hopping mad

April 20, 2006 1:29 PM

1. fail to show up for orthodontist consultation 2. ex-wife gets the account in her name 3. profit!

My daughter's stepmom took her to the orthodontist last time and !big surprise- didn't leave a check! but she left with a statement of the account, which is solely in my name.

Not that anything on there would be a surprise to them- I've paid 1850 and they've paid 475. Since he carries the insurance (free through work) they get the reimbursement checks and apparently spend them because they're not paying it toward the braces.

We have a custody thing but it's very old and that's not my question... he will eventually pay half of the uninsured portion even if I have to sue him for it.

I can understand her dad and stepmom getting information about treatment but a copy of my account?

And does anyone have a clue how insurance pays out for orthodontics?

posted by auntbunny to law & government (17 comments total)

I'm not clear what your actual question is, here, it seems like you you're venting more than asking. Are you looking for advice on how to get your ex to pay up? Ways to get his insurance to reimburse you rather than him since you're paying the bills? Information on whether its legal for the orthodontist to have given out the account statement?
posted by jacquilynne at 1:35 PM on April 20, 2006

So let me get this straight:

1) Your ex-wife takes your child to the dentist.
2) The dentist bills you.
3) Your ex-wife files an insurance claim
4) Your ex-wife spends the insurance money.

Is that correct? If so, it can't be legal. It sounds like some sort of insurance fraud (i.e. getting money he shouldn't be getting from his insurance company). If you guys are supposed to split the cost of the treatment, then the insurance should only pay for their part.

If they get indicted for insurance fraud, it would certainly help your custody case

I'm not a lawyer.
posted by Paris Hilton at 1:50 PM on April 20, 2006

You also might talk to a lawyer (I assume you already have one, talk to him or her) and get the lawyer to send a mean letter. They should not be allowed to just spend medical insurance claims on whatever they want.

Let's look at an analogy with car insurance. If someone hits my car, and I make an insurance claim, then leave my car dented and spend the money on blow, that's legal (well, except for the blow part).

On the other hand, if someone hits my car, then writes me a check to cover the damage then I make an insurance claim fix the car, and buy blow, that's probably some sort of insurance fraud, and that's kind of what's going on in your situation. I think.

Again I'm not a lawyer.
posted by Paris Hilton at 1:57 PM on April 20, 2006

This is a terrible question.

Paris Hilton, I think the ex-wife is the questioner - it's her ex-husband's new wife who took the daughter to the orthodontist. But this question is so badly worded and rambling that you have to work to figure that out.

What is the question here, exactly? Was it wrong of the orthodontist to give them a copy of the account statement? How does their insurance work?
posted by Dasein at 1:57 PM on April 20, 2006

Take a few deep breaths to get the 'hopping mad' out of your system, then restate the main question. Once we know what you need, hopefully someone can help.

Paris Hilton, I don't think that's quite right either. AuntBunny's ex-husband is re-married to the woman who escorted the child. NewWife received a copy of the account statement even though she's neither the insured (that's hubby) or payor (AuntBunny).

But apparently that's not the main problem.
posted by nakedcodemonkey at 1:57 PM on April 20, 2006

Get a lawyer. We don't accept assignment here at our dental office, and it doesn't sound like the orthodontist does either. Again, get a lawyer, you're in deep.
posted by bilabial at 1:58 PM on April 20, 2006

Paris Hilton, I think the ex-wife is the questioner - it's her ex-husband's new wife who took the daughter to the orthodontist. But this question is so badly worded and rambling that you have to work to figure that out.

Oops, your right. I got the mom and dad mixed up. I think my analysis is correct if you just flip ex-wife to ex-husband.
posted by Paris Hilton at 2:00 PM on April 20, 2006

(By the way, if there's any chance of your daughter or her father ever reading AskMe, consider revising the post's tags.)
posted by nakedcodemonkey at 2:05 PM on April 20, 2006

Sorry if it reads like a vent. It's a legitimate, covered claim. I don't get the reimbursement directly because I'm not the policy holder, but I am the responsible party for the bill. We have that each-pay-half-after-uninsured agreement, which he is trying to weasel out of. so yeah.

I feel sure the insurance company wouldn't just hand over a statement of the insurance payments. My question is: is it legal for the orthodontist's office to give out a copy of the payment record. My other question is: does anyone know how orthodontics claims are usually paid out?
posted by auntbunny at 2:05 PM on April 20, 2006

but she left with a statement of the account, which is solely in my name.

Possibly relevant bit of info, the information on a medical bill is covered by HIPAA laws. While she can't be punished the Orthodontist can be compelled not to discluse YOUR information to others again.
posted by m@ at 2:06 PM on April 20, 2006

The Orthodontist's office should not give a statement of account with your information on it to anyone but you.

I don't know what your child support agreement says. Is he supposed to pay 50% of medical and dental balances after insurance pays? If so, then he may be pocketing the insurance reimbursements against the court order. Many(most?) dental insurance plans don't pay ortho benefits anyway, but you have a right to know if this the case or not.

You may run up against HIPAA asking the ortho office, so you should find out from your ex how the dental insurance works. You probably have a right to the benefits booklet, if he was given one, but I don't know if the insurance company will disclose that to you.
posted by Jazz Hands at 2:31 PM on April 20, 2006

The ortho office made a mistake, probably through carelessness. Write them a polite letter of complaint to make sure it doesn't happen again. Don't pay the orthodontist directly. If they insist on payment, tell them it's the ex's responsibility. Let them get it out of him. They will be more successful than you are. My ex never paid his share of bills unless I let the doctor or other vendor get it from him, and not always then. He never paid child support, or any of the other court-ordered requirements. It sucks. Try not to let your anger win, because you and your child will suffer. Your ex will not care even a little bit, and stepmom will enjoy it. Must keep repeating: Try not to let your anger win.
posted by theora55 at 5:17 PM on April 20, 2006

My other question is: does anyone know how orthodontics claims are usually paid out?

I would guess this varies by insurance. When I got my braces on about 2.5 years ago, my dental insurance paid something like $1500 towards the cost of braces, PLUS had a pre-negotiated discount with orthodontists who were in the plan. So say the total would have been $8500 without insurance. With insurance, the negotiated fee was ~$6500, with $1500 going from insurance directly (in a single lump sum at the beginning of the process) directly to the orthodontist. I then worked out a monthly payment plan with the ortho for the remaining $5000.

So that's how it worked for me, but I can't tell you if that's standard procedure across the board.
posted by scody at 4:31 PM on April 20, 2006

I got vertigo reading the question. But the answer is clearly yes, or no. Yes or no. No.

_{What was the question again?}
posted by tiamat at 5:12 PM on April 20, 2006

This is a dizzy question.

I think.

1) AuntBunny's ex-husband's wife (EHW) takes daughter to dentist'
2) EHW gets account statement, so she can submit it to insurance.
3) Dentist bills AuntBunny
4) AuntBunny and ex-husband will split the cost of braces, including uninsured part.
5) EH or EHW will have received more than their half from their insurance company and (may) have comitted insurance fraud.
6) AuntBunny is stuck paying her half, even though EH/EHW will have been reimbursed for part of it.
posted by acoutu at 5:20 PM on April 20, 2006

mmm... would HIPAA apply to the parent of the patient? I think she should sill be able to get the records.
posted by delmoi at 5:31 PM on April 20, 2006

does anyone know how orthodontics claims are usually paid out?

I recently had braces (as an adult).

Total cost $5200
Insurance pays $1500
I pay $3700 ($500 down + 18 months of $177.77)

And tiamat, you're funny.
posted by eebs at 8:09 AM on April 22, 2006