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Medical Insurance Coverage & Requirements


sugarfamily

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Boy Susan, I sure wish I would have known you/read this before we got the call about Kayleigh - it would have saved Lance and I a few agonizing and scary hours.

As I mentioned in another post - when we rec'd the call about Kayleigh, we were informed that it would be a private pay case because her birthmother did not have insurance, nor did she qualify for medicaid. At that time, Kayleigh was to be discharged from the hospital the following day (she was born on a Thursday, we got the call on Friday evening and she was to be discharged on Saturday). Kayleigh was a home birth so even though Abrazo couldn't really estimate during that first phone call what her medical bills would be, we weren't too concerned - we imagined they'd be something we could manage without going to extraordinary measures to cover them.

So, on Saturday, when we talked to Abrazo, we were told that Kayleigh had been admitted to the NICU the night before (or maybe we even found that out later Friday night - we were off and on the phone with Abrazo quite a bit that weekend). To be honest, the last thing on my mind at that time was how much the medical bills were going to be - I do remember talking to my sister who had worked in the NICU just to get a rough idea of what we were looking at and I remember she said something about when she worked in the NICU, just the bed in the NICU alone was about $1600 per day - that was without any tests or procedures or any "extras". Anyway, our placement was scheduled for Monday so still, the medical bills weren't that big of a concern to us - we could handle a few days of NICU.....(and trust me, at that point - there was nothing that could keep us from proceeding with taking placement of our angel, certainly not some pesky medical expenses!)

Anyway, on Monday - Lance started talking to his employer and our insurance carrier to find out what we needed to do to get Kayleigh added onto our insurance (a group insurance plan). We were told that she couldn't be added until she was legally adopted - as in when her adoption was finalized. Oh my gosh - I just remember my heart just sank - not because we weren't going to go through with the adoption, I was just freaking out at what we would have to do in order to pay those bills - at the time, there was no estimate as to when she would be discharged from the NICU and although she was by no means one of the sickest babies in there, there was just a lot they didn't know and weren't able to give a lot of information on (and no info to us at all because we hadn't taken placement so all info we got was the info that the NICU would give to Abrazo and Abrazo would relay to us). I remember for 2 - 3 hours I was just imagining how different everything was going to be - I had planned to stay home with her and suddenly, that was gone because I knew I would be going back to work if we had hundreds of thousands of medical bills to deal with - we had a 4 bedroom house with a nursery I'd fixed up for Kayleigh - I knew we'd have to sell our house and move into an apartment - I mean, the life I had imagined with our child that we'd been waiting for had just vanished before my eyes - I had so much I wanted to give her and it just felt like in a flash, it was all gone.

Elizabeth to the rescue - when she got there to do the placement (which was just us signing the paperwork in our hotel room because Kayleigh was still in the NICU), we told her what we'd been going through with the insurance and she very non-chalantly said, "they can't do that - it's illegal" or something like that - it eased our minds a little bit but it was like pulling teeth to find someone who could give us the right information - noone at the insurance company could (and it was United Healthcare) - they kept pushing us off onto the HR people where Lance worked - the HR people where Lance worked were telling us the whole "legally adopted" thing and had no clue what legally adopted meant or how it was defined - to us, legally adopted meant when it's finalized and when we'd ask them about that, they would say, "Yes, that must be it" - it felt like we were the first people at this company (who is an international huge telecom company that has over 25,000 employees) to ever adopt a child and go through this. Anyway, finally - Lance asked to speak with the head of the HR department for the USA - she called him back and after a very lengthy conversation and a couple of return calls - she confirmed to him that Kayleigh would be covered upon placement......Ugh - it was a nightmare!

I guess that's one reason I'm so passionate about this thread - the moral of this story - try to get all this understood and worked out PRIOR to getting that phone call - because the last thing you want to be fretting over when you're adopting your precious, long-awaited little angel is whether or not you'll be able to cover medical bills, etc.

That's also why when I read Elizabeth's post from the other day - I hope that EVERYONE takes heed of her advice (which I've bolded below). It's possible, this may not ever affect you and that's great if it doesn't. But - let me just emphasize that when you're are experiencing such a joyful moment such as your child's adoption, you just don't want to be also freaking out over medical bills that may mount - definitely have a Plan B...just in case. Don't assume anything.

