[Dwonka17]

I understand Jay if you move this post to another forum board, however, I wanted to post here initially, because it is occurring in the state of CT, with hopes of getting some feedback from anyone in either the legal or medical field.

Long story short, I recently moved to CT from MD, so that I could get a divorce. I was lucky enough that one of my oncologists that was in the DC area when I was living in MD, moved two months prior to me and accepted a position in New Britain. I have since seen him, he referred me to another specialist for a consult and treatment. I call, make the appointment, I spend literally at least 4 hours on the phone/faxing/requesting medical records prior to this appointment. When I made the appointment, I verified with them that they were not only in network, with my insurance company, but confirmed that they still accepted it, etc. (things sometimes change with new calendar years, so this is typically the first question I ask when scheduling an appointment). When I made the appointment, they took my insurance info, I stated that I have insurance and it's under my ex-spouse, she is the policy holder, I'm listed as a dependent, no issues with that over the phone, nothing! They literally stalk me-having called four times prior to my appointment-with the last call being a week prior to the appointment, stating I needed to fax my records prior to the appointment, or else they would cancel. I send what they need, and also bring copies with me on the day of the appointment. I drove 45 minutes, was early, checked in, gave them my registration forms, etc., the receptionist verified my insurance, and other demographics and about twenty minutes later, a woman in a white lab coat comes to the lobby and calls my name. I go back, initially thinking this is a nurse, or a nursing technician. I am led to her office, she then tells me she is the Office Manager, and asked about my relationship to Vanessa, and then asked about my new partner-she of course, was listed on my demographics form as the person to contact in case of emergency, under relationship, I stated on the form "partner".

She then tells me that, it is the policy of their office, to not treat or bill patients that have insurance under someone else, my ex, while they are with a new partner. They will not bill the third party insurance. I WAS SHOCKED. I have NEVER encountered this ANYWHERE, and certainly did not expect it here in CT. I asked her how could they, as a practice, dictate that rule? Specifically when they are contracted and in-network with my insurance. I also asked how can they ethically deny me treatment, when regardless of health insurance or lack there of, from my experience, they cannot deny you treatment. I asked her who dictated this rule, was there a practice director, etc., she stated she could not answer my question, but would do her best to find out an answer to it. I have not heard from her since, have called once, this happened about 2.5 weeks ago. She then states that they would see me as a self pay patient, this made no sense to me at all.

I am not sure where to go from here! I have called my insurance company, made them aware of the situation-people have life changing events all the time, get divorced, get married, etc., they stated they don't mind calling the provider to verify my insurance coverage is active, and I have benefits covering the services they offer. My ex has even offered to sign an affadivit stating she would not terminate my coverage.

I cannot help but wonder, if this is related to my sexual orientation, and the fact that this is a reproductive endocrinologist. I was not seeking fertility treatment to conceive going there, I was seeking treatment for other issues that I have going on and due to my age, and cancer history my previous doctor wanted to send me to someone specializing in fertility to try to treat, yet preserve whatever fertility options I may have in the future.

Sorry it looked like I made this a long story afterall......

Thoughts are appreciated! TIA!

[willow wind]

You are in one of three situations- you are in the process of divorce, but not yet finalized, so are still a dependent spouse under your previous wife's insurance.

You are legally divorced and as part of your divorce decree, your ex-wife is required to keep you, the dependent spouse, on her policy. ( dependent spouse meaning the one with no insurance in your own name)

You are divorced but your wife was not required to keep you on her insurance policy but is doing so out of good will.

Figure out which you are and then tomorrow AM call the state Attorney General's office and explain the situation to them.

Many,many people have coverage under an ex's policy as do many children who carry insurance paid by an absent father, even though mom may have remarried. I suspect what is going on is an office policy, but you need the state to cite you chapter and verse to find out where you stand.

[JayCT]

Since it relates to Connecticut, I am going keep it here. JayCT, Moderator

[Comp625]

Originally Posted by willow wind

You are in one of three situations- you are in the process of divorce, but not yet finalized, so are still a dependent spouse under your previous wife's insurance.

You are legally divorced and as part of your divorce decree, your ex-wife is required to keep you, the dependent spouse, on her policy. ( dependent spouse meaning the one with no insurance in your own name)

You are divorced but your wife was not required to keep you on her insurance policy but is doing so out of good will.

Figure out which you are and then tomorrow AM call the state Attorney General's office and explain the situation to them.

Many,many people have coverage under an ex's policy as do many children who carry insurance paid by an absent father, even though mom may have remarried. I suspect what is going on is an office policy, but you need the state to cite you chapter and verse to find out where you stand.

Completely agree with willow wind here. This sounds like a "rule" unique to that the doctor's office has imposed. There are a few things I will add to this:

• Insurance companies are not allowed to "force" a doctor, facility, or hospital to submit a claim and/or to submit one using a particular code. That's why when you called the Insurance Company, they agreed to call the doctor's office but the only power available is for them to verify your Insurance.
• Technically, as long as you are still a covered Dependent Spouse under your ex's plan, the claim will process smoothly. Insurance companies don't have the labor nor time to audit if someone is seeing somebody else.
• The caveat is that many policies allow a 30-to-60 day window to retroactively terminate someone. I wonder if the Doctor's office is afraid that you'll be retro-terminated (e.g. backwards to March 1st), and that the claim will end up being rejected. This would mean the Doctor's office doesn't get paid and they'll end up going after you for the due money. I point out because you said "She then states that they would see me as a self pay patient, this made no sense to me at all." More often than not, billing offices start getting nervous with more costly procedures.
• Candidly, I have seen this happen with many pre/post divorced couples -- the Subscriber on the plan wants to remove the ex-Spouse to save money on Payroll Deductions. After it goes through court or settlement, that's when a mandate is placed that the Subscriber has to keep and/or re-enroll the ex-Spouse. It creates a chaotic whirlwind from an administrative paperwork perspective.
• One scenario that I've encountered before is that your ex may have his/her own partner covered now - thus there would be TWO dependent spouses on the policy. In the particular scenario that I encountered, one was legitimately a dependent spouse (due to legal marriage despite on-going divorce proceedings) but the 2nd dependent was a Domestic Partner.
• The Insurance Carrier may not reveal any extra dependent info to you due to privacy & legal issues, but that can lead to systematic problems from a claims processing perspective (since the computers aren't smart enough to handle strange scenarios like this).

Just to be clear, I'm not saying that any of the aforementioned scenarios apply to you. However, I wanted to share real-life scenarios that I've encountered in the past and why they occured. Hope this is helpful.