Adapt this letter to fit your child’s situation and give it to your pediatrician to sign.
DATE
INSURANCE
CLAIMANT:
INSURED EMPLOYEE:
Dear __________:
It has come to my understanding that there is a misunderstanding regarding the necessity for labwork completed on PATIENT shortly after the child’s arrival in the United States from COUNTRY. This testing was ordered as a part of a comprehensive evaluation for multiple medical problems (both acute and chronic) that are commonly seen in children adopted internationally. The screening was obtained not as part of a preventive medicine screening, but was ordered to evaluate medical concerns that can result from living in conditions of extreme poverty in a developing country.
PATIENT was institutionalized for the first AGE years of life in an orphanage in COUNTRY. It has been well documented in the pediatric medical literature that institutional living increases a child’s risk of developing hepatitis B, hepatitis C, HIV/AIDS, tuberculosis, and stool parasites. This is compounded by an immune system that is sub-optimal. There is no doubt that this child has been exposed to most (if not all) of these illnesses due to communal living in an unsanitary situation. Children living in orphanages frequently suffer from malnutrition, as well as exposure to toxins in the environment (particularly lead). Thus, they must be evaluated fully for the diseases that run rampant in such situations. Each child who has lived in an orphanage has an increased risk of becoming seriously ill with potentially life-long diseases. Early diagnosis and treatment (when possible) is necessary to decrease long-term consequences.
One might compare this to an adult patient being evaluated for vague complaints. Even if the history taken by a physician yields no specific information, the physician may order multiple tests due to perceived risks, such as family history, the patient’s home environment, or his dietary history. In the physician’s mind, certain risks are recognized as being linked to a given diseases, such as heart disease or cancer, and are investigated so as not to miss any potential diagnoses. In the same way, this child has similar risk factors in HIS medical history. These tests were ordered not to evaluate any specific symptoms (many of these tests evaluated for diseases that display few or no symptoms in children HIS age), but to evaluate medical concerns that result from institutionalization—poor hygiene, inadequate caretakers with chronic diseases (hepatitis, TB, parasites), limited stimulation, and so on. Thus, the lab work-up completed on this child should be considered in the same light as tests ordered each day by physicians across the country for adults at risk for more high profile illnesses.
Your prompt attention to reclassify this claim as comprising tests necessary due to the injury caused by institutional living is much appreciated. The laboratory evaluation completed on PATIENT was not a routine evaluation, and not a part of a checkup for this child. Diagnoses for billing these tests should include developmental delay, malnutrition, and exposure to viral diseases.
Extensive documentation of the need for a full evaluation of all children adopted internationally may be found in the “Report from the Committee on Infectious Diseases from the American Academy of Pediatrics” in the AAP’s Red Book. As noted in this chapter, “In prospective studies of internationally adopted children, infectious diseases are among the most common medical diagnoses and have been found in as many as 60% of children, depending on their country of origin. Because many of these infections are asymptomatic, the diagnoses must be made by screening tests, in addition to histories and physical examinations. Other important medical diagnoses include hearing loss and visual abnormalities, growth and developmental retardation, nutritional deficiencies, and congenital anomalies.”
During the full evaluation for injuries caused to PATIENT by HIS institutional stay, the physical findings were significant. These included XXX. If these tests had not been done, YYY may have developed into ZZZ. These test results indicate how important the complete evaluation was for this child, as well as for any child who was born in and lived in a developing nation.
Thank you for your prompt attention to this matter in recognizing the need for a full diagnostic evaluation due to the injury of residing in an orphanage. It is important to recognize that these children need a comprehensive evaluation to diagnose the “extent of the damage” sustained during their early years with malnutrition, a subsequently compromised immune system, and multiple disease exposures.
Please contact me if I may be of further assistance to you in this matter.
Sincerely,
[YOUR PEDIATRICIAN’S NAME]