Adoption agencies have no way of predicting (1) how much hospital bills may run, nor (2) what insurance will or will not cover, nor (3) how long it may take for Medicaid/insurance claims to be processed after the discharge/placement has been done. But as Angela was saying yesterday, this makes it that more crucial that all adopting families be fully aware of the potential bills they might face should insurance deny coverage after the fact. We do try to emphasize in orientation that there are no guarantees, and that's why our estimates include all anticipated medical costs (regardless of the birthparents' Medicaid status). But it's up to each family to know their limits and to have a Plan B, if faced with catastrophic expenses for which there is no coverage (just as they would if they had birthed a biological child for whom the bills exceeded available coverage.)

Lisa

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If someone has health insurance with something other than a group health plan, maybe there is a loophole (if the company does not have to follow federal law) but I am not aware of this instance.

Susan

Yep - unfortunately, that was us. We tried using the info you provided Susan, but then after all this ragamarole, we were finally told something to the effect of our plan (through our state) is self funded and so was also self-regulated -- I'm fuzzy on the details now, but we were trying to argue the point of, if we are matched, we are fiscally responsible at the time of BIRTH, not PLACEMENT. We really just wanted to be protected in the case of a NICU stay prior to placement, etc. But w were told they didn't have to play by those rules.

We did end up with coverage from placement, but ran into an insurance hassle anyway. PIWs beware: although we were covered, we were out of our coverage area (state) when we took placement. The hospital wanted the baby to be checked in a week and made an appt at their clinic. When we went to that, they also wanted the 2nd PKU test done in state, and it was 1 day too early to do that 2nd test, so we had to go back the next day. So -2 clinic appts. Well - our delirious, sleep-deprived, living-in-a-hotel-room-out-of-state brains didn't even think to ask for prior approval - so although we had coverage retro to placement, those visits weren't covered because they were out of network and we hadn't gotten prior authorization. I appealed, but it didn't help.

Just my story and a little warning.

Mary Helen,

We ran into the same problem but once we got home and had a Dr they then did a referral back for those visits in Texas. This took place 9 months after the fact!! Check with your peditricians office to see if they would given a referral. We also had to go to the Dr twice when we were in Texas.

Paula

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The cite is ERISA is Title 29, Chapter 18, Subtitle B, part 6, Section 1169, c, 1

Susan

I'm sorry, but this information is kind of vague as to what it is and where I can find it , could you please be a bit more specific? ;):P:lol:

I'm Just kidding of course. Excellent information and thanks for the citation.

Thank you Susan.

-A

Yes, I guess that is about all I have to show show for all of those years of policy wonk work on the Hill!! :rolleyes: Don't miss it much now that I am in the quiet mountains of VA!

Edited by Susan
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Can you imagine all those insurance policy writers gnashing their teeth at the idea of all these parents who've adopted getting together here and comparing notes so as to outsmart them?! ;p

Does my heart good, just thinking of it! HA.

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Boy Susan, I sure wish I would have known you/read this before we got the call about Kayleigh - it would have saved Lance and I a few agonizing and scary hours.

As I mentioned in another post - when we rec'd the call about Kayleigh, we were informed that it would be a private pay case because her birthmother did not have insurance, nor did she qualify for medicaid. At that time, Kayleigh was to be discharged from the hospital the following day (she was born on a Thursday, we got the call on Friday evening and she was to be discharged on Saturday). Kayleigh was a home birth so even though Abrazo couldn't really estimate during that first phone call what her medical bills would be, we weren't too concerned - we imagined they'd be something we could manage without going to extraordinary measures to cover them.

So, on Saturday, when we talked to Abrazo, we were told that Kayleigh had been admitted to the NICU the night before (or maybe we even found that out later Friday night - we were off and on the phone with Abrazo quite a bit that weekend). To be honest, the last thing on my mind at that time was how much the medical bills were going to be - I do remember talking to my sister who had worked in the NICU just to get a rough idea of what we were looking at and I remember she said something about when she worked in the NICU, just the bed in the NICU alone was about $1600 per day - that was without any tests or procedures or any "extras". Anyway, our placement was scheduled for Monday so still, the medical bills weren't that big of a concern to us - we could handle a few days of NICU.....(and trust me, at that point - there was nothing that could keep us from proceeding with taking placement of our angel, certainly not some pesky medical expenses!)

