karen1027 Posted June 13, 2012 Share Posted June 13, 2012 Located this on the Department of Labor's website regarding QMCSO's: Q1-29: To whom should the plan pay benefits? The plan should pay benefits to the alternate recipient, the custodial parent, or the provider of health services to the child notwithstanding plan terms that may require benefit payments be made to the participant. In some instances, payment will be required to be made to the State child support enforcement or Medicaid agency. [ERISA §§ 609(a)(8), 609(a)(9), 609(b)(3), Social Security Act § 1908(a)(5)] I read this as payment for benefits are to be made to the alternate recipient, custodial parent or provider no matter what. Am I incorrect? Also the term "plan", does that refer to both the health insurance carrier AND?OR the employer(if it is a self-insured plan)? Link to comment Share on other sites More sharing options...
Guest lbwilliams2018 Posted July 8, 2012 Share Posted July 8, 2012 Located this on the Department of Labor's website regarding QMCSO's:Q1-29: To whom should the plan pay benefits? The plan should pay benefits to the alternate recipient, the custodial parent, or the provider of health services to the child notwithstanding plan terms that may require benefit payments be made to the participant. In some instances, payment will be required to be made to the State child support enforcement or Medicaid agency. [ERISA §§ 609(a)(8), 609(a)(9), 609(b)(3), Social Security Act § 1908(a)(5)] I read this as payment for benefits are to be made to the alternate recipient, custodial parent or provider no matter what. Am I incorrect? Also the term "plan", does that refer to both the health insurance carrier AND?OR the employer(if it is a self-insured plan)? Karen, There are usually three parties involved; employer, plan admin, and carrier: - The employer contracts with the carrier for insurance. - The employer can then act as its own plan admin or hire someone else to be the plan admin to carry out the business of the contract as a whole. The carrier cannot be the plan admin. - The plan admin can then delegate to the carrier just the part of the contract for claims processing but still remains legally responsible for claims processing. The 29 USC 1169 law puts responsibility on the employer to: - determine if the order is a medical child support order (MCSO), - determine if the MCSO is qualified (QMCSO), - notify all involved; parents, plan admin if QMCSO, parents only if not QMCSO, - mandatorily withhold premiums from the employee's paycheck and provide to the plan admin, - keep the child enrolled during the term of the order despite anyone's request to disenroll, and - notify the court if the employee loses insurance; i.e. tries to disenroll while still eligible, is terminated, or dies. The plan admin is responsible for: - sending plan documents to the child via the custodial parent; i.e. benefits summary, claims forms, id cards, etc, - notifying the carrier and - directing the carrier to allow the custodial parent to receive information (EOBs, letters, etc.), assign benefits to providers, file claims and receive all reimbursements owed by the carrier (not reimbursements owed by the ordered parent). As a condition to receive US medicare/medicaid and DSS funds, states are required to have state laws on the books identical to 29 USC 1169. Check your state laws. Non-self funded plans must comply with state and US laws. Self-funded plans only comply with US laws; i.e. state departments of insurance have no jurisdication to enforce any laws on self-funded plans. If the state laws differ from the US laws, the US laws take priority on the QMCSO issue. Like you, I am a custodial mother with a QMCSO and difficult father/employer/plan admin/multiple carriers and have dealt with this same problem extensively since 2007. You'll find attorneys, local courts, employers and many carriers are unfamiliar with QMCSO laws although the laws are more than 15 years old. I was successful in achieving the QMCSO with the assistance of US DOL against the employer/plan admin, US HHS against the carrier, and state DSS and state appellate court against the father and employer. Let me know if you would like to discuss via phone. What did US DOL tell you? Link to comment Share on other sites More sharing options...
