DH needs to contact his company's HR department as ask that question. Each plan is written differently.
My husband's ex-wife recently got braces for her daughter. She paid up-front, and we are receiving checks in the mail that are apparently supposed to go back to her for paying for these braces up front. I have no problem with sending her money that is actually her's. My concern is whether or not she is going to take all of our benefits for the year. What I mean is, will the purchase of the braces deplete the coverage for other benefits that we receive through our dental insurance? If one of my children has a cavity, for example, will the services to fill that cavity be out of pocket for us, because his ex-wife has used up all of our benefits on this one child? I DO have a problem with that. It is not like her daughter HAS to have braces. I believe it is mostly elective. If she may be depleting our resources in our dental insurance, how much of it is she entitled to? There are 4 children, total, and then me and my husband on this plan. Would that translate into their daughter receiving 1/6 of the benefits? I'm not very good at understanding insurance coverage. So I'm wondering if there is a lawyer out there who might be able to tell me how this would work, or someone who knows a lot about insurance coverage.
DH needs to contact his company's HR department as ask that question. Each plan is written differently.
I do understand your perspective. I do. But it sounds like her mother is footing the bill entirely except for your husband providing the existing insurance coverage (in order to discount the price that she's paying out of pocket). You've gotta keep in mind that your step-daughter already has the braces on--That battle is over; you're rallying your troops on an empty battlefield. Even if your dental plan says there is a maximum annual expenditure limit on your family coverage, what can you do? Would you really withhold the ex-wife's reimbursement checks towards the what-if scenario that the other kids need dental work...? In her eyes, it would just look like you expect her to pay for your kids dental bill too. (And have you considered how much it would cost if your husband has to get his divorce attorney back into court to hash this out--yuck!)
At this point, you'll have a hard time trying to set the clock backward... The orthodontist is not going to take them off now. You should probably expect the braces to be on for the next 2-3 years.
Pick your battles carefully. Peace in blended families is worth its weight in gold. If you raise a complaint to her mother, it will only get back to the daughter, paint you as the mean step-mother and hurt your relationship with her. My 2 cents = Not worth it.
My one question is: isn't "her" child your husbands child? If so, why aren't you wanting the best for the kid. It's not her fault that her parents couldn't work things out and it's definetely not her problem that apparently her step "mom" is uncaring........
Orthodontic care is not going to be taken out of the dental portion of your insurance. It is seperate and lifetime amount that is alloted to each person on the plan. Dental insurance covers very little and I understand you frustrations. However I do want to point out that to the Ex-wife there is only one child she has to advocate for and that is hers. She might see it as your husbands responsibility to worry about the coverage of his other children. I would try to see both sides and then call your insurance because I would bet lots of money that you are worried over nothing....
(This did not mean to be rude...I just sometimes find it healthy for myself to look from the other persons perspective) I am sure it is hard for everyone involved.
Your best bet is to look at the devorce decree and the insurance policy itself. Each individual situation will be different. The devorce decree will be the desiding factor, regardless of how many children he chooses to have after this decree.
This girl (yes, and by association, her mother) shoud not have to suffer because you and your husband chose to have more children, already knowing the "bills" that he was responcible for. This is the way that most courts will see it.
She is not "her child". She is their child. You might find peace with this if you try to look at this little girl as his child. If you love him, you should try to love her also. Check the paperwork and then check your heart.
Good luck and I hope you find answers and peace.
Am I misunderstanding you? Your husband's Ex-Wife is receiving dental reimbursement for a dental expense for "her" daughter?
Is this her daughter alone? Or is this your husbands child AKA your step daughter?
Also, medical/dental coverage agreements are often laid out in the divorce and or child support agreement. Or arrangements are agreed upon between the Two responsible parties - in this case the child's parents. In some cases an ex-spouse may have agreed to a modified child support arrangement that included health care coverage until the child in question was either 18 or had obtained a college degree as a full time student (22 or 24).
In other cases the child may be covered by one plan from 1 parent/care giver or dually covered by 2 plans from 2 caregivers, and out of pocket expenses are either split equally between the parents / split equitably along the same % as overall care expenses paid for the child.
I'm sure on this issue you can ask your husband what his exact arrangements are as to the care of his child (I am assuming at this point that it would be for his child as dental/medical coverage extended to the care of a non-blood relation minor from a dissolved marriage is rare, except in cases of legal adoption).
I take it you are also not a dentist? Orthodontics are a a long, painful course of treatment. Orthodontics are not applied to a child's teeth for "vanity" reasons. No mother would put her child thru that experience on a whim - and no Orthodontist, or insurance company would recommend or approve procedure that is so expensive, invasive, painful, and time consuming (18months to 3 yrs or more) just "because".
Modern orthodontics have severally decreased the number of dentures being received and expected to be required by our aging generations. Keeping the teeth in alignment reduces the instances of dental caries (cavities), gum diseases, and prevents other procedures that over time could lead to jaw deterioration and tooth loss (partial and full tooth removal, root canals, application of crown coverings etc.)
