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Old 12-28-2006, 05:32 PM - Thread Starter
 
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I just need someone to explain something to me. I am just a little confused about something.

My DH has to have insurance on his DD. That costs him over 600 a month just for medical insurance on her. On top of that he has to pay 444 for child support. The mother is on Medicaid. Why would he legally have to get insurance if she has Medicaid on the DD? Medicaid covers EVERYTHING.

IMO if he has insurance on her, then Medicaid should be dropped right?

I just can not understand why he has to pay the full 600 a month for insurance but if they were to ever use insurance, then they would split the medical bill 50/50. Shouldnt medical insurance be split 50/50?

I am not complaining, just wanting an explanation.
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Old 12-28-2006, 05:38 PM
 
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Medicaid would only cover whatever your DH's insurance didn't cover. It's not necessarily 50/50.

If his DD went to the doctor for something, and the bill was $300, it doesn't necessarily break down into $150 for insurance and $150 for Medicaid.

Your DH's insurance might cover $280 worth of it, and then Medicaid would only be billed for $20. Or his insurance might cover all of it and Medicaid wouldn't be billed at all.

I would think that most family courts would deem that parents should be responsible for their kids' health insurance as much as possible. I don't think they would recommend that a parent stop paying for health insurance in order to get state benefits.

The mother is probably on Medicaid because she cannot afford insurance for herself. If you are a single mother trying to get state insurance, your children HAVE to be listed even if they have other insurance, and the other insurance is the primary. BTDT.
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Old 12-28-2006, 06:05 PM
 
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It is also possible that the private insurance has many more and better qualified physcians/ dentists in their network. While it is true that medicaid covers as much as private insurance for ER, hospital stays and medication, there are many, many doctors who will not take medicaid in their private offices.
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Old 12-28-2006, 06:19 PM - Thread Starter
 
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Medicaid covers first. If any parent has Medicaid, the clinic they see has to bill Medicaid first. We have been through that deal already. And they have to split the bill 50/50.

Example: Doctor visit is 1000 dollars (No Medicaid is involved, only insurance). Insurance will only cover 500. They they have to take that 500 dollars and pay 50/50. 250 a piece. The mother can not have Medicaid on herself, only the child. My DH has Medical Insurance so why would she need both. Does this make sense?
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Old 12-28-2006, 06:24 PM
 
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the medicaisd is secondary to any other coverage the kids have but with the different drug formularies and physicians networks and whatnot sometimes one insurance will cover more or less than the other.

at work (at a pharmacy) sometimes the primary won't pay so we bill only the secondary.

medicaid has much more affordable drug co-pays than most traditional insurance. (in our state it ranges from $.50-$3.00) although the formulary of what drugs they will pay for is very restrictive
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Old 12-28-2006, 07:22 PM
 
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My dh cover his dd as well. I was just asked by her mom if she should get her back on medicaid due to some health issues. I told her I didn't think we could do that since we were court ordered by the state to provide the medical insurance. I took that as a sign that they are not willing to pay anything and it is up to us. I didn't know you could have medicaid and insurance. Maybe she should get her back on medicaid since the health issues she's having could be very costly.
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Old 12-28-2006, 09:03 PM
 
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Medicaid is always secondary, Hairstylist. DD is covered by her father's insurance and Medicaid picks up any remainder if the doctor's office accepts it. Even picks up her copays for the doctors offices that accept it.

But you are mistaken aboutit payin first. It is always secondary to private insurance. Maybe it is primary for your SD because she sees a physician who isn't in your DH's insurance plan? That is the only possible reason I can think of for it being billed first.
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Old 12-28-2006, 09:28 PM
 
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As I understand it, well, in this state, I should say, the amount of insurance a parent pays is deducted from their child support. In other words, if the dad was ordered to pay 1000 a month, but 600 went to insurance, then 400 would go to the mother. That is very expensive insurance. Can he look for other insurance or does she have special medical needs? Just calling up Blue Cross and getting a policy for my kids was cheaper than the plan my work offers. It was over 300 dollars a month per child through my work and only 100 a month (still Blue Cross) when I called up and applied on my own.

In theory, the state won't pay for anything if there is a parent who can afford to pay for it. Years ago dss's mother applied for some kind of benefits in the child's name. Dh got a bill for it. In our situation, the biomom and her other kids have Medicaid, but ds can not because his father (dh) has private insurance. I know that she did have to give dss' SS number , etc when she applied for her other kids, but as far as I know, dss isn't covered.
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Old 12-29-2006, 01:44 AM - Thread Starter
 
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It does not matter to me if she has Medicaid and Medical Insurance. I just don't see why DH should have to fork out the entire payment for Medical Insurance when if it would ever be used, the bill would be split 50/50. He is having to pay 1000 a month for child support and insurance. He gets insurance through his job and it is Blue Cross Blue Shield.

