[Aphi86]

Someone please correct me if I am wrong, but isn't it the law that insurance companies must cover our children as if they were born in this country-no waiting for pre-existing conditions. When we first arrived home, the dr said to take her to have her eyes checked. I waited until we moved and then took her. The insurance company wanted proof of insurance from Washington which I gave them, and now they are saying there is a year waiting for pre-existing conditions. She was not going in for a condition, but rather an eye exam. Don't they have to cover her on this???

[lakimnafite]

I believe that they do have to cover this - the law is the same as for newborns. Contact your Member Relations department, and if they don't immediately change their tune, contact the Insurance Commisioner!

Good luck!

[Annabell]

If I were you, I would contact my state insurance commissioner.

With that said, I believe you are correct. What was it that they do not want to pay for? The eye exam itself? Some issue that was discovered at the eye exam?

[mikiment]

I thought under federal law, adopted children had to be covered just as biological children would be covered with no allowances/exclusions for pre-existing conditions as long as they were added to your insurance policy within 30 days of becoming eligible. Contact your state's Dept of Insurance to double-check laws in your state.
Best of luck and don't hesitate to escalate!

[kretzklan]

The only thing an insurance company can decline is major services that require waits - mostly on dental. If you have to be covered for 24 months to get level 3 services (such as root canals), then they can be declined if they have been covered for a shorter time than that. But, a routine eye exam - that should be covered.

[Aphi86]

Ok thanks! To answer above, no this was just the routine check. You know that when babies are born they do this eye test and the pedi said I should just have her checked out to make sure there are no concerns. Her eyes are fine, and this is just about the exam. So ridiculous! They are trying to process it as if there was a pre-existing condition.

[DoreenG]

I don't believe it is federal law that they must be covered as of the date of adoption, but it is common practice. If your insurance coverage allows imediate changes out of the "open enrollment" period, then it's usually prefaced with the fact you must notify your insurance company of the "life-changing event" within 30 (or perhaps 31) days of the occurrance, and I'm sure you have to do it in writing (or request they respond to you in writing as proof).

I would contact the employers HR dept to get help on this. The employer carries much more weight than the subscribed employee (or wife or husband or SO)

[thmc1215]

I process medical claims, and on the groups we cover, they do cover adopted children with no prex conditions provided they were added within the specified time that is indicated in your plan document. However, most of our plans do not cover routine vision - varies plan by plan. If you have vision coverage, it should be covered, but if you do not have vision coverage than it's most likely not covered - it depends on how the physician billed it and what codes he used.

[Jim_in_PA]

Most group medical insurance covers from day one for adopted kids as long as you put them on your plan within the required 30/31 days after the life event. (Adoption, in this case) PRIVATE insurance may have different terms and what is in your policy language is what is covered. If you are using a separate vision plan, it may have different terms than your medical insurance. Same for Dental. The actual contract language is what you need to consult.

[klk88]

We had similar issues with our insurance. We tried to get our children into the doctor a couple of weeks after we arrived home (for routine tests and a titers test). We were told that we were still not covered. I called our insurance company and they said we had to wait 30 days. I asked if I had given birth to the children would they be covered from the moment they were born and was told yes. So, all I had to say was - "interesting that you are discriminating against adoptive children." And lo and behold we were covered fully the next day

[Aphi86]

Well this is interesting. I was not able to speak to the claims dept but customer service...again. I explained the situation again to the girl and she said to have the dr re-submit the paperwork showing the date of diagnosis was the date of the exam.

It was a routine vision, sort of. Actually, what they test children at birth for is the condition that causes what we call lazy eye. They can actually look to the back of the iris to see this condition. So, that is what we were having the exam. I called the dr back and told them to resubmit, so we will see. Thanks!

[pequele]

no experience here with this but I was watching TV on Sunday and saw Extreme Makover Home Edition....ok everyone laugh here....well the little girl on the show had been born with a hole in her heart and the parents said that all her operations (which have cost something like in the rage of a quater to half a million bucks if I recall) WEREN'T COVERED!!! They said it was congenital/pre-exisitng! I was like since she was dx at birth. Ok granted this is what I got from tv, and I was always under the impression they'd cover an adopted child from day 1 regardless because they do so for bio kids...but this scared me! How do they (ins co) pick and chose and call something pre-exisiting like this?

