care and expenses

Posted: Tue Mar 12, 2013 06:00 am Post Subject:

Makes no sense, but appears to be 100% wrong.

Posted: Tue Mar 12, 2013 09:30 am Post Subject:

I am writing my language, I am not native speaker. I wrote what i think better

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