karen1027 Posted July 9, 2012 Author Share Posted July 9, 2012 Located this on the Department of Labor's website regarding QMCSO's:Q1-29: To whom should the plan pay benefits? The plan should pay benefits to the alternate recipient, the custodial parent, or the provider of health services to the child notwithstanding plan terms that may require benefit payments be made to the participant. In some instances, payment will be required to be made to the State child support enforcement or Medicaid agency. [ERISA §§ 609(a)(8), 609(a)(9), 609(b)(3), Social Security Act § 1908(a)(5)] I read this as payment for benefits are to be made to the alternate recipient, custodial parent or provider no matter what. Am I incorrect? Also the term "plan", does that refer to both the health insurance carrier AND?OR the employer(if it is a self-insured plan)? Karen, There are usually three parties involved; employer, plan admin, and carrier: - The employer contracts with the carrier for insurance. - The employer can then act as its own plan admin or hire someone else to be the plan admin to carry out the business of the contract as a whole. The carrier cannot be the plan admin. - The plan admin can then delegate to the carrier just the part of the contract for claims processing but still remains legally responsible for claims processing. The 29 USC 1169 law puts responsibility on the employer to: - determine if the order is a medical child support order (MCSO), - determine if the MCSO is qualified (QMCSO), - notify all involved; parents, plan admin if QMCSO, parents only if not QMCSO, - mandatorily withhold premiums from the employee's paycheck and provide to the plan admin, - keep the child enrolled during the term of the order despite anyone's request to disenroll, and - notify the court if the employee loses insurance; i.e. tries to disenroll while still eligible, is terminated, or dies. The plan admin is responsible for: - sending plan documents to the child via the custodial parent; i.e. benefits summary, claims forms, id cards, etc, - notifying the carrier and - directing the carrier to allow the custodial parent to receive information (EOBs, letters, etc.), assign benefits to providers, file claims and receive all reimbursements owed by the carrier (not reimbursements owed by the ordered parent). As a condition to receive US medicare/medicaid and DSS funds, states are required to have state laws on the books identical to 29 USC 1169. Check your state laws. Non-self funded plans must comply with state and US laws. Self-funded plans only comply with US laws; i.e. state departments of insurance have no jurisdication to enforce any laws on self-funded plans. If the state laws differ from the US laws, the US laws take priority on the QMCSO issue. Like you, I am a custodial mother with a QMCSO and difficult father/employer/plan admin/multiple carriers and have dealt with this same problem extensively since 2007. You'll find attorneys, local courts, employers and many carriers are unfamiliar with QMCSO laws although the laws are more than 15 years old. I was successful in achieving the QMCSO with the assistance of US DOL against the employer/plan admin, US HHS against the carrier, and state DSS and state appellate court against the father and employer. Let me know if you would like to discuss via phone. What did US DOL tell you? It is a self-funded fund. DOL says the insurance company (united Health Care) does not have to comply with the QMCSO. UHC, through their legal department, has indicated to me that they do not provide "that option", i.e. issuing checks to alternate recipients, custodial parents. Link to comment Share on other sites More sharing options...
