Legal Question in Family Law in Indiana

Insurance percentage agreement
I provide insurance coverage for my son. My ex and I split the different 73 (me)/27(her) percent of whatever out-of-pocket expenses that my son has is not covered or fully covered by insurance.

I have noticed that she is paying the doctor's office in full before my insurance is applied. Let's say that bill is $68. But then doctor's office accepts an agreed lower amount from my insurance because they are an in-network provider, let's say they accept $53. My ex gets a check in the mail for reimbursement, but since the doctor and the insurance settled on a lower amount what she gets as reimbursement is not equal to the original $68.

Now she wants me to pay her back 73 percent of the difference of the full bill amount and what the doctor's office and the insurance agreed upon. This is going to cost me about almost $1000 because there were hospital bills where the insurance and the hospital agreed on a much lower amount than the full bill my ex paid, since the hospital was in network.

Are the doctors required to give her back the money because they agreed to take a lower payment from the insurance company? Or am I required to pay 73 percent of the amount difference?

Asked on 2/20/09, 8:56 am

2 Answers from Attorneys

Jay Rigdon Rockhill Pinnick LLP

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Re: Insurance percentage agreement

In your scenario, it sounds like the doctor received $68 from the mother and $53 from the insurance company for the appointment which had a total approved charge of $53. If that is correct, yes, the doctor is getting double payment, and should send the $68 back to mother.

How much she pays up front should not change the ultimate cost to anyone in the slightest.

Answered on 2/20/09, 11:37 am

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