Is there anyway he could possibly get it to where they both pay half of insurance? Wouldn't that only be fair?

I am just so confused and lost on all of this.
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Old 12-29-2006, 04:37 AM
 
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Originally Posted by hairstylist View Post
It does not matter to me if she has Medicaid and Medical Insurance. I just don't see why DH should have to fork out the entire payment for Medical Insurance when if it would ever be used, the bill would be split 50/50. He is having to pay 1000 a month for child support and insurance. He gets insurance through his job and it is Blue Cross Blue Shield.

Is there anyway he could possibly get it to where they both pay half of insurance? Wouldn't that only be fair?

I am just so confused and lost on all of this.
I don't understand what you mean by that. I use my insurance and it covers everything but a 10 dollar co-payment. What would they be splitting 50/50? Many support agreements say that additional expenses not covered by insurance are split 50/50, though with such expensive insurance, I don't imagine there would be much left to cover.

The insurance is part of his support agreement, right? They don't pay 50/50 on the insurance because it is part of his child support. He is required to pay 1000 a month regardless, right? If he had less to pay in insurance, he'd pay more in child support? That is how it works here. LIke I said, I am offered it through my work but it was three times as much as just calling an insurance broker. Unless she has some pre-existing conditions, call around.
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Old 12-29-2006, 12:46 PM
 
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Texas Family Code section 154.182 requires your husband to pay for medical insurance for his DD. period. Non-negotiable. the 50/50 that you speak of is costs not otherwise coverd by insurance.... Like co-pays. Those costs are to be covered by your DH and his DD's mother, in a 50/50 split. The 50/50 has abosolutely nothing to do with how any health insurance is billed. Medicaid is always secondary to private health insurance because medicaid is an insurrer of last resort. Your DH's health insurance does, and should, pay all or nearly all of any health related costs for his DD.

Hopefully, that helps.
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Old 12-29-2006, 12:50 PM
 
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And no, because providing health insurance is required as part of your DH's CS obligation (always the case in Texas), making DD's mother pay half of it would not be considered fair.
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Old 12-29-2006, 01:09 PM
 
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Originally Posted by hairstylist View Post
Medicaid covers first. If any parent has Medicaid, the clinic they see has to bill Medicaid first. We have been through that deal already. And they have to split the bill 50/50.
That really doesn't make sense that Medicaid would cover first. Another poster said that the DD's mother must be using a doctor that isn't in your DH's network. That's possible, I guess....but if he's using BCBS, rather doubtful. Something smells fishy.

Quote:
Example: Doctor visit is 1000 dollars (No Medicaid is involved, only insurance). Insurance will only cover 500. They they have to take that 500 dollars and pay 50/50. 250 a piece.
That really stinks, IMO, but I guess that's either a Texas law or part of the divorce agreement?

Quote:
The mother can not have Medicaid on herself, only the child. My DH has Medical Insurance so why would she need both. Does this make sense?
Why can't the mother have Medicaid on herself?

The only reason I can think of that she would need both insurances is if the child has medical conditions that are so costly that she can't afford to pay her 50% of the co-pays.
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Old 12-29-2006, 02:38 PM
 
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Originally Posted by hairstylist View Post
Medicaid covers first. If any parent has Medicaid, the clinic they see has to bill Medicaid first. We have been through that deal already. And they have to split the bill 50/50.

Example: Doctor visit is 1000 dollars (No Medicaid is involved, only insurance). Insurance will only cover 500. They they have to take that 500 dollars and pay 50/50. 250 a piece. The mother can not have Medicaid on herself, only the child. My DH has Medical Insurance so why would she need both. Does this make sense?
NO. Not correct. Medicaid does not cover first hairstylist. they are always secondary.

I think you are misunderstanding the divorce decree. No, medicaid and the private insurance do not split the healthcare costs for DD. That is simply not possible and not the case. In order for that to be possible, the judge who signed your DH's divorce and custody papers would have had to order that specific situation... and in a divorce case, the judge simply does not have the jurisdiction over medicaid and the private insurace to do that. The judge only has jurisdiction over your DH and His EX, not their respective insurers.