Anyway, on Monday - Lance started talking to his employer and our insurance carrier to find out what we needed to do to get Kayleigh added onto our insurance (a group insurance plan). We were told that she couldn't be added until she was legally adopted - as in when her adoption was finalized. Oh my gosh - I just remember my heart just sank - not because we weren't going to go through with the adoption, I was just freaking out at what we would have to do in order to pay those bills - at the time, there was no estimate as to when she would be discharged from the NICU and although she was by no means one of the sickest babies in there, there was just a lot they didn't know and weren't able to give a lot of information on (and no info to us at all because we hadn't taken placement so all info we got was the info that the NICU would give to Abrazo and Abrazo would relay to us). I remember for 2 - 3 hours I was just imagining how different everything was going to be - I had planned to stay home with her and suddenly, that was gone because I knew I would be going back to work if we had hundreds of thousands of medical bills to deal with - we had a 4 bedroom house with a nursery I'd fixed up for Kayleigh - I knew we'd have to sell our house and move into an apartment - I mean, the life I had imagined with our child that we'd been waiting for had just vanished before my eyes - I had so much I wanted to give her and it just felt like in a flash, it was all gone.

Elizabeth to the rescue - when she got there to do the placement (which was just us signing the paperwork in our hotel room because Kayleigh was still in the NICU), we told her what we'd been going through with the insurance and she very non-chalantly said, "they can't do that - it's illegal" or something like that - it eased our minds a little bit but it was like pulling teeth to find someone who could give us the right information - noone at the insurance company could (and it was United Healthcare) - they kept pushing us off onto the HR people where Lance worked - the HR people where Lance worked were telling us the whole "legally adopted" thing and had no clue what legally adopted meant or how it was defined - to us, legally adopted meant when it's finalized and when we'd ask them about that, they would say, "Yes, that must be it" - it felt like we were the first people at this company (who is an international huge telecom company that has over 25,000 employees) to ever adopt a child and go through this. Anyway, finally - Lance asked to speak with the head of the HR department for the USA - she called him back and after a very lengthy conversation and a couple of return calls - she confirmed to him that Kayleigh would be covered upon placement......Ugh - it was a nightmare!

I guess that's one reason I'm so passionate about this thread - the moral of this story - try to get all this understood and worked out PRIOR to getting that phone call - because the last thing you want to be fretting over when you're adopting your precious, long-awaited little angel is whether or not you'll be able to cover medical bills, etc.

That's also why when I read Elizabeth's post from the other day - I hope that EVERYONE takes heed of her advice (which I've bolded below). It's possible, this may not ever affect you and that's great if it doesn't. But - let me just emphasize that when you're are experiencing such a joyful moment such as your child's adoption, you just don't want to be also freaking out over medical bills that may mount - definitely have a Plan B...just in case. Don't assume anything.

Adoption agencies have no way of predicting (1) how much hospital bills may run, nor (2) what insurance will or will not cover, nor (3) how long it may take for Medicaid/insurance claims to be processed after the discharge/placement has been done. But as Angela was saying yesterday, this makes it that more crucial that all adopting families be fully aware of the potential bills they might face should insurance deny coverage after the fact. We do try to emphasize in orientation that there are no guarantees, and that's why our estimates include all anticipated medical costs (regardless of the birthparents' Medicaid status). But it's up to each family to know their limits and to have a Plan B, if faced with catastrophic expenses for which there is no coverage (just as they would if they had birthed a biological child for whom the bills exceeded available coverage.)

Lisa

Lisa,

Thanks so much for your story. This sounds exactly like what i'm dealing with through United Healthcare right this minute. I cannot get a straight answer out of anybody at that company. I also have to work with them on a daily basis at my office...fun, fun!

It's nice to hear that you were able to work it out & we will have our ducks-in-a-row now too hopefully. :)

So, if you don't mind me asking, did you only have to pay for the medical bills then prior to the placement out of pocket?