Crooked teeth are, in general, a health issue - not a vanity issue. They are especially effective in children and teens who have knot received all of their adult teeth yet, or their adult set is newly arrived and their gum's are still easily malleable.
As to your dental coverage disbursement and allotment - the best place to find this information would be in the Explanation of Dental Coverage handout from your dental insurance company. I would also look at the Explanation of Coverage from your medical insurance company as well. Depending on Benefit Plans, and inter company agreements (especially when part of an overall benefit package offered by an employer) Orthodontics may fall under dental coverage or medical coverage on weather or not the Orthodontist works out of a private office or an office attached to a larger medical center or surgical center.
If you do not have a copy of these explanations of benefits available to you in your home file, then I would recommend you request copies from the human resources department of your husbands place of work.
Barring that, a phone call to the service department from the phone number on the back of your insurance carrier card should provide you all the information you require.
I doubt anyone here can tell you what coverage your dental insurance provides as no one here is in possession of your policy.
For general information I can say that most insurance policies have a $$ amt for EACH person, and also a capped yearly amount for different levels of coverage (ie, preventative (1), general care (2), orthodontics and dental surgeries(3/4) ).
One peice of information on your particular policy that I gleaned from your original post - is that they do reimburse orthodontics expenses. that is not all too common, and leads me to believe your current dental company is a solid institution of some repute.
Either way, as you do have children in the home that are 100% in your care, I would recommend that you get those explanations of benefits and become very familiar with what they do and do not cover. It's not fun being hit with an unexpected medical or dental expense simply because you were not familiar with your own policy and it;s limits. For example: lets say a child broke their arm, and mid-way thru the treatment the Dr. ordered an Xray to check on the set of the healing bone. You get the XRay done at the clinic adjacent to the Dr.s office - only to find a week later that you are on the hook for $150 in uncovered X-Ray charges since that technician location was not covered byu your ins. and you would have only had to pay $5 if you had gone someplace else?
Definitely check out your insurance info by giving them a call. Another option is FSA account. You should have one if you husbands work provides it as a benefit. Especially for 4 children (you neglected to mention your step daughter in your "little about me section"). If you can get an FSA setup, estimate cautiously how much you will spend on medical bills (prescriptions, copay's, and out of pocket expenses). Its literally like having 25% more to spend because it is NOT taxed. But, if you don't spend all your money by the end of the year, it is lost. You can also use it for over the counter cold medicine etc. Another suggestion is to communicate with the EX about your step daughter's medical needs. After all, you knew he had baggage when you married him. You knew that no matter how many children you have, the step daughter is still entitled to his love and care as well. I don't think you meant to sound bitter, but you did. Blended families are hard. I would know, I grew up in one with a bitter, selfish step mother and thanked God that I had a wonderful supportive step father. Try the communication, and get the ex on the same team. Life will be so much easier. Good luck!
You've received some good advice about checking with your insurance company, the difference between dental and orthodontic care and what the divorce decree states. I see you sent a long clarification and I'd like to gently point out something that might help you in the long run.
While I can see you intention is to have equal care for all children, your title of your post shows that you might not think of your ex wife's daughter as your husbands "...entitled to for her daughter". You differentiate between "my children" and "her daughter". For the sake of the child, please find a way to view her as yours too since she is part of your husband. On the necessity of the braces, they aren't normally done for aesthetic purposes - what would lead you to think that?
the grace and love you show to your step-daughter go a WHOLE lot farther than any insurance benefits. This isn't a battle worth contemplating.
Do not pay her all of those checks if they are sending them to you until you do your homework. You need to get the receipts from the dentist and your insurance. Another thing you already been paying support without it being credited so she's not being honest with you, she's going to nail you ever which way she can. Get a copy of the divorce decree and see what it says. Usually the father carries the insurance but both parents are responsible for 50% of medical bills, but in some divorce decrees braces are not considered medical they are considered cosmetic. Do your homework and at worst you are only responsible for 50%. Also since yall have kids of your own you may want to look and see if you can get her support lowered. Usually you don't want to have to do this you want to take care of your kids but you were paying support already and her heart didn't do the right thing. Also if this daughter would rather be with her father, she has that right at age 12 she just has to go before the judge. Could be a pretty smooth transition unless the mother wants to fight it and the only leg she has to stand on is if she had mud on you. Then she'd be paying you support. I'm a divorced mother myself, and am not a step mother but any time my ex paid me not thru the system I reported it so he'd get credit. Trust me he's not the most responsible person and he can be very tacky and ugly, getting support is like pulling teeth but you know how you live your life comes out in the wash. God blesses me by trying to do right and my ex never understands why the world rains on poor lil me. Hang in there, didn't read the other responses, just read your follow up. Myself I know how frustrating all this can be so I for one didn't think you sounded bitter just like I get anxious to know your rights.
It totally depends on your coverage, but usually if an item is covered it doesn't impact the other coverage. Braces are usually NOT just cosmetic or "mostly elective" but to correct a bite that can cause major problems later in life.
The best thing for you to do is call the Customer Service number on your insurance card and ask them.
