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Implentation of QMCSO


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Guest matthew222

Does the QMSCO specify a date of when the child(ren) needs coverage by? And the carrier should process it in a similar fashion than any other qualifying event.

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The Order has been in effect since January 1998 - the health insurance provider has changed - they have received the Order - am now being told by the person I was put on touch in at the insurance company (after contacting the legal department there), that they have to research what departments have to be notified and that it may take a while.......

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The Order has been in effect since January 1998 - the health insurance provider has changed - they have received the Order - am now being told by the person I was put on touch in at the insurance company (after contacting the legal department there), that they have to research what departments have to be notified and that it may take a while.......

The insurer has to got get their act together. There is something called a NMSN, National Medical Support Notice which is sent by the state agency after the QMCSO is issued which notifies the employer to provide health care to the child. Once the procedures have been complied with the child is covered under the employer's health care plan. Any delay by the new health care provider in processing the order doesnt change the fact that the child is covered under the new providers policy from day 1 of the effective date.

mjb

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Children are covered (non-custodial dad put them on the policy); however, I have paid for over $2000 for medical/dental services. Dad is holding the reimbursement checks.

His employer has been no help either. Do you know what the employer is responsible to do? Saw somewhere that they are to provide their written procedure regarding implementation of the QMCSO to me, the alternate recipient.

Incidentally, there is a Court Order that the Dad have the QMCSO submitted and implemented - it has never happened....

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Guest matthew222

This is something that the HR person at his company should be able to take care of with 1 phone call, assuming all the proper documentation is available. Press the non-custodial dad to talk with them to get things expedited. I've never heard of an insurance company needing to "research" what needs to be done. QMSCO's are common.

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  • 2 weeks later...

Still getting the runaround from all involved. Everyone with the exception of the customer service department insist the QMCSO is on the file. Well it's not because the checks keep going to the non-custodial parent... Who can I contact? What should I do?

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Still getting the runaround from all involved. Everyone with the exception of the customer service department insist the QMCSO is on the file. Well it's not because the checks keep going to the non-custodial parent... Who can I contact? What should I do?

If the HR people are not paying attention to you, they will pay attention to your attorney. See what hapens when the attorney tells HR tey are liable for the misdirected funds.

mjb

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Guest matthew222

I'm all against bringing lawyers into the fold.....up until a certain point and this appears to be it. Perhaps you can sue for court costs?

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  • 4 weeks later...

Health insurance company now states they do not provide the "option" of making payments to the alternate recipient. (They have indicated that they segregate all claims for those under a QMCSO - don't understand why they can't issues checks - manually if necessary - to the alternate recipient). They state they do not have to comply with the court order to made payments to the alternate recipient. Is that accurate?

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Health insurance company now states they do not provide the "option" of making payments to the alternate recipient. (They have indicated that they segregate all claims for those under a QMCSO - don't understand why they can't issues checks - manually if necessary - to the alternate recipient). They state they do not have to comply with the court order to made payments to the alternate recipient. Is that accurate?

I have a stupid question: How does the insurer intend to comply with the QMCSO if payments are not made to alternate payee/recipient?

On Mar 13 you wrote that your ex is holding the reimbursement checks. Is the insurer sending the checks to him?

The insurance co cannot obstruct the QMCSO to prevent the payments being delivered to the proper party. ERISA 609(a)(6) provides that if a fiduciary acts in accordance with the fiduciary provisions of ERISA in treating a QMCSO as being a qualified medical medical support order, then the plan's obligation to the participant and alternate payee shall be discharged to the extent of any payment made pursuant to such act of the fiduciary. In otherwords the employer's fiduciary for the health plan (not the insurer) is personally liable for payment due to the alternate payee if the insurer does not comply with the QMCSO to make payments to the alternate recilpient. While the insurer is correct in saying that it does not have to comply with the QMCSO such action makes the health plan fiduciary of the employer personally liable for the payments which have not be made. I suggest that you make the state agency which issued the QMSCO aware of this situation. Or retain your own lawyer to file a claim with the plan for the QMCSO payments under section 503 of ERISA. The plan fiduciary will have to either approve payment or provide a reason in writing within 90 days of why payment cannot be made. The denial will have to based on the terms of the plan and under ERISA 609(a)(6) the insurer's refusal to make payment to the alternate recipient because it does not provide such an option is not a valid reason for denial of payment.

mjb

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I recently received an email (there are several - about 20 - from the past 5 months) from the account rep at the insurance company (The Plan administrator got them involved.) as well as someone from "Consumer Affairs" at the insurance company (legal Department at insurance company got them involved).

