The writeoffs on medical procedures vs. what the plan actually pays can be quite spectacular. My cardiologist billed over $7k for my stents the night of the heart attack – was paid $1200. I felt badly about that one. My internal defibrilator was charged at one rate and discounted about 50% on what was actually paid.
OP, if you have a Summary Plan Description, you should be able to see what the plan covers and what the patient’s portion should be – at least to get a rough idea of what you are really dealing with.
Be very careful about changing names or beneficiaries on financial assets without (or against) the advice of your attorney. In the county in which I live and practice law some of the actions that have been suggested on this thread would be in direct violation of the family court standing orders for divorce cases and would subject the party who took the action to the possibility of contempt of court.
@Classof2015 , if you are subject to an Automatic Temporary Restraining Order by virtue of filing, then you are subject to its terms and can’t take action in violation thereof.
^^
Right…in some/many states, once you file you’re under order not to change anything, not to discontinue paying for various items, etc. That can be shocking for some who “leave the home” and file with the intention of leaving their family “high and dry”. They soon find out that they must still pay the mortgage, light bill, etc.
I hope the OP comes back and clarifies whether her ex-H has actually said that there are $160k in unpaid bills or whether she has simply deduced that from what’s she’s seen online.
If a doctor is in network they have to honor the contracted amount the insu co allows (don’t get me started on the often bogus ways insu companies come up with their often insultingly low “reasonable and customary” rates and shaft the drs, but I digress). So if a Dr charges $1000 and the insu co allows $200 and pays 80%, then they pay (if the deductible has been met) $160 and the patient (NOT the owner of the policy) owes $40. If you did not sign any financial forms at the hospitals or doctors offices, you are not liable for these payments. If y our ex/soon-to-be ex went to an out of network doctor ( I am talking outpatient, not inpatient) he would have signed promissory forms at the office. If you did not, you are not responsible (the drs cant come after you).
As for the copay, a dr must make reasonable efforts to collect the copay. They cannot just accept what insu paid and immediately write off the rest, as then the insu company would be paying 100% of the allowed amount and that is against the contract the dr has with the insurer. For outpatient services, most doctors collect the copay at the time of service. If the procedure is a non-covered service, most of the time this will be known ahead of time and the patient would be responsible for payment at the time off service. If a procedure is supposed to be covered and the insu co initially denies it (happens all the time) the drs office may ask it to be reprocessed (there are many reasons for this but outside the scope of this discussion) or the patient can go through an appeals process but there are time limits on this.
Bottom line, the difference between the allowed amount and the patient payment on the patient’s responsibility is what is key, plus the deductible which has to be met.
I wasn’t planning on changing any beneficiaries until my attorney said it was ok to do so.
Mom2ck - the info re: medical bills is purely based on Oxford website list of claims. It is impossible to get any reliable accurate info from ex, especially since he’s changed his #. Kids have it; I don’t.
@Classof2015. No advice on legal issues–just offering support. Divorce sucks–I’ve been there. There is a future; it might not feel like it now, but there is!
Even if she pays the premiums, the HIPAA laws would probably preclude her from getting access to the EOBs since they contain PHI (protected healthcare information) like procedure codes or diagnoses.
At our house, I am in charge of dealing with medical claims, etc. I set up access to each person’s info so that I can follow up, deal with stuff, etc. Of course, they gave permission for me to do this (though the insurance company doesn’t have waivers on file). I have not had problems calling the insurance company with an EOB and trying to get something corrected/clarified, even for DH or S2. With our insurance, the EOB doesn’t include procedure codes, so if I call, it makes it easier to deal with getting things corrected. OTOH, when I’ve had problems with getting codes for my bloodwork so they can be processed properly, it’s like pulling teeth, The CSRs no longer seem to be trained on procedure codes and have to send it to another department. It’s a mixed blessing.
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Mom2ck - the info re: medical bills is purely based on Oxford website list of claims. It is impossible to get any reliable accurate info from ex, especially since he’s changed his #. Kids have it; I don’t.
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Ok…so the true outstanding amounts may be much less…and maybe (hope!) have already been paid by exH.
Good point about the possibility that he went out of network.
If there were a bunch of unpaid medical bills from last year, and the medical facilities thought they could get that money from you, they would be banging on your door already. That they aren’t doing this yet makes me think that there may not be a lot of money that is owed. Since you are primary, you should go play with the insurer’s website and see if you can get to all of the EOBs. Happydad is primary on our health insurance and when I use his login I can access all of the EOBs for everyone in our family.
I have Oxford and often have to call for information on behalf of my husband. When I do, I give his member #, say I’m calling on his behalf, and invariablly the agent says…“and do you have H’s permission to discuss his information?” and I say “Yes”…and on with the conversation we go. Just sayin’…
PS. Yes. Billed Charges are MUCH more than Paid Amounts - the website will show the “Patient Responsibility”. (of course, yes, if out of network, then…???
I have called on bahalf of others and saidvso when asked and been able to get info. Some BCBS employees have had insureds file a written authorization before I caIn talk about their claims–it varies but is worth a try.
I have out of network coverage, so they would pay agreed % and I would be responsible for the rest. Once the insurance has paid their % then they are out, and after that it would be between me and my doctor.