despedina
addict
Reged: 08/14/06
Posts: 697
Loc: Hillsboro, MO
|
|
My daughter needs braces badly. She literally has teeth behind teeth due to how they grew in. Our dentist advised braces and this year said that she is ready to get some put on. We are in the process of looking for Orthodontists and researching prices and I advised my ex to please do that same. He responded that braces are like a breast augmentation or like liposuction and optional so if I wanted to do it I was responsible for all costs. Our paperwork specifically notes that "medical expenses" is defined as anything listed under IRS statute 1987 section 213 which I looked up and it does include braces on the list. Also, on our paperwork further down the paperwork it does specifically note "orthodontia". He thinks this means only emergency orthodontia and not "cosmetic procedures" as he calls it. How do I get him to understand braces are covered? Also, I believe my husbands insurance will cover part so that even further reduces the amount he has to cover. I'm thinking about having a lawyer type up a letter putting it in layman's terms for him. Any advice?
|
gr8Dad
Carpal \'Tunnel
Reged: 06/07/04
Posts: 30199
|
|
He is correct. You need to see if the braces are MEDICALLY NECESSARY. If they are not, he is not responsible for the cost.
--------------------
Why give a "senior" discount, they have had plenty of time to raise the money...
|
youngatheart
Carpal \'Tunnel
Reged: 09/03/05
Posts: 9394
|
|
I would get your dentist to put it in writing as to why it's needed, what the goal is, and what the repercussions are if it is not done.
The first orthodontist we saw did this on the very first visit. He discussed everything with me, then mailed me a report in the mail that states that the goals are, the ESTIMATED timeline, what is expected of the parents and child, etc. The report also discussed what the diagnosis was if braces were not put on.
Sooo....this year, I get to start spending about $10,000-12,000 on my son's teeth. FUN TIMES.
And yes, it's included in what Ex owes half of.
Anyway, I'd start with the report. If he responds unfavorably, I'd have the attorney send a letter. If he still responds unfavorably, I'd file in Court for him to comply.
|
despedina
addict
Reged: 08/14/06
Posts: 697
Loc: Hillsboro, MO
|
|
Wow I didn't realize this. Our paperwork does not say it has to be an emergency or anything it just says orthodontia and anything listed under IRS 1987 section 213. I guess I will get a report to convince him and we'll go from there.
Also, can someone read this part of how much medical he needs to cover? there is a sentence about me paying the first $100 that I don't quite understand:
"Heath Care Costs: The cost of a health benefit plan covering the children shall be paid by the mother. The parent providing the health benefit plan shall provide the other parent an insurance ID. All health expenses incurred on behalf of the children and not paid by the health benefit plan shall be paid 50% by father and 50% by mother. Unless both parties have agreed to use a health care provider that is not covered by the health plan, if a parent incurs an expense to a provider that is not covered by the plan that would have been covered, or covered at a more favorable rate, if a provider included in the plan had been used, then that parent shall pay 75% and the other parent 25% of the uncovered expenses. Provided however, mother shall pay one hundred percent of the first $100 of health care expenses per year per child. Health care expenses shall be defined in accordance with IRS code (1987) 213....... etc."
What is the $100? Is that just if I pick a provider outside our plan? My daughters insurance is through my husbands job and we pay the premiums out of his check. Thanks for any insight.
|
youngatheart
Carpal \'Tunnel
Reged: 09/03/05
Posts: 9394
|
|
That means that you are responsible for the first $100 of healthcare expenses (co-pays, prescriptions, ortho, dental, whatever), and then AFTER that first $100, you split the costs 50/50.
|
Renny
addict
Reged: 09/24/11
Posts: 479
|
|
He's paying the premiums? At any rate, you are reading the $100 part correctly -- you pay that if the orthodontist is outside the network.
|
M5M5
Carpal \'Tunnel
Reged: 07/29/05
Posts: 11722
|
|
Yeah we thought the same thing, and the judge made us pay for half anyway. Mind you, we were not trying to get out of paying half...we were just trying to get them to stagger out the braces (she wanted SD put in braces in Feb, and SS put in braces in May...we wanted SD put in Feb. and SS put in the following Feb...SS could have waited since they weren't even medically necessary). Judge didn't care. BTW, this was in 2007...it is now 1012 and SS still doesn't have braces...she took us to court over..nothing....and wasted a couple thousand on it. Kinda funny! Anyway, point is...if it winds up in court, a judge will probably order them to pay half whether they were medically necessary or not.
|
youngatheart
Carpal \'Tunnel
Reged: 09/03/05
Posts: 9394
|
|
That is the sucky thing about substantially different finances in different homes. Both of my kids need braces as well, but Son's are more important. Of course, they're also more costly. So, he is getting his first.
Daughter will probably get a retainer after we recover from the initial bleeding of cash on Son. The retainer will at least hold her teeth as they are until we can afford to put the braces on.
If I had a better financial outlook, though, I could put both kids in braces now and demand the money from Ex. Not that I would. As it is...I'm probably going to pay most of Son's braces.
|
Renny
addict
Reged: 09/24/11
Posts: 479
|
|
Correction on my earlier post. On re-reading the clause this morning, the clause "Provided however, mother shall pay one hundred percent of the first $100 of health care expenses per year per child" is not connected to the preceding out-of-network clause. It means, roughly, that in all events, M shall pay that first $100.
I'm surprised the ex-H hasn't insisted on the mother obtaining medical coverage per the CO. There apparently is some degree of cooperation.
|
despedina
addict
Reged: 08/14/06
Posts: 697
Loc: Hillsboro, MO
|
|
I'm not sure it matters to anyone whether I or my husband has the insurance on my daughter. I have insurance available to me but my husband gets much better rates because he works for a larger company. My ex doesn't care as long as he does not have to have insurance on her. Maybe I was unclear - my daughters step father (my current husband) has the insurance on my daughter. Ex never has.
So does the $100 mean premiums also? Also it doesn't say "un covered medical expenses" so that's why I thought it meant for out of network providers. I have a friend that is a lawyer and I think I'm going to have him read over it. Sometimes I think courts make this stuff confusing so that families argue over it and go back to court!
|
Previous
Index
Next
Threaded
Edit
Reply
Quote