In February I sent an email to the legal counsel at the insurer's legal department. Last week I sent the legal counsel another email advising them of the round around I was getting.

I now have an email from the account rep that she reached out to the legal staff (gee, after I contacted them, agve them her name and cc'd her in the email). She quotes the legal department that in administering the Medical Plan, they do not provide the option to implement payments to the alternate recipient. She also quoted some suggestions from the legal department that I could do...

I have contacted the Department of Labor to file a Complaint. The QMCSO was issued by the Family Court in my State. Who do I contact in my State? Is there someone in the State that oversees QMCSO, e.g. the State Insurance Department?

The insurance company is a major insurer. My ex is a lawyer with a major, mulit-national law firm. Ex has done ERISA work in the past....

The HR person from the ex's law firm told the account rep that the "issue was I wanted the checks to go to her (me)" back in December. It is clearly spelled out in the Order. Yes, the insurance company is sending the checks to my ex.

So the "issue" for me is with the employer - not the insurance company?

Any, all suggestions welcome!

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I recently received an email (there are several - about 20 - from the past 5 months) from the account rep at the insurance company (The Plan administrator got them involved.) as well as someone from "Consumer Affairs" at the insurance company (legal Department at insurance company got them involved).

In February I sent an email to the legal counsel at the insurer's legal department. Last week I sent the legal counsel another email advising them of the round around I was getting.

I now have an email from the account rep that she reached out to the legal staff (gee, after I contacted them, agve them her name and cc'd her in the email). She quotes the legal department that in administering the Medical Plan, they do not provide the option to implement payments to the alternate recipient. She also quoted some suggestions from the legal department that I could do...

I have contacted the Department of Labor to file a Complaint. The QMCSO was issued by the Family Court in my State. Who do I contact in my State? Is there someone in the State that oversees QMCSO, e.g. the State Insurance Department?

The insurance company is a major insurer. My ex is a lawyer with a major, mulit-national law firm. Ex has done ERISA work in the past....

The HR person from the ex's law firm told the account rep that the "issue was I wanted the checks to go to her (me)" back in December. It is clearly spelled out in the Order. Yes, the insurance company is sending the checks to my ex.

So the "issue" for me is with the employer - not the insurance company?

Any, all suggestions welcome!

First step is to ignore the insurance co bumblers who are a distraction to your getting paid because they are powerless to effectuate payment. The plan administrator can order the insurer to make payments or pay your directly.

As I stated in my prior post you need to take your case to the administrator of the health care plan by filing a claim for the payments due from the insurance co and force the administrator to either approve or deny your claim for the payments. Under ERISA the plan administrator must issue a decision in no more 90/180 days after the claim is received. If your claim is denied the plan admin must state the reasons in writing based on plan provisions which can form the basis for a law suit under ERISA. Whether your ex is an ERISA lawyer dosent matter. Under ERISA the plan fiduciary is personally liable for making sure that you get your payments approved under the QMCSO. You need to get an attorney to represent you. Until then the plan and insurer will give you the run around hoping that you will give up and go away.

Years ago an employee contacted me about violations under employment discrimination laws but declined my offer of representation. Instead the employee attempted to resolve the claim by contacting HR which ignored the employee. Finally the employee consented to my representation. The employer's attorney returned my inquiry regarding the employee's claim within 24 hours and the claims were settled satisfactorily after extensive negotiations.

mjb

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Thank you so much for your replies. I have filed several claims with the insurance company; payments have been made to the ex. I'm certain the ex knows what he's doing when he withholds payments. In fact, there is a Court Order that he is responsible to submit the QMCSO in a timely fashion each and everytime the insurance carrier changes.

I'm a bit confused; what type of lawyer do I need? (The insurance company has told me to take my ex to small claims court among other things.) I have no funds for a lawyer.

How do I file claims to force the administrator to approve or deny my claims for payments?

I really appreciate your help!

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Guest matthew222

A good starting point would be calling the lawyer you used for your divorce. He or she will obviously be familiar with the terms of the QMSCO. I'm also pretty certain you can sue him for any court costs you incur.

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  • 4 weeks later...
  • 4 months later...

Does the QMSCO specify a date of when the child(ren) needs coverage by? And the carrier should process it in a similar fashion than any other qualifying event.

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