Between Court and Homecoming

Our family sits in limbo for the next few weeks.  We legally have a new son, but we can not bring him home yet.  When we traveled to Ethiopia, we were required to present ourselves to an Ethiopian judge who would decide if we were going to be able to adopt our son.  She had already reviewed all of the paperwork and had a few questions to ask us before approving the adoption.  Once she had asked her questions and was satisfied with the answers, she informed us that we had passed court and she was approving our adoption.  We were, at the same time, relieved, overjoyed, and saddened.

We were relieved and overjoyed that we passed court and it was now certain that A was going to be our son.  We were saddened because we now knew that we would leave a part of our family in Ethiopia until the U.S. Embassy was ready to allow us to bring him home.

Over the course of the adoption process, I have loved seeing how adoption mirrors God's plan of salvation.  There are numerous places in scripture where we are described as becoming children of God when we receive God's gift of grace and mercy through our trust in Christ's sacrificial death on our behalf.  Most everyone is familiar with John 3:16, which states that Jesus is God's only "begotten" son.  So, if Jesus is God's only biological son (to use adoption terminology), how are the rest of us children of God?  We are adopted.  God has adopted us as his children.  He has one biological kid and millions of adopted kids.

Romans 8 (from biblia.com) describes exactly where our family is in this adoption process:

 14 For all who are eled by the Spirit of God are fsons6 of God. 15 For gyou did not receive hthe spirit of slavery to fall back into fear, but you have received the Spirit of iadoption as sons, by whom we cry, j“Abba! Father!” 16 kThe Spirit himself bears witness with our spirit that we are children of God, 17 and if children, then lheirs—heirs of God and fellow heirs with Christ

23 And not only the creation, but we ourselves, who have uthe firstfruits of the Spirit, vgroan inwardly as wwe wait eagerly for adoption as sons, xthe redemption of our bodies.

We, as a family, are in between verse 15 and verse 23.  We have now legally adopted our son, but we can not yet be with him.  The legal adoption has occurred, just as the moment of salvation is our legal adoption as children of God, but the adoption has not been completely fulfilled.  The adoption of our son will be completed when we return to Ethiopia and take custody of him so that we can bring him home to be part of his forever family.  Our adoption as believers will be fulfilled when Christ returns to this foreign country, Earth, and takes us home to be with the Father as part of His forever family.  May God speed the fulfillment of both adoptions!

Our Day in Court: Final Day in Ethiopia

Ethiopia day 5

Our final day in Addis Ababa had arrived.  We certainly had conflicting emotions.  We were a little nervous because our court appointment, where we would hopefully be approved to adopt our son, would occur after lunch.  We were looking forward to getting home to the kids and seeing them again.  We were sad to leave the other adoptive couples whom we had gotten to know, as well as the wonderful guest house and agency folks who worked so hard to make us feel at home in a foreign land (truly living out Leviticus 19:34:  you shall treat the stranger who sojourns with you as the native among you, and you shall love him as yourself...).  There was a chance we would get to see A again, so we were excited about that possibility.

Our day started with yet another wonderful breakfast at the guest house.  After breakfast, we returned to the Bethany office for our cultural training, which covered history, food, politics and the wonderful olfactory and gustatory experience that is the coffee ceremony.  I had the pleasure of meeting Tendai, the Bethany director for Africa.  He talked with me about possibly helping out with some medical training for some of the orphanages.  I hope to have the privilege of serving in that capacity.

We then had the opportunity to shop for crafts and spices from local vendors before heading back to Lucy restaurant for lunch.  Today, I decided to try their ravioli, which turned out to be just the right amount to satisfy my hunger.  My appetite was a bit limited since court was still upcoming and I was a little nervous because I did not know what to expect.  The fact that our family might expand by a seven-year-old depended on this court date.  

We arrived at the court building about 2 minutes after our scheduled time.  Since we are American, our group was a little worried about the fact that we were not early.  The Bethany staff don't seem to be surprised by this American anxiety with time.  On Friday, when our new friends Mitchell and Teresa were scheduled for court, Teresa asked, "It's 1:45 now, what time do need to be at court for our 2 o'clock appointment?".  Abel, always gracious, answered with a smile "2 o'clock".  Having had previous exposure to the flexibility of African time, we had a little laugh with Abel over the question.

We arrived at the courtroom and were struck by the fact that less security was in effect at court than when we went to dinner at Yod Abysinia.  We had to go through metal detectors to enter the restaurant, but there was no such security at the courthouse.  After a short wait, all four couples were called in to the judge's chambers at once.  After answering a number of brief questions, the judge proceeded to inform us that we passed, along with 2 of the other 3 couples.  The third couple did not pass simply because a particular piece of paperwork had the gender of the child listed incorrectly.  After court, Firew, the Bethany worker took us to a coffee shop for a celebratory macchiato while we waited to be picked up again.  You periodically have to take a leap of dietary faith while in Africa, and this was such an occasion.  Foods and beverages that have been boiled or cooked are generally safe, so coffee is usually o.k.  The debate with a macchiato is whether the milk is pasteurized and, if not, did it reach an adequate temperature to take care of any bacterial organisms.  Four weeks later, I can say that no problems have yet arisen from this particular leap.

