Splitting Orthodontic Treatment

I agree with you (and I have been the bio-mom carrying coverage even when ex was ordered to because he often quit jobs and therefore lost coverage and even when he had coverage we kept secondary insurance)...the coverage is for the child's health needs and having the dual coverage helps both parents by reducing total out of pocket expenses (so while they have the coverage to help them, it helps both sets of parents).

I suggest that dad go to the doctor's office, with court order to show what they both responsible for. Be sure doctor knows that there is dual coverage and that after both insurances have paid, he will be responsible for half of the balance. They would know what the out of pocket expense would be (or could find out) and you would get the most objective/unbiased info.

ETA: My apologies, I didn't realize that the coverage his ex's husband has is not a supplemental policy that they have purchased, but rather coverage for your stepson through her husband's normal insurance, that is just deemed to be 2ndry.
In this case, I think it would be fairly straightforward to determine that "all fees that are not covered by insurance" would be AFTER both policies have paid.
I again urge you to get a consultation with your attourney, as soon as possible.

Original:
I have no claims to understanding all the "legalese" of the divorce decree, but the accountant in me is wondering if the $1805 that they are asking your husband to pay is 50% of what is left over after the primary insurance, & the 2ndry insurance picks up 1/2, leaving the other 1/2 for your husband?

If so, it is possible that a judge would determine that they are "paying their 1/2" through the insurance premiums which allow for the coverage that pays 50% of the primary insurance out-of-pocket balance. It could be argued that they pay those premiums, not knowing if they will recoup the expense in coverage down the road.

This seems like it is truly an "interpretation" of the divorce decree, & considering his ex's response already, it doesn't seem likely that you will be able to resolve this in your favor without consulting your attourney.

On the plus side to that, consulting now should resolve the issue for any occurrences going forward.

Best of luck! T.

I think that your husband and you need to go to the ortho's office and tell them that the figure that you will cover is AFTER both insurances pay out. Unless I'm not thinking about it right, that means you'd spend $602.50. You make it plain to them that you know that she has secondary insurance on the child and that you will only pay 50% of what is left over after BOTH insurances pay.

I would think that the ortho's office has done this plenty. I actually think that the one 5 years ago helped her defraud your husband. If it's the same office, don't let this happen again.

When you have signed to ONLY pay "x" amount and no more, it will be up to the ex to try to take you to court. You have the decree to prove your case, and I think it's all hot air she's blowing about taking you to court. And your husband SHOULD tell her that she had better think this through because she will only end up having less money to go towards the boy's car. He doesn't get both teeth fixed and a car. AND if you have to go to court, his car money will go to the lawyer.

My guess is that she'll shut up.

I assume it costs you something to have his son covered on your husband's insurance, right? But I also assume that cost - say $50 a month, was part of the calculation for overall child support, right? So if you pay $1k a month, if you didn't pay the $50 for insurance, you'd have to pay them $1,050 a month. Random numbers here but get what I mean? So they then decided to take out more insurance and they pay maybe $100 a month. That's $1200 a year. Or say it's $600 a year bc they pay $50 a month too. That is money that needs to be part of this equation. And somehow I do see it as kind of their business. Maybe you could have gotten more insurance too... I think I see it as they are covering 50% of what the primary insurance doesnt cover - they're just doing it a different way. Lucky for them but it doesn't make you spend more than you would have if they didn't take out this extra insurance...

I agree with Boss Fan. Sounds like they're trying to cut themselves a deal. My SD's mother was always shady with insurance too. I have been providing my SD's health insurance since my husband and I got married and I add him and her to my plan. Her mom used to ask my husband to pay half of her co-pays for doctor's office visits, which he always did - $10 here, $20 there, $100 for glasses, etc. We then later found out that she also had my SD enrolled on state insurance and that she wasn't paying anything at all - the co-pays were billed to Mass Health. In our case, it was short money but we were pretty ticked off.

I would hold the line. It sounds like the spirit and wording of the decree support the idea that the parents split the costs after *any and all* insurance is applied. She can threaten all she wants...I doubt that what she wants would be held up in court and the costs of getting her attorney to drag you all into court probably aren't worth the hassle. Have your husband continue to demand a copy of the coverage/benefits and refuse to pay anything until you know exactly what is being covered and what is left over after all insurance is paid. As the parent who signs the paperwork at the orthodontist's office, the bio mom has already signed a form that says that she is financially responsible for all payments so if your husband refuses to pay until you see what the insurance situation really is, she has no recourse through the ortho to make him pay. We went through that several times with SD's mother too. Her secondary insurance (MassHealth) was obtained fraudulently because my SD was already covered under my plan. There were all kinds of payments that were taken back by the state, leaving balances due at several doctors' offices. At the end of the day, despite holding the insurance, my husband had never signed any of the paperwork so her mom was responsible for any of those payments.

