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From Adoptive Families magazine:
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.
In plain English, insurers must cover adopted children as though they are biological children. Insurers can’t deny adopted children coverage due to pre-existing conditions.
However, insurance companies will still try not to cover your new baby. At least, that’s been my experience.
I had our health insurance policy with me in Missouri in 2006. I had it open to the page that discussed adopted children. I called the 1-800 number to ask for the forms I would need to add our new baby to the policy. The woman on the other end of the phone tried to tell me that I couldn’t get coverage for the baby until the adoption was finalized.
I told her that I had the policy in my hand. She tried to tell me that the hospital stay wouldn’t be covered because we didn’t have custody of the baby. Except that the policy explicitly stated that newborn adoptions were to be handled as newborn biological children. She still tried to fight me. I finally stopped and just asked her to fax the forms to our hotel. After Jack was born, and we had the adoption decree, we filled out the paperwork and faxed it in. We were never questioned, and the submitted expenses were paid.
All’s well that ends well, right?
Not so much. To make a long story short, the doctor’s office billed us separately from the hospital. However, the doctor’s office didn’t contact the hospital for our contact information, so they sent us to a collection agency who hunted us down, lied to my husband, and soaked us for over $800. We got some of that back, but not all of it.
Lesson learned? Make sure that you give your contact and insurance information to anyone who touches your baby.
Your insurance company may tell you that they can’t cover the baby until the date of placement. According to Federal law, the “date of placement” is the date that the adoptive parents become financially responsible for the baby. In the many legal documents you receive when you adopt your baby, there should be one that states that you are responsible for the child’s medical expenses from his date of birth. To be proactive, ask your attorney to ensure that the date of birth and the date of placement are specifically called out as one in the same.
If your child is born out of state, then the provider may be “out-of-network”. It is possible to appeal to the insurance company and get them to cover the costs as they would for an “in-network” provider. This will likely mean spending a lot of time on the phone.
In summary:
- Before your baby is born, familiarize yourself with your insurance policy.
- Make sure that the hospital and doctors have your contact and insurance information.
- Make sure that you have the contact information for the hospital and doctors.
- Ask your agency or attorney to clarify the date of placement. If the date of placement and the date of birth are not or cannot be the same, look into getting Medicaid for the time that isn’t covered.
Note that your insurance provider will not cover the birth mother’s hospital expenses, as she is most likely not your dependent.
