I think I consider myself a medium-sized conspiracy theorist — i.e., I’m on board that our government does things that the writing team for the Jason Bourne franchise would toss in the circular file as being too far-fetched, but I don’t quite buy that there are secret laboratories in the New Mexico desert. That’s about my level of conspiratorial conscription. And asserting that health care and health insurance in this country are a crooked, crooked business — I don’t feel like that’s even a conspiratorial, or even controversial statement to make. Those who devote their lives to healing the sick and comforting the dying will have my respect until my own final days. Those who make a living wrongfully wrenching money from those who are dying and those they leave behind, or those whose paychecks get padded by finding ways not to pay for a kid’s cancer treatment? They get a special circle in hell.
With all that said, I will go on record as stating that there seems to be an added level of aversion to covering adopted children on employee health plans. After two adoptions, my husband and I are among the many who have watched our employers and/or our insurance companies actively seek to avoid including an adopted child on a health insurance policy — occasionally to an extent that friends and family have refused to believe. “They can’t really do that…can they?” Well, ‘they’ have certainly seemed to think so.
Our first son, we were told, could not be included on our policy until his adoption was finalized — in his case, about four months after he was born. Babies can ring up quite a set of well-baby visit bills in a few short months, let alone should anything go wrong. It took union intervention and a court order to get him covered, retroactively to the moment of birth, as is specified by law. (At this time, I’d like to invite anyone who thinks government employees don’t need union representation to kindly say so within arm’s reach of me. Thanks.) During the process of my husband’s paternity leave for our older son, my husband was also inexplicably cut from the Fire Department personnel roster altogether, including from all benefits, so that was another fight to get coverage, this time for all of us.
So this time, with the birth and placement of our second son, we knew the system. We knew what documentation to have on hand, we knew not to panic when giant bills started showing up at the house, and we knew which offices to call both within the Fire Department Benefits Division and at our insurance company. We did inexplicably lose all coverage for the family — again — but we knew our way around getting ourselves reinstated. And we slalomed the initial refusals of coverage like Olympic skiers. We felt like ninjas. Downhill skiing ninjas. Bills got paid, insurance cards showed up — we were even so bold as to switch from PPO (one of the last remnants of our fertility treatment days, since that was the only way to see a great specialist) to HMO, with only the predictable lapse in coverage and handful of phone calls to set everything straight.
And then, about a week ago, I opened an envelope from the hospital in which J.D. was born to find a bill for nearly $30,000. We were being re-charged for all of his birth expenses, even though these expenses were paid months ago. After a few calls — dialing as fast as I could at 4:40 on a Friday afternoon — I learned that our employer, the City of Chicago, had suddenly and inexplicably changed J.D.’s date of coverage eligibility from his date of birth to the day after he was born. Conveniently enough, this meant that our insurance, administered by the city itself (Chicago is what is referred to as self-insured) was no longer responsible for his birth expenses. And the insurance company had subsequently revoked all payment. No explanation, no indication at any point that this might happen.
What frightens me most is that somewhere downtown, someone collects a paycheck to do this — to review employee policies and billing to find out where they can scrape back a few bucks. Adoptive families are apparently easy pickings, because I’m not the only one who has had to fight an employer about this. Adoptive parents go in circles over Social Security numbers, which aren’t given until weeks or months after finalization. Medicaid declares the baby ineligible since she is allegedly covered by her adoptive parents’ insurance, except that she’s not, and neither side wants to be the one to give in and pay for her care. Care and coverage hinge on court dates, when the insurance company knows they have to cover the child — they just want to see if the adoptive parents will fold first.
And adoptive families are by NO means the only, or even easiest target. In my own extended family, an aunt fought tooth and nail for nursing facility care explicitly covered by a policy designed for exactly those circumstances. Another aunt volleyed from her son’s hospital bed while he fought leukemia — twice — to phone fights with an insurance company who thought they’d found a way to cut off his care. And so on, and so on, and so on.
Before I rivet you any further with horror stories and insurance lingo, our situation has been settled. J.D. was still covered by Medicaid under his birth mother. But it led me to address this here, because in all the burp-cloth buying and the name debates and the nesting, this is a concrete matter that every waiting couple would be very wise to investigate. Get your hands on a copy of your employee benefits handbook. Call your insurance company when you’re matched, and run the hypothetical scenario past at least two customer service representatives — make sure you get the same answer twice, with regard to how and when your new baby will receive coverage. Call again when the baby is placed in your care, and follow up within a day or two. When in doubt, ask again, a notch or two up the chain of command. Involve your union, if you have one. It’s what they’re there for, and they’ve handled this before. Email your lawyer if a question arises. Do not trust that anything happens automatically.
The only automatic response in our case was from me, when a staggeringly large medical bill showed up in the mail. I didn’t panic. I rolled my eyes and reached for the phone, thinking, ‘Here we go again.’