Sounds like Mom has medicaid to pay for what ever your DH's health insurance does not... like co pays. Since you have posted earlier that she does not work and stays at home, it would make sense that she has medicaid to cover the copays and other incidentals not covered by DH's insurance. And if Medicaid is being billed first, then that is FRAUD and your DH could be liable if it is occurring because he does not want to furnish his insurance information to DD's doctors.

I don't mean to sound like such an alarmist, but I have a lot of experience in this area and I do know of what I speak.
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Old 12-29-2006, 02:47 PM - Thread Starter
 
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That really doesn't make sense that Medicaid would cover first. Another poster said that the DD's mother must be using a doctor that isn't in your DH's network. That's possible, I guess....but if he's using BCBS, rather doubtful. Something smells fishy.



That really stinks, IMO, but I guess that's either a Texas law or part of the divorce agreement?



Why can't the mother have Medicaid on herself?



The only reason I can think of that she would need both insurances is if the child has medical conditions that are so costly that she can't afford to pay her 50% of the co-pays.

You have to be pregnant, so for her to get Medicaid on herself, she needs to go out and get pregnant.

I was on Medicaid while I was pregnant before we got medical insurance and MY medicaid was terninated 2 weeks after my baby was born but my baby then had Medicaid in himself. Then we cancelled it due to Medical Insurance.
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Old 12-29-2006, 02:49 PM - Thread Starter
 
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They are not divorce papers, just wanted to clear that up. They were NEVER married.
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Old 12-29-2006, 03:59 PM
 
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The SAPCR paperwork then. Makes no difference. Everything I said above is still true. A judge can't order the situation you described because the judge doesn't have jurisdiction to do it.

If you are still confused, maybe you might want to consult a Family Law Attorney in your area? If you do so, make sure to take the SAPCR with you.
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Old 12-29-2006, 05:40 PM
 
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You have to be pregnant, so for her to get Medicaid on herself, she needs to go out and get pregnant.
I guess eligibility varies from state to state, then.

A single mother can use state health insurance here without being pregnant.
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Old 12-29-2006, 06:25 PM
 
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Hairstylist,

Are you really trying to say that the state, or we the people should be paying for medical coverage that your husband is court ordered to pay?


Universal coverage is the only way to go in my opinion, but then I think you would be complaining about the extra $$ she would be getting in child support.

The costs of medical insurance is deducted from the total CS amount. My former spouse gets credit for the 33 bucks a month he has to pay. (gotta love a union job) and I get credit for the 19 my husband has to pay for the secondary coverage. (again work union)

When I was pregnant with my daughter, and my former spouse and I were not married yet... I had insurance though my workplace, and it cost me a pretty penny. So I applied to OHP, or Oregon health plan. They helped me with my costs on my policy, and gave me ohp for the co pays, deductibles and the like. When my daughter was born, her father's insurance picked her up, and because she was double covered with my insurance and his, OHP dropped her... but they continued to help pay for my insurance costs.

Sometimes with your posts, all I see in them are the bitterness you have towards the woman who has a child with your husband. I feel so very sorry for this child, and yours as well. At some point you really need to put the child's best interest ahead of your own negative feelings.
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Old 12-30-2006, 12:30 PM
 
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Medicaid is always the payer of last resort. Always. Dual coverage with Medicaid is possible and allowable. However, dual coverage with a S-CHIP (state insurance for working poor) health insurance plan and private insurance is not allowed. Your husband's insurance is $600 for his child alone or for all of you??? I have an individual health insurance plan through BCBS Michigan and it is $455 per month. Is your husband's child eligibile for S-CHIP due to his low income and the high cost of insurance through his employer? It would certainly be much cheaper. In fact, private insurance not through an employer could be much cheaper than $600 a month.
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Old 12-30-2006, 03:29 PM
 
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Though, as I understand it, even if he got cheaper insurance, he'd still be paying the same each month as his CS paid to the mother would go up if the insurance cost decreased. He still has to pay 1000 a month, that is his obligation.
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Old 12-30-2006, 04:30 PM
 
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Either way, $1000/month for ONE kid sounds like a lot to me. I get $1000/month for two kids, and I live in an expensive area and only make about $20K/year of my own.

Either the father is very well-off, or the mother is very broke.
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Old 12-30-2006, 04:51 PM
 
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I agree with what the PP in MI said about looking into SCHIP coverage for DSD thru DH. However, I, too, am in MI, and OP is in TX. According to my cousin in TX, it's just about impossible to get SCHIP there. Sorry, mama!

