The Health Insurance Blues

Back in November of last year I called our health insurance plan and asked them about what paperwork I needed to give them to get our daughter on our health plan. I am quite sure that I told them that we would be getting a court order that gives us guardianship of her from an Indian court. They said all we needed to send was the court papers. Oh sweet hindsight. I should have gotten that in writing. A week or two before we took her to the doctor I sent in the papers as requested to get her put onto our policy. After that battery of tests we were reported to the county health department due to that little contagious stomach parasite. The Doc wrote a scrip for it which we tried to get filled at our favourite pharmacy. About 6 hours later I get a call from the pharmacy telling me that the system is kicking out the scip saying she is not on file. Humm no insurance means $95 out of pocket rather than a mere 7 to 20

Dang, we are talking 3pm . A quick call to the agency gets me a nice person that tells me oh yeah we sent you a letter just yesterday (thursday) telling you that we have denied your request because she is not adopted. I said no you are right she is not however I have a court order that gives me guardianship thus making me her sole provider for her well being from providing a roof over her head to filling her empty belly. well they said we need a US court order we don't recognize non-US courts. Huh, well that is odd, the US Customs and Integration Service recognized that court order and has given her permission to live with us, the US Embassy also recognized that little piece of paper and gave me a Visa that grants residence and citizenship in the US. And yet you do not recognize her!

A call to our adoption agency said take it up with the California Department of Insurance. They were unable to help as I think they deal with all insurance but health. All was not lost as they pointed me over to the California Department of Managed Healthcare (www.hmohelp.gov). The reposne I got was WOW! You definitely have a case here with possibly punitive damage. So he started taking my info. We get to my insurance card number and he says oh well here is bad news. You are a government employee and we are not allowed to get in it with your issuance agency. If you were still at your other company then we could have helped. You need to call the OPM (Office of Personnel Managemnt) in DC. Sorry no toll free number. Great. So I call the OPM and grr they patch me through but as that is happening the time crosses into the dead zone and gee sorry we are closed for the weekend. Awesome I go to work for the first time an a month and a half and this is on my plate.

Half of Monday is spent trying to hit upon the right department at the OPM. Ah my government at work. Shuttle her shuttle there, dropped me on hold, given wrong numbers to call. Finally I decide to call our office manager who is not located in our office but is a phone call away. Sorry she is on vacation for the day call her back-up. This gets me over to our HR department with whom I leave a message. Ok yime for lunch now and I should probably get into the 400 plus emails and 20 plus phone messages.

The next day our HR department calls me. I give her the info and she says lucky for you we can help. If you were in the private sector you would probably be working on this for a week or two. Our contract with your insurance is a bit unique. Go to page xxx and see this paragraph? That right there states that if we (your employer) says to add a dependant onto a policy they must add the dependant and there is no arbitration on this. Here fill out this application and we will code it so that it states you are FOSTERING your child. You probably confused them when you said guardian. That option is not in their code book. Foster child is in their lexicon. When you finally adopt then we will change foster to dependant.

So I get my paper back from HR with their signature an ph number. Now to hunt down and submit a few claim forms.

So what is the lesson here other than speak softly and carry a big stick?

Choose your words carefully When dealing with your Health Insurance group get it in writing and tell them you are fostering a child.

je

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