Filing a Complaint

[karen1027]

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.

[leevena]

The DOL does not have oversight on all benefit plans, so you will need to be more specific. Can you include information about the specifics of the complaint, the type of health plan you are/were enrolled in, and anything else you can think of.

[karen1027]

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

[Chaz]

Hi Karen,

You seem to be having a lot of problems with your QMCSO based on all your postings on these boards. I'm sure you have been told this many times before, but I think it bears repeating: You will have a MUCH better chance of success (and much less stress) if you hire a competent attorney to help you navigate the legal system instead of trying to do it all yourself. I'm sure your local bar association can recommend a number of attorneys who practice domestic relations law.

Charlie

[karen1027]

Hi Karen,

You seem to be having a lot of problems with your QMCSO based on all your postings on these boards. I'm sure you have been told this many times before, but I think it bears repeating: You will have a MUCH better chance of success (and much less stress) if you hire a competent attorney to help you navigate the legal system instead of trying to do it all yourself. I'm sure your local bar association can recommend a number of attorneys who practice domestic relations law.

Charlie

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?

[GBurns]

I was not aware that this was even be a DoL issue, I have always seen it resolved through the state dept of insurance.

Also this is what I found on the DoL website and this also points to the state to resolve the conflict:

DoL website

[karen1027]

I was not aware that this was even be a DoL issue, I have always seen it resolved through the state dept of insurance.

Also this is what I found on the DoL website and this also points to the state to resolve the conflict:

DoL website

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

[GBurns]

I cannot believe that you read it and still ask this question.

First, I must correct myself, I should have said State child support agency, instead of dept of insurance. But, that should have been obvious given the number of times reference is made to that agency.

Second, there is absolutely no mention anywhere, that I can see, in the document that suggests or gives an enforcement role to the DoL, so I cannot understand why you would even have thought of going there in the first place.

In the document, there is reference to "State laws". Enforcement of State laws is done by State agencies not by DoL. This should have been your first clue that DoL was not the place to go. Then there is the repeated use of the term "State child support agency" . In Q1-4 there is mention of the entities who can/might issue a medical child support order. These are almost always state agencies and which do their own enforcement.

Particular note should be made of Q1-7 and Q1-8 where it refers to "laws" that the "State" must have. Enforcement of these laws would be a State matter.

Then there is the second section of the document. Here I suggest that you substitute, in your thinking while reading, the word "Your" for the word "National. It is unfortunate that the author did not deem it necessary to do a section on "Local Medical Support Notices". However, the enforcement is the same.

[Guest lbwilliams2018]

Karen,

Can you please explain the issue. Do you have a court order requiring the other parent to carry insurance through his employer? Have you or the other parent presented the order to the employer?

You can have an order enforced through state DSS for a small cost of ~$25. It takes months to accomplish given it is a welfare government agency. DOL can enforce the laws if the employer doesn't act appropriately but DOL would be dealing with the employer breaking the DOL law and not dealing with violating your order. You could use the DOL action as evidence to support your own action in local court; but again it takes a looooong time.

The employer, state DSS and DOL cannot enforce the other parent reimbursing you for out of pocket. The reimbursement referred to in QMCSO law involves whenever you pay for a child's services and the insurance company reimburses for those services; not for the out of pocket that the insurance company does not reimburse.

Lisa

[leevena]

I cannot believe that you read it and still ask this question.

First, I must correct myself, I should have said State child support agency, instead of dept of insurance. But, that should have been obvious given the number of times reference is made to that agency.

Second, there is absolutely no mention anywhere, that I can see, in the document that suggests or gives an enforcement role to the DoL, so I cannot understand why you would even have thought of going there in the first place.

In the document, there is reference to "State laws". Enforcement of State laws is done by State agencies not by DoL. This should have been your first clue that DoL was not the place to go. Then there is the repeated use of the term "State child support agency" . In Q1-4 there is mention of the entities who can/might issue a medical child support order. These are almost always state agencies and which do their own enforcement.

Particular note should be made of Q1-7 and Q1-8 where it refers to "laws" that the "State" must have. Enforcement of these laws would be a State matter.

Then there is the second section of the document. Here I suggest that you substitute, in your thinking while reading, the word "Your" for the word "National. It is unfortunate that the author did not deem it necessary to do a section on "Local Medical Support Notices". However, the enforcement is the same.

So, you crucify her for her reading error "I cannot believe that you read it and still ask this question", yet part of your original answer was ( I have always seen it resolved through the state dept of insurance ) also in error!

[karen1027]

Karen,

Can you please explain the issue. Do you have a court order requiring the other parent to carry insurance through his employer? Have you or the other parent presented the order to the employer?

You can have an order enforced through state DSS for a small cost of ~$25. It takes months to accomplish given it is a welfare government agency. DOL can enforce the laws if the employer doesn't act appropriately but DOL would be dealing with the employer breaking the DOL law and not dealing with violating your order. You could use the DOL action as evidence to support your own action in local court; but again it takes a looooong time.

The employer, state DSS and DOL cannot enforce the other parent reimbursing you for out of pocket. The reimbursement referred to in QMCSO law involves whenever you pay for a child's services and the insurance company reimburses for those services; not for the out of pocket that the insurance company does not reimburse.

Lisa

Thank you LIsa.

