Medical Reimbursement 101
Several months ago, I was searching for a counselor for my 15-year-old daughter. She was about to have significant back surgery and was having a lot of anxiety about it. I knew I didn’t have the skills to deal with her emotions (heck I barely have enough skills to deal with her usual 15-year-old self).
Luckily for both of us, my daughter has excellent medical insurance. Her father works at Apple and can cover his children under his insurance without costing him anything extra. On the other hand, as a Founder who bought back SupportPay after being fired am in bootstrap mode and am self-funding the company. Therefore, medical/mental health/dental insurance is not a luxury I can afford… but I digress!
As I sought out a therapist for my daughter to help her through the next few months of her life, I ran into a few surprises.
First, good luck finding ANY mental health professional for your children that takes insurance. Actually, good luck finding ANY mental health professionals for your child at all. We live in a world where we finally talk about mental health. Unfortunately, the number of professionals focused on children is still severely lacking. After 17 phone calls, I received four calls back. Three told me they didn’t have openings. One called back and said she didn’t either but knew of another place that might and gave me their number.
I called, and luckily that referred therapist did have an opening. However, she warned me she didn’t take insurance. There was no one in our area (Sacramento, California), focused solely on children, who took insurance. The reason for this is something I can understand. With children, it’s not merely a 1 to 1 conversation between therapist & patient. The therapist has to coordinate between the parent(s), the school, medical professionals, and the child. It takes a lot of time! If they had to worry about billing insurance as well, it would make it nearly impossible for them to provide a service.
The good news is, I could submit the bills for reimbursement to her insurance, and they would pay at least a portion of it. Long story short, I ended up paying $150 / session out of pocket.
After eight sessions and $1,200 spent out of pocket, I submitted the claim to her insurance for reimbursement. The process was relatively simple, but as I filed the claim, there was no place to update the address or person to send the reimbursement check. In the system, it defaulted to my ex-husband’s name and address. I sent a note along with the submission asking them to send the medical reimbursement payment to me as I was the one that paid the session fee and, therefore, the one to be reimbursed.
Wait. What? You aren’t sending ME the check?
I submitted the claim and waited a few days. The total claim was $1200 – after the $300 deductible, the reimbursement was $900. After a few days, I logged back into the system, and it showed the processed claim, and a sent out check. I checked my bank account, nothing. I got on the phone and called the claims department to make sure they received my note to get my check. It was then that I learned the rules.
Medical reimbursements can only go to the Insured. I was shocked. I even asked if they wrote the check in my name but sent it to my ex-husband’s address. The answer was no. The check was sent in my ex-husband’s name and sent to his address. I asked the nice gentleman, “So you are saying I just gave my ex-husband $900?”.
How unfortunate; 50% of our children do not live with both of their biological parents in today’s world, yet the insurance companies are not set up to support the new “modern family.” I learned that healthcare / medical reimbursements do not go to the person who pays it goes to the person who holds the child’s insurance.
Lucky for me my ex-husband and I have a reasonably amicable relationship. So I simply called him up and explained the situation. I logged it as an expense for $900 in SupportPay, and it became part of his monthly payment. But I will say I am lucky as I am sure not all parents would have such an amicable outcome.
I am merely telling this story to share what I have learned to share with other parents who may face this situation. If I knew this before, I would have made sure to document it in my child support agreement. “The person who pays the deductible, co-payment, the fee is the parent that should receive the reimbursement.”
Did you have a different experience when it comes to medical reimbursement? Is this something that you have experienced a divorced parent? Any suggestions or advice you would like to provide?