Nichole

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I do not know if this would help anyone but... I found it easier to actually read the medical policy/manual provided by our employer/insurance company. Besides, I wanted to see it in writing. When I asked folks within that department that were supposed to know, they really did not know very much about adoption terminology.

The manual (actually a book) was very clear about when coverage begins when adopting, for us this was at placement. All bills prior to placement were scooped together (in my mind) as part of the cost of adopting.

Karen

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Just my two cents.....whatever they tell you, always get a name and last name or id# and tell then to put it in writing and don't back down. We sent our insurance company the letter given to us at orientation and they called me to let me know they would not cover from birth, but from time of legal placement....I made them send me a letter from their legal office stating the facts because this could be costly if they said that I misunderstood as they did with one of my fertility procedures.....still fighting that one :angry: Anywho, thats just my two cents....trust no insurance person and make them back it up with ink.

Sandi

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  • 1 year later...

I am just bumping this up for Susie and Ben, and other from the Late Night StickBacks since we talked about this issue at orientation this weekend. Hopefully the information on this thread will help to answer your questions!

Susan

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  • 1 year later...
Hi everyone,

This forum is amazing and I'm so glad Abrazo has created this resource. Our home agency and the social worker who is working with us on the home study are really resourceful, but I still feel like there are many aspects of adoption that remain a question mark, and it's really good to have our group to share the journey with!

I'm curious if anyone has experience dealing with a health insurance provider that will not pay for medical costs for an adopted child, prior to placement. The ladies at Abrazo gave us a form at orientation to submit to our medical insurance representative, who has essentially refused to sign and notarize it. I'm pretty surprised because I work for a socially conscious employer, and I thought I remember reading somewhere that there is a law requiring medical insurance providers to cover costs as soon as adoptive parents become financially responsible for a child, which would be at birth in the case of domestic adoption of a newborn.

Anyhow, I'd be curious to know if anyone else has dealt with this, and whether it's worth pursuing it with our benefits specialist at work or the medical insurance provider, or whether this is a dead end and I'd be wasting my time. :huh:

Corinne

Hi Corinne,

When I contacted my insurance, they basically told me that although they wouldn't sign Abrazo's form, that they would be willing to send me a copy of their own letter stating that they would cover medical fees for adopted children. It was something legal and how their liability people won't let them sign outside forms. When I spoke with Angela, she seemed to think that a letter stating their coverage policies would be sufficient. Is your insurance refusing to pay or just refusing to sign Abrazo's form?

Thanks everyone for your encouragement and answers to my questions above!

Carissa

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Hi everyone,

This forum is amazing and I'm so glad Abrazo has created this resource. Our home agency and the social worker who is working with us on the home study are really resourceful, but I still feel like there are many aspects of adoption that remain a question mark, and it's really good to have our group to share the journey with!

I'm curious if anyone has experience dealing with a health insurance provider that will not pay for medical costs for an adopted child, prior to placement. The ladies at Abrazo gave us a form at orientation to submit to our medical insurance representative, who has essentially refused to sign and notarize it. I'm pretty surprised because I work for a socially conscious employer, and I thought I remember reading somewhere that there is a law requiring medical insurance providers to cover costs as soon as adoptive parents become financially responsible for a child, which would be at birth in the case of domestic adoption of a newborn.

Anyhow, I'd be curious to know if anyone else has dealt with this, and whether it's worth pursuing it with our benefits specialist at work or the medical insurance provider, or whether this is a dead end and I'd be wasting my time. :huh:

Corinne

Hey Corrine -

My Insurance sent a letter stating our coverage and then a letter saying they would cover our child once placed. They would not sign the form that Abrazo gave us and I think that is a pretty common theme with insurance companies because when I mentioned it to Angela it wasn't a big deal. I guess they said that in orientation too but there was so much info I didn't remember it but Chris did. I would definitely call your insurance company directly - that's what I did and the letter's they gave me were sufficient.

I hope everything works out!

Judy

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It seems to be very rare for an insurance company to be willing to pay before placement. I know that ours will not.

