Spouse caused unnecessary healthcare expense

[thelawdotcom]

I am divorced with 50% custody. I have a divorce agreement which states that my ex-spouse is to insure the children through her employer and that I am to pay for half of the medical coverage that is not covered by insurance. I agreed to this, of course, as it is obviously fair. However, this past November my ex inexplicably switched them to a different policy, presumably to save money on premiums, and in the process signed a non-pre-existing condition clause. My ex did this 2-weeks before a scheduled follow-up echocardiogram for one of my children. In doing so, this procedure was not covered and my ex is now asking for half of the $1200. I do not believe I should have to pay for this blunder. Do I have any legal ground to not pay this expense? Why should I have to pay for my ex's bad decision?

 

[cbg]

Are both policies through her employer? Was there any gap in coverage between the two?

It makes a difference to the answer.

 

[thelawdotcom]

Both policies were through the same employer and there was no gap in coverage. The issue is that a pre-existing condition clause was part of the new policy. The timing was terrible to do this since the appt was 2-weeks away.

 

[cbg]

Under Federal law, if they are both group policies and there was no gap in coverage between the two, the new insurance CANNOT apply a pre-ex clause.

Contact the OLD insurance carrier and tell them that you need a HIPAA certificate. They will know what is meant by that. Then submit the certificate, once received to the new insurance carrier. Technically you should not have to do this, but if they still refuse to pick it up after you provide them with the HIPAA certificate, you will be able to take legal action against the new carrier.

You owe the expense. There is no getting out of that. The provider is entitled to be paid, regardless of whether a former insurance policy would have paid more. Your ex can only make changes at certain times of the year which are determined both by law and her employer; she did not do it randomly. But, assuming that she was covered on the old carrier for 12 months or more, and assuming that both policies are group policies that succeeded each other with no gap, there is legally no such thing as a pre-ex clause.

 

[jharris352]

Yes you have grounds to dispute this cost. It may take a trip back to divorce court to do it, but I think she caused the bill and she should bear it. I would at least look into disputing it.

 

[cbg]

But since legally there CANNOT be a pre-existing clause under these circumstances, that issue should be taken care of first, since it might affect what has to be paid in the first place.