Hi all - hubby and I recently adopted a beautiful 2 month old boy with deletions of exons 5-7 (he was tested at birth due to having a biological brother living with DMD). I know there is so much that we will have to learn along the way, and we have already done so much reading. We are blesse to have been able to adopt him and he has brought so much joy to so many people already!
We have applied for his Social Security card so that his social worker can apply for a state issued medical card. We also have insurance through my husband's employer and plan to enroll him (quickly approaching our 60 day enrollment period after adoption placement), but the social worker has encouraged us to wait as long as possible before enrolling him so that we have the "best chance" of the medical card being processed without any hiccups.
Here are my two questions:
1 - Do any of you have experience with using a medical card vs. private insurance for receiving needed services?
2 - Do you have suggestions on which is better to list as our son's primary - the private insurance or the medical card?
Thank you in advance for any help/advice you can offer.
Which is better, private insurance vs SCHIP/Medicaid, is going to totally depend on how good your employer coverage is, and what state you live in. I'm assuming you're in the US.
You're probably not going to draw on any benefits for DMD care very heavily for a couple of years, if your son is only 2 months old.
When choosing which is primary, I'd consider strongly which plan has coverage that will allow you to get to a multidisciplinary neuromuscular clinic. That's the best standard of care. There are several very good ones around the country. It may be covered as in-network on some plans, and out of network, or not covered on others. I'd also look at the coverage for physical therapy. That varies greatly between plans.
We're in Michigan. There's a FACES group on the West side of the state, they might know better what options for care are nearby the Chicagoland area. Lots of people from the Midwest travel to Cincinnati or Columbus for MD care, those are nationally known multidisciplinary centers, but others are now following the same model, so in many cases you can get care locally in the same format.
Which insurance is the primary may be dependent on the State Insurance Program rules. If there is an option, Keith's advice is spot on. It will depend on which plan provides the better coverage. The programs in which I am most familiar, the private insurance is considered the primary policy.
Other things to investigate is whether either plans are managed care and where you are able to get care and what doctors are part of the network. Also ask if there are restrictions covering out of state services. There may be reasons to seek care at other clinics and it's a good option should you need it.
I hope the caseworker is able to help you navigate the process. It isn't easy, but getting coverage is important.