Change of Physician and insurance

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Change of Physician and insurance

Unread postby Tx295 » Wed Jan 10, 2018 3:48 pm

TX finalized 7/2017, S10 and D7, joint managing conservators, 50/50 schedule.

Son sees a psychiatrist every 3 months. His current psych stopped accepting insurance in Sept 2017. He saw the psych in Nov 2017 and has another appointment in Feb 2018 that was scheduled by the ex at the time of his appointment. We each paid for half of the visit in November.

Ex now wants him to see an in-network psych.... The one she wants him to see is a significantly farther drive and doesn't specialize with adolescents. She seems to be looking simply at the cost.

Decree stipulates we must both consent to psych treatment. Decree also says that if insurance isn't used that the party incurring the expense is responsible for 100% of the cost, rather than a 50/50 split, unless we have a written agreement.

She's now saying if I want him to continue to see the current psych that I'll be responsible for the entire cost. Is the fact that we've continued to use the current psych, after they stopped accepting insurance, an agreement by her? I feel like it's best for him to continue seeing the psych that he's been seeing for 1.5 years rather than switching to a new one simply because she wants to pay less. In addition since we both have to consent to treatment my view is we have to agree on picking a new psych before he can see a different one.

I'm not sure how to respond to her and which direction to go. Thanks for any advice!
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Re: Change of Physician and insurance

Unread postby dad2grls » Wed Jan 10, 2018 4:11 pm

I'm siding with your exwife on this one. Nothing wrong with looking at cost when choosing a doctor, unless every single one of the in network doctors is incompetant, and that's unlikely.

If you choose to take your son to the considerably more expensive noncovered therapist because it's closer and because you have decided he's more competant than the new network therapist, it's on your dime.

Your train of thought is exactly what my exwife's used to be, and I always made the case for us having insurance with network, we go to in network doctors unless there's a REALLY compelling reason to do otherwise. I don't see a compelling reason.

Just because your son continued to see the current therapist for a few visits after coverage ended does NOT mean your wife has tacitly agreed to continue to do so and is somehow legally responsible for continued noncovered out of network costs.
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Re: Change of Physician and insurance

Unread postby changeofplans » Wed Jan 10, 2018 5:11 pm

Yes, you're decree is pretty clear on this-if you want him to remain at the out-of-network physician, you'll need to foot the bill.

I do agree with you that there are likely benefits to your son to continuing to use the same therapist. It sucks that money is an issue here, but maybe you can offer to have mom pay whatever her half would be for an in-network and you cover the rest (rather than you taking on 100%)? She might wish to continue same doc too but simply can't afford it.
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Re: Change of Physician and insurance

Unread postby Trevor » Wed Jan 10, 2018 5:45 pm

The existing shrink will surely pass over the notes/records to the next one, once notified properly.
"Personal density is directly proportional to temporal bandwidth."
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Re: Change of Physician and insurance

Unread postby TJinCA » Wed Jan 10, 2018 6:39 pm

I'm not going to pretend that I know better than you and your ex do whether it's really important for your son to continue to see his existing psychiatrist or if a new one would do just fine. You know the nature of his issues, his treatment and his relationship with the current doc. Nobody here does.

So that said, if you think it's important for him to continue with the current doc, maybe offer his mom that you don't think it's fair for you to pay 100% but you'll pay the difference over and above what her share of an in-network therapist would be.

So she's in the same position she would be (without the extra transportation or the hassle of finding a new doc), you pay a bit more than 50% of the total cost and the kid gets the treatment that you think is best for him.
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Re: Change of Physician and insurance

Unread postby Tx295 » Wed Jan 10, 2018 9:37 pm

TJinCA wrote:I'm not going to pretend that I know better than you and your ex do whether it's really important for your son to continue to see his existing psychiatrist or if a new one would do just fine. You know the nature of his issues, his treatment and his relationship with the current doc. Nobody here does.

So that said, if you think it's important for him to continue with the current doc, maybe offer his mom that you don't think it's fair for you to pay 100% but you'll pay the difference over and above what her share of an in-network therapist would be.

So she's in the same position she would be (without the extra transportation or the hassle of finding a new doc), you pay a bit more than 50% of the total cost and the kid gets the treatment that you think is best for him.