Judy, on the CPR/infant care class, we took those, but I don't remember being able to count them for homework. You might check with Angela just to be sure. So glad your friend included you! :)

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It seems to be very rare for an insurance company to be willing to pay before placement. I know that ours will not.

I am trying to dig up a past thread that outlined the details of when health insurers are required to cover adoptive children. So watch for this on View New Posts.

But, basically HIPAA law states that insurance companies are required to cover at the time of placement. Placement is defined in the law (if you read the fine print) as the time that you (adoptive parents) become financially responsible. So, for example, if you are matched with an expectant mother prior to the birth and are paying for expenses, you could argue that you are financially responsible. Most health insurance companies, in my experience, do not know the detailed reading of the law this way, so you are probably safe planning for coverage at placement. If any of your companies say they will cover at legal adoption (finalization) they are not following stated law.

I am happy to help clarify --

Susan

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I am just bumping this us for the new Coochie Coochie Coos... Read back through and you will find detailed verbage from the law stating that health insurance coverage starts at placement.

PM me if you need any help :)

Susan

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It seems to be very rare for an insurance company to be willing to pay before placement. I know that ours will not.

I am trying to dig up a past thread that outlined the details of when health insurers are required to cover adoptive children. So watch for this on View New Posts.

But, basically HIPAA law states that insurance companies are required to cover at the time of placement. Placement is defined in the law (if you read the fine print) as the time that you (adoptive parents) become financially responsible. So, for example, if you are matched with an expectant mother prior to the birth and are paying for expenses, you could argue that you are financially responsible. Most health insurance companies, in my experience, do not know the detailed reading of the law this way, so you are probably safe planning for coverage at placement. If any of your companies say they will cover at legal adoption (finalization) they are not following stated law.

I am happy to help clarify --

Susan

Thanks all, this is really helpful. Susan, I will look out for the thread on health insurance.

I also got our insurance company to send me a statement of their policy, since they wouldn't sign the form. But because the policy states coverage only begins at "placement," I was hoping there was some way to get them to pay for medical costs from birth, since that is when adoptive parents become "financially responsible". That argument fell on deaf ears both with our benefits specialist and the insurance company. So I guess the norm is for adoptive parents to cover cost of medical care at the hospital prior to placement, out of pocket?

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Deleting my comment... SORRY I see now the posts in the CCC's thread about insurance. You're saying that is the federal law minimum that they have to cover from placement. Ours covered from birth though we never had to "test" that (as in submit claims).

Edited by suziandben
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I am just bumping this us for the new Coochie Coochie Coos... Read back through and you will find detailed verbage from the law stating that health insurance coverage starts at placement.

PM me if you need any help :)

Susan

The actual law that states coverage from placement is ERISA and the law that discusses the definition of placement is HIPAA -- Here is a useful link --

http://www.adopting.org/adoptions/health-i...d-children.html

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Our insurance coverage began at placement.... and my husband works for insurance carriers... ;)

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Our insurance company told us they would only cover after placement, but once Jack was born and spent several days in NICU they did end up paying all cost.

I called the insurance company as did our HR person. I was amazed that they paid, but very happy!

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Just wanted to add something here I found interesting with our insurance provider. Yes, our children have been covered since day of placement, but with Emma (our 12 week old daughter) my husband's HR department told him that we would have to have a social security number by the six month or they would drop her from coverage. Of course, that is not possible, considering finalization will not take place until after six months. However, they were satisfied with us applying for the adoption taxpayer identification number and using that number until a permanent social security number is obtained.

Wanted to let others know that an adoption taxpayer identification number is not only good for the purposes of filing taxes. It actually proved very beneficial to us in this case as well.

Footnote: It takes approximately 6-8 weeks to obtain this number!

Hugs,

Melanie :)

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So, for example, if you are matched with an expectant mother prior to the birth and are paying for expenses, you could argue that you are financially responsible. Most health insurance companies, in my experience, do not know the detailed reading of the law this way, so you are probably safe planning for coverage at placement. If any of your companies say they will cover at legal adoption (finalization) they are not following stated law.

