Saturday, March 08, 2014

Current State of the Adoption

I finally got my updated passport on Friday which means we're currently waiting on three things before the homestudy will be marked complete and run through the signatures and notaries and submitted to USCIS:

1. Julie's medical statement
2. Pediatrician's medical statement
3. Proof that we have completed the required 10 hours of adoptive parent training.

Let's go through those backwards:
3. Is basically done.  We had 8 hours of training before our winter hosting and that covered all kinds of stuff like language learning, food issues, dealing with moody kids, etc.  The agency requires 10 hours so today we did a 2 hour online video thing about "adopting the older child" which covered a few things we hadn't covered in hosting training.  At the end, there was a 5 question essay test and those will be reviewed early next week.  Assuming our answers are acceptable, we'll get a certificate indicating a successful completion of two credit hours and that will satisfy everyone.

2. The pediatrician needed to sign a form saying all three kids were healthy and up to date on medical things.  The form said "A physical exam is not necessary if the child has been seen by the physician's office in the past 12 months."  The boys have both been in for updates or illnesses, but Katie's managed to avoid the pediatrician's office for 2 years.  The soonest they can get her in is March 18, so we won't have that form signed until then.  We're trying for an earlier date.

1. Oh, lands.  This is making me nuts.  Let me start with this: I'm totally healthy.  I'm in the best physical shape I can remember in 5-10 years.  Maybe ever.  I'm clear of all diseases, in good spirits, strong, and healthy.  (Praise the Lord.  And finding a good gym routine.  And roasted vegetables.)  However, when the social worker was here she asked if we had any history of mental health concerns and I truthfully detailed the very low dose issues I had after August was born.  By law she had to put this in the homestudy because I disclosed it.  Now, stick with me.

A. The documents that get translated and set in-country are the homestudy and a signed and notarized letter from our medical doctor.  These must be exactly consistent.  Anything in one must be in the other, using the same diagnostic codes and wording.
B. The homestudy will mention the disclosed issues, but won't put a medical code to it unless it's on her agency's medical form that the doctor filled out at our physical.  So there are 3 forms that all need to match, two of which come from our medical doctor.

So, obviously, we need the medical doctor to write a code on the agency's form so she can put it in the homestudy; and then we use the same code in the letter that we'll ask the MD to sign.  Easy enough, right?

Wrong.

The medical doctor had not history of my postpartum moods considering I nearly never go to the doctor. Instead, the OB who did my follow-up care handled my mood situation and so I contacted them to get the confirmation.  The only thing they found on my record from that time period was anemia.

For real.

I called the social worker.  She can't remove it.  We need to force it into the medical reports.

So we start contacting medical people and our agencies.  Here's where things get really maddening.

In Ukraine they use a set of diagnostic codes from a book put out in the 90's while in the US we use a codebook from the 70's. Both books break conditions down into 20 large groups coded by a first letter: A...T.  The "O" codes are all "complications of pregnancy and post-pregnancy conditions"; "F" codes are all mental disorders.  Postpartum mood conditions could, in theory, fall under either.  In the book from the 70's (the US book of choice) all types of postpartum mood complaints fall under "F".  In the 90's book (Ukraine's book of choice and the US is moving to it in October of this year), there is one mild postpartum mood disorder that is an "O" code.  This is very important because Ukraine will NOT allow a family to adopt if they have an "F" code ("mental disorder") in their medical record that is less than 5 years remission.  So I need the medical sheets to indicate that my "mood disorder" was consistent with the "O" code that is in the book from the 1990's.  And, really, from the 90's book that is by far the best fit for what I experienced.  However this "O" code doesn't exist in the book from the 1970's and so the medical staff keep saying that if they list it, it will have to be one of the "F" codes which will block our adoption.  They all agree that, based on the descriptions of the "O" and "F" codes from the '90's book, my mood issues were more of an "O" code, but they just keep insisting that they can't put it on as such because they aren't using those codes in the US.

Meanwhile, I know of several other families that have managed to get medical people in their states to write a note saying "conditions and treatment consistent with [O code from '90's book]" .  I know it can be done, but I keep getting routed to nurses who push me off to medical coding offices who just say they can't.  Or told that someone will call me back and then hearing nothing for days.

What we really need to be allowed to do is this:
1. I need to be allowed to write (or bring back to the office to have my MD write) on the agency form under "history" a statement that says "Mild mood disruption after birth of youngest.  Treated and now well balanced and stable.  Consistent with [O code from '90's book]." 
2. This would then go to the homestudy agent who would write that in the homestudy.
3. In a few weeks we will have another medical letter that we'll basically write at home that says "I've seen these patients, they're healthy, tests came back clear, and they have a typical life expectancy.  Also, in 2010 Julie had a minor mood disorder consistent with [O code] and is now well balanced and stable."  We'll bring that to the MD's office to copy onto letterhead and ask them to sign it in front of a notary.  That will go to Ukraine with the homestudy.

So, really, at NO POINT does this stupid code need to be put into my chart or sent through coding and billing or anything official.  I just need the MD to agree that it's a good description of my health and sign off on it twice on documents I will provide.  But we've been playing phone tag and messages and nurses and confusion for nearly 3 weeks instead.  I'm on spring break all next week and have huge work goals, but I'm also hopeful that during this week I'll get to go talk to the doctor in person and sort this out.

But, um, the passport is here.  Yay!!  This really is a big step forward.
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And a state of the blog note: I typically keep this all updated on Facebook where I can control privacy settings a little easier, but I know a bunch of friends are on FB fasts for Lent and others are just de-Faced entirely, and this is my go-to journal so I need to keep this updated.  I'm going to try to keep this updated a few times each week.


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