After our macchiatos and coffees, which collectively (for 4 couples and Firew) cost around 5 bucks, we all went to the hospital to visit Jay and Noelle's boy, who was doing better.  Following the hospital, we returned to our son's orphanage and were able to spend another hour or so kicking the soccer ball around.  Amy thought that A had figured out that we were going to be his family and noted that every time A got the ball, he kicked it to me.  Being male, I am much less observant and did not catch that fact.  I was aware, though, that my lack of soccer skills became obvious.  When it was time to leave, we were able to tell A good-bye and give a quick hug.  

We returned to the guest house to finish packing and ate dinner again with group.  Since we didn't have the chance to print the medical letter for the embassy earlier in the day, I handwrote a letter, to which Chris added his thoughts and concurrence.   We gave our handwritten, notebook paper letter to Jay and Noelle and then finished our final preparations to leave.  We had a group prayer before heading to the airport.  Birtukan prayed for us this time.  I couldn't understand a word of her Amharic prayer, but it was powerful and passionate.  Three (couples) of us were on the same flight and had a little extra time at the airport to socialize before boarding the flight for the trip home.  

As we boarded and settled in, we wondered how long it would be until we could return to this beautiful country and be reunited with our new son.  We wondered how difficult it would be to wait for the invitation to come back, knowing that A was now legally ours.  We have discovered since our return that it is definitely not easy to know you have a son halfway around the world that you cannot yet be with.  A few hours into the flight, I looked over at Amy to find her in tears.  I knew what was wrong, but I questioned what triggered the tears at this point rather than at takeoff.  She told me that she had just looked at the map tracking our flight path and our plane was just exiting the African continent. 

Once we reached Frankfurt, we had a short opportunity to say good-bye to our friends before we all headed to our respective flights home.  It was terrific to get home and be with our kids again, but we cannot wait to return to claim our son and have all of our family together for the first time.  We hope our kids will be able to make the second trip with us, but we are not yet certain if that will be possible.

A Church, A Shop, A Hospital, and A Letter: Ethiopia Day 4

Ethiopia day 4

Our fourth day in Ethiopia was a Sunday.  We awoke and had another wonderful breakfast and were then taken to the International Church by Abel (whose shoulder was still hurt and who still promised us he was going to go to the doctor that day).  We were blessed again to worship with believers from around the world that morning and met a number of interesting people after the service.  Following the service, Abel took us to the market so that we could shop for souvenirs (still in obvious pain, but with his ever-present smile as he patiently waited for everyone to finish shopping).  Abel encouraged us to haggle with the shop owners.  The best negotiator by far was Noelle.  My favorite quote: "I love to shop!  If you give me a good price, I will come back here and buy more."

We returned to the guest house for a traditional lunch of injera and wat.  Shortly after lunch, we received the news that the child of Jay and Noelle had made it to Addis Ababa and was ready to be admitted to the hospital.  Brandi, Chris (the other pediatrician with us), and I joined Jay and Noelle for the trip to the hospital.  Along the way, we picked up the social worker from Bethany.  We continued toward the hospital and then pulled over after the driver and social worker said they saw the baby and the orphanage workers.  It turns out that the person who drove them from the orphanage in the south had agreed to get them to Addis, so he let them out (in the median of a 4 lane highway!) once he got into the city.  The orphanage director, the nanny, and the baby crossed the street and hopped into the van with us to ride the rest of the way to the hospital.

The hospital is the building on the right

The gate to the hospital

We arrived at the hospital and were quite quickly taken upstairs to a "private" room (Privacy in Africa is not the same as privacy in the U.S.  We had several people spend time in the hospital room who were either random strangers or who really had no good reason to be in the room). The admissions process was tremendously more efficient that an admission here in the U.S.  Once the child was checked in, we waited for the pediatrician to arrive after church.  Chris and I were able to take a peek at the child and share our thoughts with Jay and Noelle.  Hopefully we were able to give some reassurance. 

What you do when you don't have a stethoscope.

I will not include any medical details, but I will make a few observations.  First, it really is a luxury to have a private room, even if it is not always private.  When we were in Kenya, there would be 8 beds in some of the rooms with each bed being shared by a child AND his/her mother.  There was no privacy at all in those rooms.  Second, I felt like the pediatrician was very good and that the child was in good hands.  Third, you could tell that the nanny really cared for the child.  As a parent who is adopting, it is a great relief to know that the people caring for your child before you adopt them are truly caring for your child.

