karen1027

Yes, I have read that publication from the Department of Labor. I'm confused; where does it say the State should resolve it? Thanks!

I can't even afford to retain an attorney let alone incur additional fees after that. What's upsetting about the DOL is that on their website it states the QMCSO must be followed and reimbursement payments must be made to the custodial parent and/or alternate recipient, i.e. me. Children need medical care; I have to pay for it; ex is pocketing some of my reimbursement even though there is a QMCSO. I would like something in writing from the DOL. Ex's health insurance is a self-insured fund - does that affect this?

Am trying to get a QMCSO (Qualified Medical Child Support Order) implemented. Health insurance company says it's an option that don't provide.

I filed a Complaint with the Department of Labor in their Philadelphia office after breifly sepaking with someone there who advised me to send in documentation. Their website says if you send them a complaint in writing you will get a written response from them. I received a phone call from someone in Washington - nothing written. She indicated that the insurance company was correct. I sent another letter to the original party asking for their assistance as I disagreed with what the person from Washington had told me. Who can I contact now? I really would like somethng in writing.

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)?

What type, i.e. specialty, of lawyer do I need to retain to get this accomplished?

Shouldn't the payee be listed on an explanation of benefits? Received an EOB indicating what the plan paid but there is no indication of who received the payment. I paid the provider at the time of service; the provider is non-participating. I did not receive reimbursement even though I am the designated alternate recipient in accordance with the QMCSO.

If you are the designated payee and these payments are amounts that are due you as designated payee under the QMCSO then you can cash them. But you need to make sure that you are entitled to receive the payments and they are not to be made to a state agency. You may also be required to keep the funds segregated from your personal accounts and keep a record of all payments made to providers. You need to have an attorney review the QMSCO to make sure that you are in compliance with all of its conditions. Bit confused - these payment checks from the health insurance company, made payable to my ex-spouse, are for reimbursements for health expenses that I have already paid. The QMCSO states I am to receive payments and designates me (the custodial parent) as the designated payee. The ex is also allocating some of the amount of the payment check to other services I have paid for the children resulting in a lower payment than I am due.

If you are the designated payee and these payments are amounts that are due you as designated payee under the QMCSO then you can cash them. But you need to make sure that you are entitled to receive the payments and they are not to be made to a state agency. You may also be required to keep the funds segregated from your personal accounts and keep a record of all payments made to providers. You need to have an attorney review the QMSCO to make sure that you are in compliance with all of its conditions. Bit confused - these payment checks from the health insurance company, made payable to my ex-spouse, are for reimbursements for health expenses that I have already paid. The QMCSO states I am to receive payments and designates me (the custodial parent) as the designated payee. The ex is also allocating some of the amount of the payment check to other services I have paid for the children.

Yes, the QMCSO designates me as the designated payee. (The insurance company has refused to implement the QMCSO stating they are unable to do so.) The QMCSO was sent to the health insurance company by the employer (after I sent it to the employer.)

Previously posted regarding difficulties I was having regarding the implementation of a QMCSO. Payment checks are still going to the non-custodial parent (which is in non-compliance with the QMCSO); however, the ex has started to send me the health insurance checks endorsed over to me - what should I do with these checks?

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!

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!

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?

Thanks for the advice. I can't afford a lawyer and my ex is a partner at a huge law firm!

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?

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....

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.......

How long does a health insurance company have to implement a QMCSO after they've received it?

If the divorced parent who provides health insurance changes to a plan where the out-of-pockets costs are much higher for the other parent than the original coverage, is there anything the parent who now has much higher out-of-pocket costs can do? The plan is not what is indicated on the QMCSO.

Thank you. This hasn't happened previously - there has been at least 8 health insurance companies since 1998. I do recall one from years ago telling me it had to be renewed every year but that never happened. When I was first advised by the insurance company that it had to come from the employer, I contacted the employer and was assured that they (the employer) had sent it in, the health insurance company had it and that it was in effect. Ex is now getting the checks and is withholding reimbursement for those checks from me. He is not cashing the checks but he is not giving me credit either for the total amount of the check. There also is wording in the QMCSO regarding the level of coverage. The plan my ex is now covered under causes me to have a much higher out of pocket than previously. Also it has an extremely high deductible and coinsurance. I(my share of the payment) am now subsidizing his family's deductible and coinsurance. One of my children takes a medication that costs over $4400 every three months under this plan (was much less under a different carrier). It results in me having an out of pocket over $1100 (I can't afford that.). He has the option to purchase a different plan at work which has better coverage with less out of pocket expense. The insurance company has a form the employer fills out - they do not want the actual Order. It lists the children's name, my name and questions whether or not it is a "full QMCSO". What exactly is a "full QMCSO"? The other option on this form is to get a health insurance card directly from the health insurance company. Kids always got cards directly from their father. How can the insurance company ignore a Court Order?

I am a custodial parent of three children. A QMCSO has been in effect since 1998 whereby I am suppose to receive payment, i.e. reimbursement, checks and EOB's. My ex has changed health insurance carriers several times. The health insurance company he currently has is refusing to accept the court order from me. They indicate it must come from his employer. Can the health insurance company refuse to accept it from me?