This is just one more example of how !#@%&! up our current health system is. How on earth does one child use $7200 in health care per year? Assuming that she is reasonably healthy, I wonder if it would be cheaper for DH to pay for her medical expenses out of pocket, and carry a separate (presumably court ordered) high deductable, low premium catastrophic plan for DSD. Unless insurance specifics are laid out in the custody agreement or TX state law, (something I highly doubt) such a policy could be pretty bare bones. DSD is double covered by Medicaid, so she's covered no matter what, so DH really doesn't have to worry about that.

OT: Honestly, I think it is ridiculous to expect ANY parents to pay for health insurance for their children. If we have Medicare for the elderly, why should we not have something similar for the other non-working population of kids? Say it with me, people: Universal. Single Payer. Medicare for ALL! *end rant here*

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Old 12-30-2006, 04:54 PM
 
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Originally Posted by boobybunny View Post
Hairstylist,

Are you really trying to say that the state, or we the people should be paying for medical coverage that your husband is court ordered to pay?


Universal coverage is the only way to go in my opinion, but then I think you would be complaining about the extra $$ she would be getting in child support.


Sometimes with your posts, all I see in them are the bitterness you have towards the woman who has a child with your husband. I feel so very sorry for this child, and yours as well. At some point you really need to put the child's best interest ahead of your own negative feelings.
Whoa. How 'bout a side helping of snark with that dish full 'o judgement?

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Old 12-30-2006, 05:29 PM
 
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Whoa. How 'bout a side helping of snark with that dish full 'o judgement?

I admit I am being judgemental about hairstylist's posts, almost everything she has ever posted here about her step daughter's bio mom has been complaining about money. What I think she does not get, no matter how much myself and others try to explain to her, it that is not the bio mom saying how much child support should be, it is the state. And the state of Texas decided that 400 a month plus dad pay for insurance (very standard btw) is what is fair for this baby.
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Old 12-30-2006, 06:07 PM
 
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Oh, agreed. The state makes the call, for sure.

Trying to turn hearts and minds toward universal healthcare, one post at a time.
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Old 12-30-2006, 10:00 PM
 
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I think this issue keeps coming up over and over again with the complaints over biomom not pulling her weight. The issue is irrelevant, it seems, the bottom line is that her DH pays too much despite state guidelines. I can sense her enormous frustration and it must be very hard to deal with on a daily basis. I know it is easy for me and other to say, but it is best to just accept the fact that this is how it is and stop wasting energy. Good luck, mama!!!
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Old 12-31-2006, 01:00 PM
 
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Whoa. How 'bout a side helping of snark with that dish full 'o judgement?
You know, when you (or me, or anyone else) points out judgement, you're being judgemental, too.

The old saying...when you point a finger, three point back at you...
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Old 12-31-2006, 10:49 PM - Thread Starter
 
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The BM and I get along great now. There is no bitterness towards anyone or anything. She even told me the other night when I was at her house visiting her DD, that she did not see why he got Medical Insurance on the DD when she is on Medicaid. She said that Medicaid pays for EVERYTHING and not only would he be saving himself money but would also be saving her money by taking the child off of Insurance. She said that she knows the papers say he is supposed to pay insurance but they do not have to go DIRECTLY by the papers.

They have a conference in February to have the whole Child Support Papers to be looked over and for either of them to request changes. Everything is going good between all of us for now and I hope it continues to stay that way.

I know some of my posts may seem like I am gripping about money but I just need some advice and suggestions, not rude comments.
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Old 01-01-2007, 03:13 AM
 
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The BM and I get along great now. There is no bitterness towards anyone or anything. She even told me the other night when I was at her house visiting her DD, that she did not see why he got Medical Insurance on the DD when she is on Medicaid. She said that Medicaid pays for EVERYTHING and not only would he be saving himself money but would also be saving her money by taking the child off of Insurance. She said that she knows the papers say he is supposed to pay insurance but they do not have to go DIRECTLY by the papers.

They have a conference in February to have the whole Child Support Papers to be looked over and for either of them to request changes. Everything is going good between all of us for now and I hope it continues to stay that way.

I know some of my posts may seem like I am gripping about money but I just need some advice and suggestions, not rude comments.

Please be careful with this. Be sure that Medicaid knows that the child has insurance. In general, the state will not pay if there is a parent who can afford to do so. It is fraud. Dss's biomom applied for some benefits in his name and dh was billed by the state, and she was investigated for welfare fraud. Dss's mom has state insurance and we'd love him to have free insurance, but he doesn't qualify based on our income.

Do your papers say 444 a month plus insurance, or 1044 a month including insurance (which is what I believe is most common)?

If it is 444 a month plus insurance, why not look for cheaper insurance?
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