Divorce Settlement Conference -- need advice from those who have gone through this

Parent Cafe
41

If she is the holder of the policy, can she call the insurance company and ask why they didn’t cover much?

As the holder of the policy, how far does HIPAA go? I know that my H can clearly see online what my insurance costs have been and which doctors I’ve been to (even tho technically isn’t that supposed to be “secret”…not that I care).

So, can’t she go online and see some details? If she sees doctors’ names, can she look up what kind of doctors they are (plastic surgeons, etc).

(H just told me that prior to January, he could see all kinds of details for me and our adult children’s doctor bills and their Rx’s…since then, BC tightened up a bit, but he can still see dates, charged amount, and then covered amount
BUT…even tho BC tightened up in January, H can go back to 2014 and see all the details for each of us…he just showed me…)

How does she even know that there are truly $160k in uncovered costs? Is she just taking his word for that? or has she been shown that bills were submitted to her insurance and then that is the remaining?

I can’t help but feel that he’s scamming her…either by sneaking some cosmetic stuff in or by lying about what wasn’t covered by insurance or some other way.

Rotator cuff surgery isn’t nearly that expensive.

I know of someone who did “stomach stapling” surgery w/o any insurance coverage…that cost was about $35k total. He had a couple of complications, but that only added a few more thousand.

Heck, my sister has had kidney transplant surgeries (three times) and none of those those surgeries cost anywhere near $100k.

Something smells. I suspect…face lift, hair plugs, and other cosmetic stuff.

42

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He won't pay the bills and since I'm the subscriber, collection agencies will come after me.

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this is the part I’m confused about.

Your insurance has done their part (paid $20k).

At this point, he owes doctors, hospitals, etc. His name is on those bills. The insurance company doesn’t have an interest in this part. The collection agencies will have agreements with the doctors and the hospitals (not your insurance company), so why would you be held liable? What would your insurance company’s concern be?

43

Yes to that

44

Class of 2015, just wanted to say how sorry I am that you are in this situation. I will personally be happy when you are free of him.

45

Thanks deb922 (is that a Bloody Mary? Order me one :slight_smile: ) and everyone else, especially mom2ck – thanks for your caring PM – means a lot to me :slight_smile:

Maybe I’m not reading the Oxford claim history right for him – don’t want to misrepresent things – but for 2014 billed amount was $157,817.82; paid was $28,655.77. For 2015 (through end of April) billed amount was $21,504.24; paid was $7676.64. Oxford member site is down but I thought he had racked up more bills since April.

So I’m taking billed amount minus paid amount to determine the outstanding medical bill liability, which totals $142,989.65.

Is this not correct?

46

For my insurance you get billed amount, amount paid and subscribers amount. Many times the billed amount is much higher than the paid amount and the subscribers amount due is still zero.

47

That’s why I think you need to have discovery on what the actual bills are and what he is responsible for. ^^^

Unless he is willing to accept all responsibility for unpaid debts for these medical procedures.

48

thanks tom1944 – so how do I find out the subscribers amount? If I call, I think they’ll say they can’t release info to me for his account

49

What you need to look at is what the subscriber is responsible for, not what they billed minus what’s paid. A doctor may bill $1000, but the negotiated price is $200 and the insurance pays $160, then you are responsible for $40, as long as the doctor is in the network. If the doctor is outside of network then how much you are responsible depends on if out of network services are covered and what %.

I don’t believe you could be out of pocket for 160K unless those medical procedures are not covered procedures.

50

If you can look at the Oxford site online - you should be able to click on the claims and see the details. They will probably say something like this - billed $30,000, ins paid $4,000, subscriber owes $120. The insurance companies negotiate rates with medical providers and you are not liable for the balances. Some of the actual payments are so low, I wonder how labs stay in business.

Best wishes for your meeting.

51

<<<
Maybe I’m not reading the Oxford claim history right for him – don’t want to misrepresent things – but for 2014 billed amount was $157,817.82; paid was $28,655.77. For 2015 (through end of April) billed amount was $21,504.24; paid was $7676.64. Oxford member site is down but I thought he had racked up more bills since April.

So I’m taking billed amount minus paid amount to determine the outstanding medical bill liability, which totals $142,989.65.


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  1. We don’t know if the provider agrees to take less…many times the health provider bills for $XXXXXXX, yet only gets paid $YYYYYY. However, it is doubtful that a health provider would accept only $28k for that big of a bill.

  2. Even if he still owes his health providers money ( he does NOT owe your insurance company), then why is that an issue for you? Your insurance company doesn’t care if your ex-H owes his provider money for uncovered costs.

If I went and got a face lift (uncovered by insurance) and I didn’t pay my doctor/hospital, then my insurance company wouldn’t care at all. They wouldn’t even know about it.