Guest lbwilliams2018 Posted July 12, 2012 Share Posted July 12, 2012 Located this on the Department of Labor's website regarding QMCSO's:Q1-29: To whom should the plan pay benefits? The plan should pay benefits to the alternate recipient, the custodial parent, or the provider of health services to the child notwithstanding plan terms that may require benefit payments be made to the participant. In some instances, payment will be required to be made to the State child support enforcement or Medicaid agency. [ERISA §§ 609(a)(8), 609(a)(9), 609(b)(3), Social Security Act § 1908(a)(5)] I read this as payment for benefits are to be made to the alternate recipient, custodial parent or provider no matter what. Am I incorrect? Also the term "plan", does that refer to both the health insurance carrier AND?OR the employer(if it is a self-insured plan)? Karen, There are usually three parties involved; employer, plan admin, and carrier: - The employer contracts with the carrier for insurance. - The employer can then act as its own plan admin or hire someone else to be the plan admin to carry out the business of the contract as a whole. The carrier cannot be the plan admin. - The plan admin can then delegate to the carrier just the part of the contract for claims processing but still remains legally responsible for claims processing. The 29 USC 1169 law puts responsibility on the employer to: - determine if the order is a medical child support order (MCSO), - determine if the MCSO is qualified (QMCSO), - notify all involved; parents, plan admin if QMCSO, parents only if not QMCSO, - mandatorily withhold premiums from the employee's paycheck and provide to the plan admin, - keep the child enrolled during the term of the order despite anyone's request to disenroll, and - notify the court if the employee loses insurance; i.e. tries to disenroll while still eligible, is terminated, or dies. The plan admin is responsible for: - sending plan documents to the child via the custodial parent; i.e. benefits summary, claims forms, id cards, etc, - notifying the carrier and - directing the carrier to allow the custodial parent to receive information (EOBs, letters, etc.), assign benefits to providers, file claims and receive all reimbursements owed by the carrier (not reimbursements owed by the ordered parent). As a condition to receive US medicare/medicaid and DSS funds, states are required to have state laws on the books identical to 29 USC 1169. Check your state laws. Non-self funded plans must comply with state and US laws. Self-funded plans only comply with US laws; i.e. state departments of insurance have no jurisdication to enforce any laws on self-funded plans. If the state laws differ from the US laws, the US laws take priority on the QMCSO issue. Like you, I am a custodial mother with a QMCSO and difficult father/employer/plan admin/multiple carriers and have dealt with this same problem extensively since 2007. You'll find attorneys, local courts, employers and many carriers are unfamiliar with QMCSO laws although the laws are more than 15 years old. I was successful in achieving the QMCSO with the assistance of US DOL against the employer/plan admin, US HHS against the carrier, and state DSS and state appellate court against the father and employer. Let me know if you would like to discuss via phone. What did US DOL tell you? It is a self-funded fund. DOL says the insurance company (united Health Care) does not have to comply with the QMCSO. UHC, through their legal department, has indicated to me that they do not provide "that option", i.e. issuing checks to alternate recipients, custodial parents. Karen, I successfully fought this same battle with the help of DOL and HHS. Your DOL regional office is wrong. Ask them to check with the DOL national office of Interpretations and Regulations, specifically Susan Rees, who has worked on this issue continuously since 1993 and understands the law. She helped my DOL office (Atlanta Regional Office, Veronica Patterson and Patricia Young) figure it out so they could help me fight it. Veronica advised the employer it was wrong to refuse the QMCSO. When the employer still wouldn't cooperate, Veronica referred my case to the DOL office for Enforcement, David Ritter, who investigated the employer, sited them for violation for not honoring the QMCSO and forced them to comply. Feel free to call if you would like to discuss this. Link to comment Share on other sites More sharing options...