Schedule a one-off consult (or make a phone call) to your attorney's office and ask for clarification on the language of the decree. Explain the background, and ask what portion your husband is responsible for. Then proceed from there.
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I reiterate... talk to your attorney and have them spell out for you what the language means in real terms. From the language you used in your post, my reading would be that your husband and his ex split equally WHATEVER is not covered by ANY insurance. Makes no difference whether she (or her husband) is paying the premiums on the additional insurance. My guess would be that this is exactly why she doesn't want to give you a copy of the policy.

You could also ask your attorney to draft a brief demand letter for a copy of the supplemental policy. If they choose to drop the coverage because you follow up, then so be it. Their decision to make. Betting they won't, though.

Most attorneys won't charge you an arm and a leg to mail a letter. It doesn't put them on the record as your counsel to do that. Filing anything with the court, however, will cost plenty, I'm sure. Alternatively, you could have your husband draft his own letter and send it certified mail to the address the court has on file for her, and send a copy to the court file. That should get her attention, too.

I know our dental for our kids is almost $800 a year and the lifetime cap on ortho is $1500. I think the fact that they pay for the insurance, there for saving you from $###-###-#### in regular dental fees every year for check ups, more then balances the $1500-1700 lifetime they will cover for ortho, and you are getting off easy in the end. Do what you feel you need to, talk to the lawyers, but in the end since they pay the yearly fees and it saves YOU money every year on the regular dental stuff I would just pay my half and be glad I only have to pay for ortho.

Hmm. I am going to go out on a limb here and say - if they were still married he'd be paying 100% and covering his kids under his insurance. Maybe she is lying, but that is her deal and it does come back (karma) both of you should just calm down. Pay for the braces and get over it. I understand, "But it's not fair!" "It's not what the decree says." but it is life and sometimes we just need to cut some people slack - even when we know what is going on and don't like it (or them).
My parents did this a lot. guess who ended up having to get a babysitting job to pay for contacts, school sports and cheer uniforms because my mom didn't have the $$ and my dad and his wife felt it was unfair or were just "following the divorce decree" ME.
As you pointed out the only one standing to be hurt in all of this or lose in all of this is his son.
This is 150 a month for a year. Chalk it up to the cost of raising kids and let it go.
Good luck. Tough decision and sorry for applying my personal experience to yours. Different, but a little the same . . . just food for thought.

It is important that everyone is working together for the benefit of the kids. It sounds like they are trying to cut corners a little and leave you footing the insurance balance. Since the info on the secondary plan is spelled out, I guess you could have your attorney write a letter requesting that policy info. I don't know if they might react by dropping coverage??? Does your husband have joint custody where he has access to medical/dental info on his children? Maybe he should make an appt with the billing specialist or the office manager and have them pull all pertinent information on the costs and payment schedules required--the same material they gave his ex-wife. Bring the info on the plan you carry. There is usually a lifetime maximum for orthodontic treatment--what is the amount they will pay--and what is the total amount of the charges? Ask if the office knows what the other policy will cover. Then you can get a better idea of the charges. Medical (& dental insurance) has changed recently (at least with ours) If you have double coverage, sometimes the 2nd will only pay a percentage of what the first doesn't cover. What might work out best is to see if they can split the ortho treatment into two phases separated by a few months (and into another calendar year). Use one policy's lifetime max for Phase 1 and use the other policy's lifetime max for Phase 2. Then split the remaining costs. You will need to discuss this with the office manager and/or the billing specialist.

My decree, as are most in Texas, reads almost identical to yours. We split all medical/dental, etc. I have dental insurance on my daughter through work that cover's up to $2,000 for orthodontics. My ex and I split the cost for her braces AFTER what the insurance paid. We did have 2 separate contracts to make things easier. His monthly payments were drafted from his account and mine were drafted from my account. But we paid out of pocket the exact same amount. So yes, you're correct. Your husband and his ex should be splitting the cost AFTER whatever the insurance pays.

1995-2001, paid $200 a month to insure his children, and they were on Medicaid. Ex-wives can be real !@#$%^&'s