I have submitted the Court Order which is a Qualified Medical Child Support Order, issued by a judge many years ago, to both the ex's employer and the health insurance company. (It's been submitted to several health insurance companies in the past several years and there has not been a problem in compliance with sending, and making payable to me, the reimbursement checks from the health insurance carrier)

The health insurance carrier refuses to send me the reimbursement checks; instead they are going to my ex-spouse who, in turn, is withholding part of the reimbursement check; i.e. he applies the check to other expenses he owes me not for the actaul exoense the check is for. I have paid for the services for the children. I should get the full reimbursement from the insurance comapny (plus his percentage of the remaining out of pocket from him)

His employer (he's a partner is a large, multinational law firm) has not complied with the order in any regard other than to tell me it's a qualified order. They haven't followed any other procedures that they are suppose to. Even ID cards for the children aren't mailed directly to them.

I am not familiar with DSS. Child Support payments are paid to me directly, there is no state agency involved. (which is/was a mistake!).

I hope this makes it clearer. I am disabled and unable to work

[karen1027]

Karen,

Can you please explain the issue. Do you have a court order requiring the other parent to carry insurance through his employer? Have you or the other parent presented the order to the employer?

You can have an order enforced through state DSS for a small cost of ~$25. It takes months to accomplish given it is a welfare government agency. DOL can enforce the laws if the employer doesn't act appropriately but DOL would be dealing with the employer breaking the DOL law and not dealing with violating your order. You could use the DOL action as evidence to support your own action in local court; but again it takes a looooong time.

The employer, state DSS and DOL cannot enforce the other parent reimbursing you for out of pocket. The reimbursement referred to in QMCSO law involves whenever you pay for a child's services and the insurance company reimburses for those services; not for the out of pocket that the insurance company does not reimburse.

Lisa

Thank you LIsa.

I have submitted the Court Order which is a Qualified Medical Child Support Order, issued by a judge many years ago, to both the ex's employer and the health insurance company. (It's been submitted to several health insurance companies in the past several years and there has not been a problem in compliance with sending, and making payable to me, the reimbursement checks from the health insurance carrier)

The health insurance carrier refuses to send me the reimbursement checks; instead they are going to my ex-spouse who, in turn, is withholding part of the reimbursement check; i.e. he applies the check to other expenses he owes me not for the actaul exoense the check is for. I have paid for the services for the children. I should get the full reimbursement from the insurance comapny (plus his percentage of the remaining out of pocket from him)

His employer (he's a partner is a large, multinational law firm) has not complied with the order in any regard other than to tell me it's a qualified order. They haven't followed any other procedures that they are suppose to. Even ID cards for the children aren't mailed directly to them.

I am not familiar with DSS. Child Support payments are paid to me directly, there is no state agency involved. (which is/was a mistake!).

I hope this makes it clearer. I am disabled and unable to work

If firm is self-insured, is the firm in non-compliance?

[Guest lbwilliams2018]

Karen,

Can you please explain the issue. Do you have a court order requiring the other parent to carry insurance through his employer? Have you or the other parent presented the order to the employer?

You can have an order enforced through state DSS for a small cost of ~$25. It takes months to accomplish given it is a welfare government agency. DOL can enforce the laws if the employer doesn't act appropriately but DOL would be dealing with the employer breaking the DOL law and not dealing with violating your order. You could use the DOL action as evidence to support your own action in local court; but again it takes a looooong time.

The employer, state DSS and DOL cannot enforce the other parent reimbursing you for out of pocket. The reimbursement referred to in QMCSO law involves whenever you pay for a child's services and the insurance company reimburses for those services; not for the out of pocket that the insurance company does not reimburse.

Lisa

Thank you LIsa.

I have submitted the Court Order which is a Qualified Medical Child Support Order, issued by a judge many years ago, to both the ex's employer and the health insurance company. (It's been submitted to several health insurance companies in the past several years and there has not been a problem in compliance with sending, and making payable to me, the reimbursement checks from the health insurance carrier)

The health insurance carrier refuses to send me the reimbursement checks; instead they are going to my ex-spouse who, in turn, is withholding part of the reimbursement check; i.e. he applies the check to other expenses he owes me not for the actaul exoense the check is for. I have paid for the services for the children. I should get the full reimbursement from the insurance comapny (plus his percentage of the remaining out of pocket from him)

His employer (he's a partner is a large, multinational law firm) has not complied with the order in any regard other than to tell me it's a qualified order. They haven't followed any other procedures that they are suppose to. Even ID cards for the children aren't mailed directly to them.

I am not familiar with DSS. Child Support payments are paid to me directly, there is no state agency involved. (which is/was a mistake!).

I hope this makes it clearer. I am disabled and unable to work

If firm is self-insured, is the firm in non-compliance?

Hi Karen,

Is the employer also the Plan Administrator? If the employer has acknowledged the order as a QMCSO then it is responsible for passing the Order to the Plan Administrator who is responsible for directing the insurance company to provide you documents, access and reimbursements.

What does US DOL say?

State DSS is required to enforce any custody order whether or not you receive any other DSS services; i.e. DSS must enforce private case custody/support orders if they receive an request application.

State department of insurance cannot enforce self-insured plans, only DOL can enforce those.

The insurance company is required under US HHS insurance and US DOL employee benefits laws to handle QMCSO's. Who is the insurance company?