SELECTED ARTICLE
Author
Alla Gordina, MD, FAAP 
Article Title
Medical Insurance and the Adopted Child 
Posted Date
12/19/2005 
 

Medical insurance questions are equally painful both for families and for medical providers. As far as I can understand, adoption and birth have to be equal in the eyes of the insurance providers. Adopted children have to be covered beginning THE DAY of the official adoption - therefore the court date is the date of the effective coverage.

By law, parents have only 30 days to report their "new arrival" and within those 30 days the child is supposed to be covered RETRO-ACTIVELY. I usually recommend that families have all paperwork ready before the final adoption trip and that someone in your insurance office submit the papers or application forms, the moment your adoption becomes final (the court date).

  • Also, it is a good idea to review your insurance policy before your final trip. Questions to have answered:
  • Do you have to select a primary care physician? If you are not satisfied with him/her, how quickly can you change a doctor?
  • Are well child care visits covered? How often? Some plans will limit preventive are only for pre-school kids, some will cover one visit in 2 years and so on.
  • Are "out of sync" immunizations covered? (some insurances do limit amount of money allowed for the preventive care/year. For instance, if you are bringing a 2 year old child home who needs a lot of catch-up vaccinations, payment for the vaccinations can be denied just because children in the US are not usually immunized between ages 2 and 4. Also, some plans do not cover any vaccinations, period. In this situation, it's better to locate where your health department's immunization clinic is situated.
  • Are "pre-existing conditions" covered? If not (which can be an issue with the "old fashioned" indemnity plans) what can you do? - Do you need referrals to specialists and are those referrals made on paper or prepared electronically? Electronic referrals require your child "being in the system", which can take days, if not weeks. If you will need some visits to specialists immediately after arrival, this can be a problem.
  • What about coverage for vision and hearing evaluations? What about evaluations and therapies - physical, occupational, speech - will they be covered, if it will be necessary? What lab can you use?
  • What hospital is covered under your insurance plan? Where is it located? The last thing you need is to search for directions, when or if your new child needs stitches or emergency care the first night arriving home :-)
  • What are your prescription benefits? Do you have to use the mail-out pharmacy for acute care drugs (like antibiotics)? chronic medications (like vitamins)?

Medical evaluation should not be deferred because of the insurance delays. Taking into consideration that some evaluations are recommended to be done as soon as you arrive home (initial visits, bloodwork, stool cultures, etc.), insurance coverage can become a very painful issue. Make sure that you have all promises from your insurance in writing and know the names of the people you were talking to.

This article was originally posted at www.welcomegarden.com in April 2003

The information appearing here is intended for educational purposes only. It should not be used as a substitute for professional medical advice tailored to your child's individual needs. If you have questions or concerns regarding your child's physical or mental health, please seek assistance from a qualified healthcare provider.

References
GLOBAL PEDIATRICS is an international adoption medical support service that has specialized in assisting families adopting from the Former Soviet Union through every step of the adoption process for the past ten years. Dr. Gordina's unique professional background and attention to detail ensure the highest possible level of service. She is recognized by her patients and peers as a leader and pioneer in the field and has presented her adoption-related research at sessions of the AAP, JCICS, NACAS and other meetings. Dr. Gordina has both participated in and organized several humanitarian missions to pediatric clinics and orphanages in the Former Soviet Union. For all questions regarding our services please check www.globalpediatrics.net 
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