I like this as a win-win. I doubt she'll go for it but I could be pleasantly surprised.

She's a control freak when it comes to the psych. The kid has been to 4 different ones in 2 years... This would make 5 if we switch. I think she sees it as an opportunity to make another change for whatever her reason is. He sees the doc 4 times a year and her additional out of network cost would be $60/visit. She makes pretty good money plus gets a child support check. I don't see how it can possibly be about money to her.

To me its an easy choice, its a bigger benefit to keep the same doc for the extra cost being split 50/50 than it is to change. If he was seeing the doc more frequently I could see the argument based on cost.

Additionally, our decree requires consent from both of us for psychiatric care. The way I see it we both have to agree on which doc he will see. If we don't then he doesn't see one, if we do then we split the cost. In/out-network really wouldn't matter since we both have to consent. I could be totally off base with that but that's why I'm asking the question.

Thanks for all the replies so far!
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Re: Change of Physician and insurance

Unread postby Trevor » Wed Jan 10, 2018 10:12 pm

Tx295 wrote:He sees the doc 4 times a year and her additional out of network cost would be $60/visit.

Wait, what?

All this for $120 a year out of pocket? I get it if you're living paycheck to paycheck and can't afford an additional $10/mo for your kid's health care. (cough|one less starbucks trip every two weeks|cough)

Consider the non-financial aspect: for this $120 and your silence on the matter, your x doesn't know where your goat is tied up, and you don't have this conversation at all. Your kid doesn't have to change shrinks. What price is there on your peace and quality of life?
"Personal density is directly proportional to temporal bandwidth."
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Re: Change of Physician and insurance

Unread postby Tx295 » Wed Jan 10, 2018 10:33 pm

Trevor wrote:
Tx295 wrote:He sees the doc 4 times a year and her additional out of network cost would be $60/visit.

Wait, what?

All this for $120 a year out of pocket? I get it if you're living paycheck to paycheck and can't afford an additional $10/mo for your kid's health care. (cough|one less starbucks trip every two weeks|cough)

Consider the non-financial aspect: for this $120 and your silence on the matter, your x doesn't know where your goat is tied up, and you don't have this conversation at all. Your kid doesn't have to change shrinks. What price is there on your peace and quality of life?


$60 x 4 = $240 but I get your point.

I haven't responded to her yet. So she doesn't know where my goat is at this point. This is exactly why I think the offer to pay the additional over her in-network expense creates a win-win. Again, I doubt she'll go for it because this seems like a control issue. We aren't talking about a lot of additional expense to see a good doc that my son has been successful with. It doesn't make sense that she would bring this up now when she scheduled the appointment knowing the cost.

I guess her response to the offer will tell me if it's really about money or not for her.
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Re: Change of Physician and insurance

Unread postby Trevor » Wed Jan 10, 2018 10:51 pm

You missed my point, and I do understand math.

Your math misses the fact that your costs are shared. Your math assumes she'd pay for all of the difference.

Even asking her about this could possibly poke the bear, and you should consider, as I wrote just there, your peace by letting the bear sleep for so little a difference.

Your call.
"Personal density is directly proportional to temporal bandwidth."
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Re: Change of Physician and insurance

Unread postby Tx295 » Wed Jan 10, 2018 11:03 pm

Trevor wrote:You missed my point, and I do understand math.

Your math misses the fact that your costs are shared. Your math assumes she'd pay for all of the difference.

Even asking her about this could possibly poke the bear, and you should consider, as I wrote just there, your peace by letting the bear sleep for so little a difference.

Your call.


I didn't miss the point. My original explanation of the math my not have been completely clear, it's $60 more/per person/per visit assuming we split it 50/50.

The issue needs to be addressed, theres no avoiding the bear. Either I capitulate and agree to send him to a different psych or I hold my ground and he keeps going to his current psych. If I can get her to buy off on paying what she would be with an in-network doc, it's better than footing the entire bill... win-win.

If she doesn't want him to see his current psych with the offer then her original objection obviously wasn't about money. I suspect that's the case because $240/year doesn't change anyone's life significantly.
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