[adobe1234]

We just got matched with a situation in FL. The agency agreement says we assume all costs of medical care for baby from birth. But our insurance company says they will only cover the medical costs for the baby starting from the time of placement (not from birth).

Has anyone else had this problem? Is there a way to get insurance for a few days? Or do we just need to pay out of pocket?

We'd appreciate any info on this. Thanks.

[SupaModel]

Our insurance only covered at placement.

[adobe1234]

Hi Supamodel, thanks for the quick reply. So did you pay the hospital out of pocket for the period before placement? What kind of costs are we talking about for this? Also, I am assuming "placement" means starting at TPR. Is that correct?

[calee]

Hi!
Placement should mean from the time the baby is placed in your care. For instance, if baby goes home with you, but TPR doesn't happen for a month, you SHOULD still be able to have coverage. The agency should be able to give you paperwork that shows that you are the gaurdians/responsible party for the baby while it is in your home, even before TPR or finalization.

As for the hospital stay, I would talk to your agency about this. Sometimes, the birthmom's insurance will pay. Othertimes, agencies can apply for state insurance to cover the child as long as he/she is in "their" (the agency's) care (which, legally, is until finalization).

[startedover]

We got conflict information fro m our ins company. Bottom line was they would pay from birth, however our child was on tn care (because bmom was) and tn care covered her for over a year. We had a horrible time getting her switch over , which was fine because nothing cause a penny for the first year, but we wanted to feel like she was 100 percent ours. Our insurance and all. Good luck but you may have to dig a bit and get at least a second opinion from your ins company.

[SupaModel]

Originally Posted by adobe1234

Hi Supamodel, thanks for the quick reply. So did you pay the hospital out of pocket for the period before placement? What kind of costs are we talking about for this? Also, I am assuming "placement" means starting at TPR. Is that correct?

Our insurance covered the DS from the time he went home with us. We didnt TPR until a month later. I think DS bmom actually had insurnace through her job and that's what paid for the hospital stay.

[devildogwife]

Ours started covering him at birth (DH is military), just like they would a bio child. Even though he was also covered by his birth mom's medicaid, which was nice. Tricare went back and reimbursed them a LOT of money from day one. They considered that his placement with us was at birth, regardless of TPR.

[fisbaby]

Our covered him for birth. His birthmother was on state aid I believe so whatever that didn't cover on our son's expenses, my insurance did thankfully!

[Mkap]

the baby we are adopting will be born beginning of May. Our insurance company said all I need in order to put her on our plan is custody. Once she is born, the birth parents will go to court to sign relinquishment papers. After they sign, we will legally have her in our care and she will then be covered on our plan. Prior to that, she is on birthmom's insurance.

[Gwen72]

Ask your agency for an ERISA letter. ERISA was a law that was passed in the 90's that states your insurance has to cover an adopted child with the same benefits as a bio child. If they cover your bio child from birth then they are required to do so for your adopted child. This law is still not well known to the general public so Insurance companys try to get away with not paying. Our agency gave us a copy of the ERISA law when we signed on with them. Luckily for us our Insurance agreed to cover W from birth without any fuss. Good Luck on wrangling your insurance company. I have heard some serious stories from others who had to fight for coverage.

[minibus]

Our insurance paid as soon as the kids were in our care - that happened when the agency had legal guardianship but we had custody. Most insurance companies don't understand adoption, depending on which worker you talk to. Keep trying!

[Magic_Hat]

Our agency said PAP's insurance would cover the baby from birth. Question whatever you are told by the person you speak with on the phone at your insurance company.

[mandirenee]

We just fought this battle.

Insurance companies will say they don't cover till placement, But IF YOUR PLAN IS EMPLOYER BASED the ERISA considers placement at birth in the case of a newborn adoption regardless of when TPR or finalization occurs.

Talk to you attorney and agency they should have documentation of this law.

Here are some websites:

Health Insurance for Adopted Children -

This attorney does work pro bono helping adoptive parents get coverage. He's the one who wrote the ERISA advisory board getting the clarification of "placement" meaning birth. He is VERY nice and extremely helpful.

Winston & Strawn LLP > Michael S. Melbinger

Also, if your health plan is employer based they are under the ERISA laws. Go to HR at your employer with this law information and ask them to enforce it through the insurance. IF the employer doesn't, then they are violating ERISA. The Department of Labor was a huge help to me getting my employer to work with the insurance to add at birth.

Here's the contacts listing for the Department of Labor that could help you.
https://www.dol.gov/ebsa/aboutebsa/o...html#section13

You can PM me if you have any questions. Good Luck!

[mandirenee]

MORE INFO

Here's the note that we got from one attorney:

The Omnibus Budget Reconciliation Act of 1993 (OBRA'93), Public Law 103-66, amended the Employee Retirement Income Security Act of 1974 (ERISA). The amended law requires that any group health plan which provides coverage for dependent children must provide benefits to a child placed for adoption under the same terms and conditions as apply to a child who is the biologic child of a plan participant. OBRA'93 specifically eliminated any requirement that the adoption be finalized in court before there is coverage. The new law also prohibits carriers from restricting coverage of adopted children on the basis of a preexisting condition. The changes implemented by OBRA'93 apply to the medical benefit plans of all employers subject to ERISA. Since ERISA covers almost all employers except government employers, OBRA'93 provided broad coverage to families with adopted children. Even the above gap in coverage has been closed. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-91, which also amended ERISA, extended the prohibition against discrimination to governmental employers. As a result, health insurance coverage for adopted children is now available to all families covered by group health plans as soon as those families assume financial responsibility for the child.

This link is a letter from the ERISA advisory board providing explanation of the law:

Doc Prototype

The agency can provide a document of placement and a letter of "financial responsiblity". Our agency gave us both. The letter stated that we assumed full support of the child financially on date of birth. Based on this advisory opinion from the Department of Labor, this law says birth expenses must be covered if financial responsibility was that of the adoptive parents.

Hope this helps.

[adobe1234]

Thanks all for the info. My insurance is thru my employer, which is the state government. So does that mean they don't come under ERISA?