Guest lbwilliams2018 Posted July 12, 2012 Share Posted July 12, 2012 Located this on the Department of Labor's website regarding QMCSO's:Q1-29: To whom should the plan pay benefits? The plan should pay benefits to the alternate recipient, the custodial parent, or the provider of health services to the child notwithstanding plan terms that may require benefit payments be made to the participant. In some instances, payment will be required to be made to the State child support enforcement or Medicaid agency. [ERISA §§ 609(a)(8), 609(a)(9), 609(b)(3), Social Security Act § 1908(a)(5)] I read this as payment for benefits are to be made to the alternate recipient, custodial parent or provider no matter what. Am I incorrect? Also the term "plan", does that refer to both the health insurance carrier AND?OR the employer(if it is a self-insured plan)? Karen, There are usually three parties involved; employer, plan admin, and carrier: - The employer contracts with the carrier for insurance. - The employer can then act as its own plan admin or hire someone else to be the plan admin to carry out the business of the contract as a whole. The carrier cannot be the plan admin. - The plan admin can then delegate to the carrier just the part of the contract for claims processing but still remains legally responsible for claims processing. The 29 USC 1169 law puts responsibility on the employer to: - determine if the order is a medical child support order (MCSO), - determine if the MCSO is qualified (QMCSO), - notify all involved; parents, plan admin if QMCSO, parents only if not QMCSO, - mandatorily withhold premiums from the employee's paycheck and provide to the plan admin, - keep the child enrolled during the term of the order despite anyone's request to disenroll, and - notify the court if the employee loses insurance; i.e. tries to disenroll while still eligible, is terminated, or dies. The plan admin is responsible for: - sending plan documents to the child via the custodial parent; i.e. benefits summary, claims forms, id cards, etc, - notifying the carrier and - directing the carrier to allow the custodial parent to receive information (EOBs, letters, etc.), assign benefits to providers, file claims and receive all reimbursements owed by the carrier (not reimbursements owed by the ordered parent). As a condition to receive US medicare/medicaid and DSS funds, states are required to have state laws on the books identical to 29 USC 1169. Check your state laws. Non-self funded plans must comply with state and US laws. Self-funded plans only comply with US laws; i.e. state departments of insurance have no jurisdication to enforce any laws on self-funded plans. If the state laws differ from the US laws, the US laws take priority on the QMCSO issue. Like you, I am a custodial mother with a QMCSO and difficult father/employer/plan admin/multiple carriers and have dealt with this same problem extensively since 2007. You'll find attorneys, local courts, employers and many carriers are unfamiliar with QMCSO laws although the laws are more than 15 years old. I was successful in achieving the QMCSO with the assistance of US DOL against the employer/plan admin, US HHS against the carrier, and state DSS and state appellate court against the father and employer. Let me know if you would like to discuss via phone. What did US DOL tell you? It is a self-funded fund. DOL says the insurance company (united Health Care) does not have to comply with the QMCSO. UHC, through their legal department, has indicated to me that they do not provide "that option", i.e. issuing checks to alternate recipients, custodial parents. Karen, I successfully fought this same battle with the help of DOL and HHS. Your DOL regional office is wrong. Ask them to check with the DOL national office of Interpretations and Regulations, specifically Susan Rees, who has worked on this issue continuously since 1993 and understands the law. She helped my DOL office (Atlanta Regional Office, Veronica Patterson and Patricia Young) figure it out so they could help me fight it. Veronica advised the employer it was wrong to refuse the QMCSO. When the employer still wouldn't cooperate, Veronica referred my case to the DOL office for Enforcement, David Ritter, who investigated the employer, sited them for violation for not honoring the QMCSO and forced them to comply. Feel free to call if you would like to discuss this. I also filed a complaint with HHS, office of Civil Rights Lisa Anderson, to deal with the carrier UHC who was also sited for violation for not providing info and reimbursements. She worked with a national vice president at UHC Doug Niska, 309-736-4551 to get the problem resolved with the carrier. Link to comment Share on other sites More sharing options...
