Most Reliable Documentation for Medical Reimbursement and a HIPAA Question - Mothering Forums

Thread Tools
#1 of 2 Old 12-23-2011, 10:27 PM - Thread Starter
MrsSurplus's Avatar
Join Date: Dec 2005
Location: The Family Farm
Posts: 373
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I'll try to make a long story less long...


My ex-husband and I have 3 kids from our marriage.  The eldest is on her own, the next is 18 and a senior in high school.  The youngest will be 17 in February.  Until the summer of 2010 all of the children have lived with me since my ex and I split in 1998.  The ex has tried, for years and years, to entice our 2 girls (the oldest and the youngest of our children) to live with him.  I finally capitulated in 2010 against my better judgment.  However, I had hoped that the ex's undermining of me would cease if I allowed the change in physical custody and that all of us would get along better if I allowed the move.  (My ex moved across the country as soon as the divorce papers were signed.  He lives on the east coast, I live in the west.)  We have joint legal custody.


All was fine after the move until last Spring.  At first all I knew was that DD was just rude to me on the phone.  Often she wouldn't return my calls and when she did she was distant at best and never asked how any of us were here.  Later I learned that her dad was divorcing her stepmom and moving in a girlfriend.  All of a sudden DD and her dad were the best of buds and I was enemy #1.  This summer ex also told the state Child Support folks that our son (who lives with me) was not in school and the state stopped CS until receiving documentation that DS is, indeed, in school.  It took a couple of months for the wheels to turn so the ex ended up being about 3.5 months behind in CS and his attorney has been trying to negotiate with me ever since to lower CS (ex is in a jam now that he no longer has his second wife's income) and forgive the arrearages.  Her last offer was that we agree to my proposed CS amount and that we tell the state that the arrears are forgiven and the ex will just apply this credit to my half of any uncovered medical costs.  That was of no interest to me because a) our children have had very few medical costs and I couldn't see my half of any uncovered medical costs coming to the $2,500 he still owes me and b) the ex has ripped me off in the past when it came to insurance reimbursing him after we'd both paid on medical costs - with the net result of him making money on the deal.


So...(here are my questions, finally)...  I get an email from my ex a couple of weeks after his attorney's offer stating that our daughter will have some dental bills (which I already knew about) and medical bills that would result in each of us paying about $1,000 in the next month or two (a crown) and then $50/month for medical bills lasting through the spring - and then an additional $300-$400 in the summer.  Of course I called him to see what was up with our daughter's medical situation.  No return call so I emailed.  No response.  So, after receiving DD's progress report which indicated that her grades had plummeted in recent weeks, I called DD.  I told her that I was worried about her - between her grades and her mounting medical bills, I wondered if she was okay.  She told me she was "in perfect health."  So I asked what the bills were for.  "Prescriptions."  I asked for what.  She asked if I wanted to talk to her dad.  You bet I did.  She asked him to talk to me and he said something, loudly,in the background that I couldn't make out.  So he said it again: "HIPAA."  Later I explained to him, via e-mail conversation, that HIPAA doesn't prevent parents from discussing their child's medical situation.  He disagreed and insisted that our daughter is "asserting her HIPAA rights" with regard to her medical care as well as her conversations with school counselors.   I realize that HIPAA is often misunderstood and that I could get different answers as to what information I can access depending on to whom I speak.  Do medical offices have a "HIPPA officer" who gets training on these things - someone I could speak to at my daughter's medical provider's office that would actually know what I can be told?


Also, I received copies of "bills" today.  One was an Explanation of Benefits for which I'm happy to reimburse my ex.  It shows that my daughter had an office visit with an "MD" (I looked her up online - she's an OB/GYN) and it showed what the charges were, what the insurance company paid, and what remained: the $20 co-pay.  Then there were two bills from the dentist.  One I'm fine paying - it showed the office visits as well as what insurance paid.  The next one was a bill printed 2 days later that showed $785 for a crown (as well as the amounts for the previous work - also included on the previous bill).  Well, I spoke to the office in November and happen to know that they were waiting on the insurance company for preauthorization and didn't expect to receive that until mid-December.  So, the work hasn't been done yet and that amount did not reflect the amount post- insurance.  There was also another "bill" from the OB/GYN that was really a cover letter that just said "Pay this amount: $50."  For all I know, that included the $20 co-pay from the previous bill.  Then there were 2 drug store receipts - no name on them, so I have no idea if they were for my child or someone else.  The drug name was blacked out with a marker on one - and no drug name was even listed on the other.  Obviously, I am going to court to have the judge compel my ex to tell me what is going on with my daughter. (It is, of course, in our decree, that we share this type of information and that we have equal access to medical records.) I also, however, want more reliable medical bill information.  I am absolutely fine with paying half of my daughter's uncovered medical expenses for legitimate procedures/treatment.  However, I'm not about to reimburse for expenses that are not clearly for my daughter's benefit.  Neither am I going to pay before insurance has paid their share - in effect lining my ex's pockets.  Are the Explanation of Benefits printouts the best option for discerning these issues?  I am going to ask the judge to order that the insurance companies give me the same access to my daughter's insurance information as her father has - but should he not order that, what is the most reliable documentation for me to request in order to insure I know what I'm paying for and that I'm actually paying half of the uncovered medical costs.


Thank you for reading my book! 


Mrs. S. 

Mrs. S - Crunchy child of The King, Wife to my best friend, and Mama to my many blessings.
MrsSurplus is offline  
Sponsored Links
#2 of 2 Old 12-24-2011, 02:20 AM
34me's Avatar
Join Date: Oct 2006
Posts: 2,457
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I would require an EOB for all medical and dental bills and the pharmacy part of her insurance should be able to print off an official list as well. 

34me is offline  

Blended Family Advice

User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page

Posting Rules  
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off

Online Users: 8,986

23 members and 8,963 guests
AngelicaParedes45 , aparent , Diana Lombide , Emilia.H , girlspn , happy-mama , justlizzy , katelove , kathymuggle , Leelee3 , MamaLeigh , Michele123 , NaturallyKait , quiltermom , RollerCoasterMama , shantimama , singhnish2802 , Springshowers , sren , transylvania_mom , Vanessa Garrido , worthy
Most users ever online was 449,755, 06-25-2014 at 12:21 PM.