I hope you get a repreive from your's ...don't give up and keep fighting if they say no again!!

[trnews71]

Laws are different in every state.
Get a copy of your policy & call your insurance company and ask them to lead you into the page where the exclusion are listed and where it speaks about the children. I would contact your insurance company one more time for detailed explanation of your coverage and if that does not work contact the insurance commisioner.

[sak9645]

The federal law that you are talking about is the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Unfortunately, the law applies ONLY if you have GROUP insurance, and work for an employer with more than two employees covered by the plan. It does NOT apply if you have individual insurance or insurance for a very small group.

If you have group insurance, and your policy would normally cover biological children, it MUST treat adopted kids the same as if they were born to you. For example:

1. Coverage MUST begin as of the date the child is adopted by you OR PLACED FOR ADOPTION by you. In other words, if you adopt from a country like Korea, where you get custody of the child but don't finalize for six months to a year, the child must be covered from the day you get legal and physical custody.

2. The policy may not exclude the child from coverage or say that his/her coverage will begin in a year or whatever.

3. The policy may not say that certain conditions will not be covered, or will be covered only after the passage of a certain amount of time, because they existed before you got custody of the child. The policy must cover any and all conditions, as long as it would cover such conditions for a bio child, from the time the child is placed with you.

4. If you lose your job while in the midst of your adoption process, and elect COBRA continuation of your health care coverage, you may add your adopted child to the COBRA policy.

The only major caveat is that you MUST notify your employer and insuror, in writing, within 30 days of the date on which you adopted the child or got legal and physical custody. Failure to notify means that your child will NOT have the protections afforded by HIPAA.

If you have group insurance, I would suggest that you go to the Internet and print out a copy of the law and some commentaries on it. You can find the law on thomas.loc.gov, the website of Congress. As to commentaries, look for one by Maureen Evans that she wrote when she was at the Joint Council on International Children's Services.

Take the copy of the law and related commentaries to your insuror and/or employer. If they still claim that your child isn't covered:

1. Contact your state's insurance commissioner. If you are truly covered by HIPAA, he/she can force the insuror to comply with its provisions.

2. Contact a reputable attorney who is familiar with HIPAA issues. He/she will often be able to get results by writing a simple letter to your employer, and this would cost you very little.

If you do NOT have group insurance, all may not be lost. SOME, but not all, states have their own laws that mirror HIPAA. These states, such as New York, have laws that extend HIPAA type benefits to the children of people with individual insurance coverage.

By the way, just getting on my soapbox, I am always shocked to hear that some homestudy agencies don't discuss the issue of health insurance coverage during the homestudy process. It should be required, as part of general parent preparation. It is always terrible when a person discovers, only AFTER he/she adopts, that his/her individual policy will not provide coverage for the adopted child. And it is always terrible when a person decides not to adopt a child with a medical issue, because he/she doesn 't know that his/her group insurance would pay for the child's medical care, as of the date that the child was placed into his/her care.

And let me add just two other things. If you do have a group policy, check to see if it covers care in foreign countries. If it does, remember that you can apply for reimbursement of some of the costs of care that you get for him/her while in Russia. You will probably have to pay out of pocket for the care while in Russia, simply because the Russian clinics don't usually take insurance and because you won't have things like a membership card for your child at that point. But once you notify your employer of your adoption, and your child is added to your policy, you can submit receipts for the care delivered once you took custody of your child in Russia and get at least some reimbursement. (You may, of course, have deductibles and copayments to satisfy.)

Second, your employer and insuror will want certain information when you notify them of your adoption. Some of it, you may even be able to fax from Russia, such as the adoption decree and birth certificate. However, many employers and insurors want to see a child's Social Security Number. The employers and insurors have the right to request this information. Just remember that you CAN get a SSN as early as the day after you get home from Russia. If you have any questions about how to do so, or what to do if the SS office gives you misinformation, please let me know, and I will try to help you.

Sharon

[papedge]

my insureance TRIED this but it did not work, they sent me a paper to fill out for a pre-exsting illness form and I wrote across it no known illness @ the time of adoption