Guest lbwilliams2018 Posted July 12, 2012 Share Posted July 12, 2012 Located this on the Department of Labor's website regarding QMCSO's:Q1-29: To whom should the plan pay benefits? The plan should pay benefits to the alternate recipient, the custodial parent, or the provider of health services to the child notwithstanding plan terms that may require benefit payments be made to the participant. In some instances, payment will be required to be made to the State child support enforcement or Medicaid agency. [ERISA §§ 609(a)(8), 609(a)(9), 609(b)(3), Social Security Act § 1908(a)(5)] I read this as payment for benefits are to be made to the alternate recipient, custodial parent or provider no matter what. Am I incorrect? Also the term "plan", does that refer to both the health insurance carrier AND?OR the employer(if it is a self-insured plan)? Karen, There are usually three parties involved; employer, plan admin, and carrier: - The employer contracts with the carrier for insurance. - The employer can then act as its own plan admin or hire someone else to be the plan admin to carry out the business of the contract as a whole. The carrier cannot be the plan admin. - The plan admin can then delegate to the carrier just the part of the contract for claims processing but still remains legally responsible for claims processing. The 29 USC 1169 law puts responsibility on the employer to: - determine if the order is a medical child support order (MCSO), - determine if the MCSO is qualified (QMCSO), - notify all involved; parents, plan admin if QMCSO, parents only if not QMCSO, - mandatorily withhold premiums from the employee's paycheck and provide to the plan admin, - keep the child enrolled during the term of the order despite anyone's request to disenroll, and - notify the court if the employee loses insurance; i.e. tries to disenroll while still eligible, is terminated, or dies. The plan admin is responsible for: - sending plan documents to the child via the custodial parent; i.e. benefits summary, claims forms, id cards, etc, - notifying the carrier and - directing the carrier to allow the custodial parent to receive information (EOBs, letters, etc.), assign benefits to providers, file claims and receive all reimbursements owed by the carrier (not reimbursements owed by the ordered parent). As a condition to receive US medicare/medicaid and DSS funds, states are required to have state laws on the books identical to 29 USC 1169. Check your state laws. Non-self funded plans must comply with state and US laws. Self-funded plans only comply with US laws; i.e. state departments of insurance have no jurisdication to enforce any laws on self-funded plans. If the state laws differ from the US laws, the US laws take priority on the QMCSO issue. Like you, I am a custodial mother with a QMCSO and difficult father/employer/plan admin/multiple carriers and have dealt with this same problem extensively since 2007. You'll find attorneys, local courts, employers and many carriers are unfamiliar with QMCSO laws although the laws are more than 15 years old. I was successful in achieving the QMCSO with the assistance of US DOL against the employer/plan admin, US HHS against the carrier, and state DSS and state appellate court against the father and employer. Let me know if you would like to discuss via phone. What did US DOL tell you? It is a self-funded fund. DOL says the insurance company (united Health Care) does not have to comply with the QMCSO. UHC, through their legal department, has indicated to me that they do not provide "that option", i.e. issuing checks to alternate recipients, custodial parents. Karen, I successfully fought this same battle with the help of DOL and HHS. Your DOL regional office is wrong. Ask them to check with the DOL national office of Interpretations and Regulations, specifically Susan Rees, who has worked on this issue continuously since 1993 and understands the law. She helped my DOL office (Atlanta Regional Office, Veronica Patterson and Patricia Young) figure it out so they could help me fight it. Veronica advised the employer it was wrong to refuse the QMCSO. When the employer still wouldn't cooperate, Veronica referred my case to the DOL office for Enforcement, David Ritter, who investigated the employer, sited them for violation for not honoring the QMCSO and forced them to comply. Feel free to call if you would like to discuss this. I also filed a complaint with HHS, office of Civil Rights Lisa Anderson, to deal with the carrier UHC who was also sited for violation for not providing info and reimbursements. She worked with a national vice president at UHC Doug Niska, 309-736-4551 to get the problem resolved with the carrier. Feel free to mention my name, Lisa Williams in SC, as Veronica, Patricia, Susan and David at DOL, Lisa at HHS, and Doug at UHC are very familiar with my name and case. Link to comment Share on other sites More sharing options...
karen1027 Posted December 17, 2013 Author Share Posted December 17, 2013 Lisa, How long does it take for you to get a check? I get EOB's about three weeks after they're issued. Sometimes I have to contact UHC for checks as they don't come or it takes another three weeks for them to send one out. This means it takes about six weeks to get a check AFTER the claim has finalized..... Currently, there are several checks outstanding. Link to comment Share on other sites More sharing options...
karen1027 Posted December 18, 2013 Author Share Posted December 18, 2013 Aren't there guidelines for the amount of time a claim is processed? Doesn't that timeframe include the issuance of a payment? Link to comment Share on other sites More sharing options...
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