We returned to the guest house and had a tasty spaghetti dinner.  I composed a letter after dinner to the U.S. Embassy in hopes of being able to help expedite the rest of the adoption process for Jay and Noelle.  My plan was to print it at the Bethany office on Monday and sign it, so they would have a physician letter in hand when they went to embassy.  More on that in my next post.  After finishing the letter, we headed up to our room to start packing, since we would be leaving the next day.  Our time in Ethiopia was drawing to a close, but our day in court would have to happen first.

Coffee, Thanksgiving, Birthdays, and Dancing (More of Day 3)

I don't think I have talked much about the coffee in Ethiopia, but, being a coffee lover, I should.  The coffee that was served each day at the guest house was some of the best I have had anywhere, and the coffee served in the coffee ceremony was possibly even better.

For Ethiopians, a coffee ceremony is an expected show of hospitality.   Whenever a visitor comes to your home, you are expected to perform a coffee ceremony.  If you have 5 different visitors over the course of the day, you are expected to perform 5 different ceremonies.  The ceremony begins with the host roasting the coffee beans over coal.  The smell of roasting coffee is one of the most fantastic olfactory experiences in the world (you may recall my description of the Jittery Joe's roasting house from  this post last year).  Incense is traditionally burned during the ceremony as well.  After the beans are roasted and any inadequately roasted beans are discarded, the beans are ground by hand and then the coffee is prepared.  The host will serve a food with the coffee, usually popcorn.  The popcorn is usually sprinkled with sugar and tastes much like kettle corn.  I had never considered popcorn as a complement to coffee, but it was a tasty combo.

After the coffee ceremony, Birtukan graciously invited to join her family and friends for a time of praise to God for a successful adenoidectomy for her son.  Although we almost take the success of such a procedure for granted here in the U.S., it is a much bigger deal in Ethiopia because the odds of complications are significantly higher.  Birtukan and the other parents specifically set aside this time to give praise as an opportunity to teach their children something about thanksgiving.   They were even hospitable enough to give an English explanation of what was being said in Amharic.  We can learn a great deal from other believers, particularly those who have endured greater hardship than we have.  What a blessing to worship with believers from other cultures.  I have now had the opportunity to worship with believers in Mexico, Cyprus, Kenya, and Ethiopia, and it has been an uplifting experience every time.  I might have been able to include Italy in that list, but we slept through that opportunity because we were a bit jetlagged. 

Following the worship time, we were also invited to participate in a birthday party for Birtukan's son.  This was another enjoyable experience.  By the time we finished the coffee ceremony and birthday party, we were rather full, but then it was time to head out to dinner.  Abel arrived to collect us and was wearing a sling on his left arm.  He explained that he had fallen earlier in the day and hurt his shoulder.  Being the gracious host, he still intended to take us to dinner, despite the fact that his left shoulder was clearly sitting an inch or so lower than his right.  We returned to Yod Abysinia for dinner with two other couples (Chris, Jana, Wade, and Jennifer) and Abel.  Abel helped us order and then explained the different foods when the food arrived.  After he explained everything, we insisted that he go home and attempt to get some pain relief and sleep.  The level of his pain must have been quite high, because he accepted some Advil and was willing to actually go home (after he was certain that all arrangements for our transportation home were set).  He told us he was definitely going to go to the doctor on Sunday.

We had another great evening at Yod Abysinia, with excellent Ethiopian food and traditional music and dancing.  The evening got even more interesting when the dancers came into the crowd to select patrons to join them on stage.  As the dancers approached our area, we all tried to avoid eye contact (kind of like high school when the teacher is looking for someone to answer a question), but to no avail.  The dancers came to our table and tapped Amy on the shoulder and brought her on stage.  She handled this quite well.  She ended up being asked to join in the dance (a wedding dance) and channeled MC Hammer and Vanilla Ice during her stage debut.  See the video below:

 Once Amy was released by the dancers (after a piggyback ride around the restaurant), we asked for the check and made an exit before any of the rest of us could be called up on stage.  It was a great end to a great day.

The Sponsored Child: Two Decades Later

So, our third day in Ethiopia was Saturday, November 3.  We awoke and had another delicious breakfast at Morning Coffee Guest House before heading to the main office of the Yezelalem Minch ministry.  The story of Yezelalem Minch is quite inspiring.  One of the founders, Birtukan, runs the Morning Coffee Guest House.  When she was a child, she was sponsored by World Vision.  When she grew up, she went to work for World Vision and would go about her usual life when she wasn't working.  One day, she was reading a letter from a sponsor to a sponsored child.  Birtukan had always figured that all sponsors were rich Americans or Europeans who had plenty of extra money to give toward sponsorship.  This letter changed her point of view and the path of her life.  This letter was from a disabled man on a fixed income who explained that he felt led to sponsor a child despite his limited resources.  Birtukan was struck by this and thought (paraphrase by me), "This man is disabled and he is helping these children.  Look at me, I am able-bodied.  What I am doing?"

