My husband has a daughter from a previous marriage. Their divorce decree states that the father shall maintain health insurance on the child. We agreed to let her mother put her on her stepdads insurance, however, they are now separted. So, we added her back to our policy like the court papers read. The mother has not taken the child off her stepdads insurance, and said that she was going to continue seeing the doctors that the child has been seeing. Keep in mind, we have HMO and she has to be seen my a participating doctor. She has an insurance card from our insurance company and our insurance company said that because it's court ordered that we maintain insurance that the HMO would be primary. The mother hasn't released any information to the doctor office, pharmacies, or her stepdads insurance co relating to the HMO being primary. None of them know that she even has additional insurance. Is this considered insurance fraud? I thought that you had to disclose any and all coverage that you have. Basically she is still using her stepfather's health insurance and it's suppose to be secondary to our HMO, but because she hasn't provided the information she is continuing to not use our insurance and using the other to beable to see the doctors that our not contracted hmo providers... She is figuring that if she doesn't tell them then she can continue seeing the doctors and the stepdads insurance will pick up because they are unaware of the HMO being primary...

Hello g:

Well, she's just a naughty girl, isn't she? She probably IS committing fraud.

And, your interest is what?? You certainly don't want to put the mother of your husbands daughter in jail, do you?? That wouldn't be very nice. I don't think your hubby or his daughter will appreciate it, either.

excon

Both are companies are being paid,? Correct, it is up to them to decide which is first or second. And the fact the other was bought first may well make them primary, just court ordered only means you have to pay.

You can
1. petition the courts to allow you not to pay yours since she is keeping her own insurance.
2. send copies of her insurance cards to her doctors.
3. or care less and let her go to the doctor she wants to see

Personally I don't know why anyone cares or would want to make an issue out of it? Until both companies have to decide who pays first, I am not sure anyone but them can say for sure who is primiary.

Hey there,

Just a few thoughts regarding your dilemma having worked for a major insurance company for over 10 years.
1. The mother is committing fraud
2. The divorce decree determines who assumes financial responsibility for medical insurance regardless of which policy was in force first.
3. If there was not a clause in the decree then most insurance companies follow the birthday rule. Meaning regardless again of which insurance policy was in force first the parent with the birthday earliest in the year would be primary.
4. Theses two companies can not make the determination as to who is primary because for one the stepfathers carrier is not even aware that your daughter has other insurance. And also because of the divorce decree. They must follow the court order.

As stated in the previous post I would get a copy of the new/your plan cards to all of her doctors and make them aware that the previous carrier is no longer primary. Once her stepfathers carrier finds out that they were incorrectly paying as primary they will seek reimbursement for all the "overpayments"

I would think the stepfather would remove her from his plan. Depending on his coverage it could lower his premiums. Hmmm interesting situation.. The mother probably feels she is acting in the best interest of her daughter by keeping her with her current doctors and therefore, in her mind justifys the fraud be committed. Who knows, but you can bet that there will be repurcussions regarding all of the overpayments.

-M-