Susan

Susan,

Even if the adopting family tried to argue, why would an insurance company ever consider agreeing to cover an infant before it is born, in the case of an adoption/placement which may or may not happen? I would think agreeing to be financially responsible is at the hope-to-adopting parents risk for the time period prior to relinguishment, not earlier than 48 hours after birth, since matching is all based on promises and hope. After relinguishment and signing of the entrustment papers which allows for placement, a legal responsibility

is now created with this child.

I guess one could argue that if placement happens, why wouldn't the insurance company go back and make coverage retro-active to the birth? Probably because they don't have to. Melissa, wow, glad to know they covered Jack.

Interesting discussion.

Karen

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So, for example, if you are matched with an expectant mother prior to the birth and are paying for expenses, you could argue that you are financially responsible. Most health insurance companies, in my experience, do not know the detailed reading of the law this way, so you are probably safe planning for coverage at placement. If any of your companies say they will cover at legal adoption (finalization) they are not following stated law.

Susan

Susan,

Even if the adopting family tried to argue, why would an insurance company ever consider agreeing to cover an infant before it is born, in the case of an adoption/placement which may or may not happen? I would think agreeing to be financially responsible is at the hope-to-adopting parents risk for the time period prior to relinguishment, not earlier than 48 hours after birth, since matching is all based on promises and hope. After relinguishment and signing of the entrustment papers which allows for placement, a legal responsibility

is now created with this child.

I guess one could argue that if placement happens, why wouldn't the insurance company go back and make coverage retro-active to the birth? Probably because they don't have to. Melissa, wow, glad to know they covered Jack.

Interesting discussion.

Karen

I realize that this is a fuzzy area and open to interpretation. I know that when we were in the waiting process before Tasia came along that I sent the language on the definition of placement from HIPAA to our health insurance provider (Blue Cross Care First) and that they accepted that they would cover a baby from birth if we were matched prior to birth (we would have needed to have sent the match paperwork too). This was all theoretical at the time, and then Tasia was a BOG so we never had to cross this bridge.

I think it is safe to say that coverage starts at placement, but for those legal minds out there (I am not a lawyer by the way, just a policy junkie) there seems to be language in the law if you read it closely, but as I said it is open to interpretation.

Yes, I too find this interesting :)

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(I've taken the liberty of moving some of the preceding posts from the Cootchie thread over here, to keep the discussion flowing smoothly.)

Perhaps this might help clarify things: Why Your Insurance MUST Cover the Child You Adopt.

Once again... we KNOW that MOST insurance companies will NOT sign that form we send home with you from orientation, because it confirms that the insurance company will grant you coverage from birth, and once signed and notarized, it becomes a legal agreement.

Why do we ask you to try to get them to do it, then?

Because a surprizingly high number of companies that do not cover babies being adopted from birth DO sign that form when asked (for whatever reasons?!) and in doing so, a surprizingly high number of Abrazo's families have gained additional insurance benefits for the children we placed with them.

So it's worth a try!! but if they won't sign it, no need to inform Abrazo. And if they DO, send it back in to us quick and count yourselves lucky! ;)

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Just putting in my two cents...I worked as an insurance agent for 14 years and just left the industry in April, so this info should be fairly accurate.

The first thing to remember is that all of this info is general - the laws and the coverage will differ from state to state and company to company. As an adoptive parent, the laws of your state (noth the birth state) will be the ones that come in to play. Very few companies will provide coverage at birth since you have not legally become responsible for the child. Prior to actual placement, you have no legal tie to that child, it's a good-faith contract that the birthmother will place her child with you, or for that matter, that you will accept the child. (Let's be honest, placement may not happen for any number of reasons on either side.) Once placement occurs, a company MAY agree to provide retro-active coverage back to the date of birth - again, this will vary from company to company and it's always best to call your hotline to find out. As for the social security number, if you explain the situation to you company they will be able to make an exception. Adoptions do not need to be finalized for coverage to occur - that really should be nationwide. Also, if there are pre-existing health issues (preemie, jaundice, etc) your company should be covering those costs from the time of placement, again, if you KNOW that there will be health issues, double check with your company. But, it shouldn't be a problem since most companies look at placement date just as they would a birth date.

Hope this helps.

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  • 7 months later...

Interesting story on one adoptive family's plight: Adopted Children Left Behind When Insurers Ignore Federal Laws

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