Every insurance policy is different so the best two sources for information would be the HR dept. at your husband's office and the insurance company itself. Some policies have collective family deductibles and limits while others have individual deductibles and limits.
Since you are receiving checks from the insurance company for your stepdaughter's orthodontic treatment, her mother is filing for benefits through your husband's policy. Chances are the check amounts are to reimburse for what is covered under the policy that the mom may have just paid upfront.
I was a little confused by the wording on your post - is the daughter your children's half-sister/husband's daughter?
I have worked in the dental field for many years. Your husband can call his customer service phone number that is on his policy or dental card to find out the annual maximum PER PERSON on his current plan. All dental plans are set up this way, to cover each dependent and the employee as individuals. No need to worry that his ex-wife had used the FAMILY benefits. You should definately have your husband verify with his insurance company exactly what dependents he has currently covered. Also, for ortho benefits, there is a lifetime maximum per individual. Your husband could also request a statement from the dental office to show that his daughter's account is paid in full or find out if those checks should be sent directly to the dentist that has been rendering those services. There are a lot of dentists that request payment be set up directly from your insurance company unless the POLICYHOLDER makes the request to have those payments paid to himself. It would not be a very pleasant surprise to find out that your husband released those benefit checks to the wrong person. Hope this helps.
I read the post and your response and I just want to let you know that I understand exactly where your coming from! It's not about who gets what but about making sure everyone gets what they need.
I'm not licensed in TX but I did sell insurance in Pennsylvania and know that almost all plans there are a specific amount per child/adult. Not usually for the whole family where orthadontics is concerned. Most often you can see everything on your carrier's website and don't need to call.
You will be looking for the verbage like $XXXX per individual for orthodontic care. At least in PA Orthodontic care is seperated from all other care, however it usually goes toward your total family benifit to some degree. Most of the policy's that I am familiar with cover $2000 towards the lifetime of orthodontic, so if the child gets the braces now and uses the whole benifit sometimes they will end up paying totally out of pocket for any future orthedontic work.
I hope this helps and I'm sure your provider will help you. Also sometimes you can up your coverage with the company to ensure that you have plenty to meet your needs or carry a seperate smaller policy just on the step child if she seems to be using a large portion of the familys benefit needs.
coverage benefit for dental insurance is for each person in the family. if your child needs braces, and your insurance max is 5000 your insurance will pay up to 5000 for selected work, then it is out of pocket. if another child needs braces, then the benefit is same for them. at the same time.
benefits are the same for each member of your family.
call your insuranace company and ask them to explain it better.
Orthodontics is separate from dental insurance. Most insurances will pay a certain percentage rate up to a maxium. For example, years ago when I worked for an orthodontis and someone had Metlife insurance. Metlife had a schedule benefits $3350.00. Then the insurance would pay a certain percentage up to a maxium usually $1000.00. Then the rest of the portion would be divided out for 24 months if she was in braces for 2 years. There would be a discount from the doctor if the payment is paid in full. So, since she paid in full she should get the checks. Your children will not be effective from there dental benefits. I hope this helps. Good luck.
Discuss it w/your insurance.I would think they would beable to answer all your questions.
Call the insurance company & ask them to explain it all to you. They usually are pretty helpful in helping you understand it all. Who filed for the insurance? If she paid upfront, then the dental office most likely didn't file, they have been paid...? Make sure you understand how it works. The insurnce comapny will not pay out unless they have been submitted a bill to pay on.
C., usually the annual max is per person . Meaning that each person is entitled to the maximum benefits of the policy, it is not divided between family members. so each person has up to say 2000. per year to use up. You should contact the ins. co to verify but I have never heard of a benefit being divided betweeen family members. I would definitely return the money to the ex.
I am a Dental Account Manager for a million dollar practice. We provide General and Orthodontic services for many patients each year. This is what I can advise you about your situation. First of all, Orthodontic benefit is per person per lifetime. Payments are typically made quarterly. The total amount is usually $1,000 to $1,500 based on the individual's plan. The checks that are coming to her will not effect you or other dependents on this plan. If you have other dental needs those claims will be paid out of our yearly allowance or maximum benefit per person per benefit year. If you need to take your other child to the Dentist you should do so without worry about the child in braces. Hope this puts your mind at ease.
It most divore decrees the parties split medical 50/50 so if she paid up front she is entitled to half the cost of the braces in return
What does the child support papers cover? Most non-custodial parents are required to pay full medical; but things like dental and vision are not mandatory. If this is the case, then I think it would be fair to pay 1/2 of the total bill. It sounds a little odd for the ex ti expect any and all of the refund you've received from the insurance + a little extra. Also, I'm not sure about your dental plan (so you should check with your provider); but I think there's a limit per person not per family...meaning your step-daughter should be able to have her braces covered as well as any other children. My insurance co. pays a portion for braces, then the remaining balance is out of pocket. That might be the case for you guys too. In my own opinion, if that is the situation the I would arrange to pay 1/2 of the remaining out of pocket expense directly to the dentist not the ex.
Good luck! Call the insurance company and then take it from there. Have a great Easter weekend!