  1. Has your exH or his attorney implied that you are responsible for those bills and if you don’t pay somehow you will be held liable? Who would hold you liable? Collection agencies? How would they do that? Where is your name on his bills?

I could see may be holding you responsible for the part that the insurance didn’t cover for a COVERED expense. But if he tried to bill the insurer for something cosmetic, and the insurance company didn’t pay one dime of those costs, then why would the INSURANCE company care whether you paid or not?

  1. Is your only source for knowing THAT big figure thru online? Has your exH told you that he owes that much? If so, then he has to be told that you know that a rotator cuff surgery would not have that much “patient portion” to pay. At most, you’d have something like $2000-4000 to pay.
52

I strongly doubt the outstanding amount is $160K. As others have said, a physician can bill any darn amount he wants. But the insurance company will have a negotiated fee with the doc, and the doc is not permitted to get more than that negotiated amount.

All bets are off if your husband went out of network, but if that’s the case, it seems to me the judge could put the responsibility on him, not you.

53

OK net net (regardless of billed amount/paid amount) I want a statement from each and every doctor/hospital he visited since we separated saying he does not owe them any money. Because if he does owe them money, I am positive they will come after me.

54

The term is allowed amount, the hospital bills $1000, the negotiated allowed amount is $500, the 20% co-pay leaves yo owing $100. So, you want to find the negotiated or allowed amount, if he went out of network, that could definitely be argued to be his responsibility.

55

You should have a legal right to see the EOBs if you are in any way responsible for them. It is true that sometimes the charges are ridiculously high, with no expectation of being fully paid, but his numbers seem suspicious as they are. I suppose this has to wait until the settlement date? Is there any way to ask in advance by having your lawyer ask his lawyer what paperwork might be needed?

For now, listen to Sinead O’Connor sing “This is the Last Day of our Acquaintance” and be glad that it will soon be over!

56

http://www.newchoicehealth.com/procedures/rotator-cuff-surgery

57

If the ex is actually saying that there are $160k in uncovered expenses, then he must be trying to pull a fast one somehow.

I don’t know what/how he’s doing it, but something smells if there are truly that much in uncovered costs and he expects @classof2015 to pay.

If he’s hiding behind HIPAA in order to hide what these expenses truly are, I think I’ve heard that your atty can have an “independent 3rd party” look at the expenses (to protect his “privacy”) to determine if the claims are legit.

58

@Classof2015 ,

I went back over your initial post and noticed this. Even though NYS is not a community property state, your ExH could lay claim to your business as it was started during your marriage. I noted that you mentioned he is also self-employed. Perhaps he will fall for the “mutually release one another from any and all claims on the other spouse’s business” so that he will not want 1/2 the “value” of your business as part of the settlement.

And, with all due respect to your attorney, other than your 401k plan account and your medical insurance policy, IIWY, I would not wait until after the ink is dry on the settlement agreement or the divorce before I replace him on my financial assets on which I am under no legal obligation to make him my beneficiary. Though the chance of it occurring is minute, I would not want you to risk any “what if” occurrence that would grant him a windfall if something calamitous were to happen to you in the interim. There would be no reason for him to know that you have quietly gone online or submitted documents to put in your children as beneficiaries.

As for the medical claims, if you want some direct assurances, you should contact Oxford (?) and confirm that based on what you have seen in your account info (you are the subscriber, after all), and assuming that the services were rendered in-network (which you should confirm independently), then the ExH’s health care providers cannot come against you for the balance. That ought to give you independent confirmation that you are not on the hook for the difference between “billed” and “paid” amounts. Otherwise, there is a chance that you will get bogged down in this aspect of the settlement negotiations when what you want to do is move this along quickly.

59

Also, maybe your ExH is not well-advised and won’t notice that you have elected to keep those financial assets that have the highest post-tax value to you – IOW, those assets the sale of which will result in the lowest taxes for you. If you haven’t already done so, you should definitely evaluate your assets with an eye towards tax consequences.

60

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That ought to give you independent confirmation that you are not on the hook for the difference between “billed” and “paid” amounts.


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Is there a difference between the two scenarios:

  1. Ex-H had medical treatments where insurance covered X amount and he’s expected to pay Y. I know that insurance companies are adamant that health providers collect for the “patient’s share” because they don’t want providers to “just accept” the insurance portion.

  2. Ex-H had cosmetic improvements which he submitted to insurance and the Oxford rejected those claims (paid nothing).

I would guess that Oxford doesn’t care about #2 at all. Why would they care what the OP paid or refused to pay in that case? If most of that $160k was from treatments that weren’t covered at all, would the insurance company be as disinterested as if he had submitted a car repair bill? lol