That letter spawned in Birtukan a strong desire to help orphans.  What began with someone sponsoring a child through World Vision has led to that sponsored child taking some orphans into her home and then beginning a ministry that now reaches over 1200 needy orphans and widows.  Among other types of ministry, YM has a feeding program that feeds hundreds of orphans and widows each Saturday.  For many of these kids, this may be the most nutritious meal of the week.  We were blessed to be able to participate in the feeding program on this particular Saturday (though I think we slowed the process down, the usual workers were very gracious to let us participate).  

While we were there, Nesibu (Birtukan's husband) gave us a tour of the building where they have begun a pilot program offering a preschool for the children of single mothers.  This free preschool feeds the children two meals a day and allows the mothers to work to support their kids.  If you need a worthy place to give financial support, consider Yezelalem Minch.  You can give to them through Bethany Christian Services or Helps International Ministries.

After the feeding program, we returned to the MCGH to have lunch, another delicious meal of tacos on homemade tortillas.  In the afternoon, Birtukan had arranged for us to participate in a coffee ceremony with her and the other families staying at the guest house.  If you love coffee, don't miss my next post.

Ethiopia Day 2 - First Meeting

The big day arrived: we got to go to the orphanage and meet A.  We left the guest house in the morning and were taken with our social worker to visit the orphanage.

We arrived at the orphanage and didn't see him initially.  The social worker went inside the building and brought him out to the courtyard.  Several of the younger children recognized us from the day before and had already come to us so we could pick them up.  We brought a kickball and a soccer ball with us and were able to spend some time kicking the soccer ball with A and another child.  The kids were apparently feeling competitive and started to play a one-on-one soccer game with each other.   A had to kick to the uphill goal, so he played with a bit of a disadvantage.  After each goal he scored he come to us and tell us his score and give us five.

We spent about an hour playing with A and the other kids in the courtyard, then all the kids were brought inside for snack time.  Snacks today consisted of  bananas, of which we were invited to partake.  The nannies then decided to put in a movie for the kids to watch, which allowed us to sit inside with the kids for some quiet time.  Amy sat next to A and I sat next to her.  The toddlers were pretty attention-seeking and wanted to sit in our laps and were very interested in my watch.  A nudged closer to Amy as the movie went on, but it was still a bit awkward and hard for her to know how much contact to make.

Abel returned just as the movie was ending and we had to say our good-byes (actually our ciao-ciao's), and return to Bethany to pick up Mitchell and Teresa and head to lunch before their court appointment.  The restaurant chosen for lunch (Lucy) had a good variety of international dishes.  After asking the waiter for a recommendation, Amy settled on a soup and I ordered a steak, which was quite good.  

Lunch at Lucy restaurant

Didn't know the FBI had a church in Ethiopia.  I think the CIA has a secret church somewhere.

Mitchell and Teresa were taken to their court appointment and we were taken to visit Mount Entoto, which is roughly 10,000 feet elevation.  Abel had our driver drop the three of us at an overlook where we took a few photos of the city.  We were then approached by a few locals.  The first offered a baggie with some type of leaves in it, which we think was oregano.  I told Abel that if someone approaches you in the U.S. with a baggie of leaves, it is not oregano. ;)  Amy then bought a traditional hat from another lady and Abel led us up the hill to look at a stand of eucalyptus trees.  We walked back down to the road to find that our van had disappeared.  

On Entoto, overlooking Addis Ababa

Amy, modeling a traditional Ethiopian hat

The hike up Entoto

Abel said the driver had probably driven to the top of the mountain and that we should walk up to find him.  I was quickly reminded of our time in Kenya when I would walk up the hill from the hospital to the apartment and find myself short of breath by the time I got there.  The air here was even thinner than the air at Kijabe and the hike turned out to be the most exercise I got the whole week.  At the top, Abel gave us a tour of a museum that contained a variety of historical Ethiopian artifacts.  We then walked a bit further and got to see one of the former emperor's palaces.  It was at the palace that Abel explained to me that it is the year 2005 in Ethiopia.  I decided that I would adopt the Ethiopian calendar, so I am now 7 years younger!  Not a bad deal at all.

Abel explaining the Ethiopian calendar to me

Just a cool cat at the palace

Sights on the way down the mountain

These ladies would carry these huge bundles down the mountain to sell.  Hard to see them struggling under the burden.

From there, we met up with Mitchell and Teresa after their court appointment and returned to the guest house, where we had a nice farewell dinner with Mitchell and Teresa (and Brandi and the kids) before they had to head to the airport to return home.  The three couples returned from their journey to the south and introductions were made.  We enjoyed spending the rest of the evening getting to know the other couples and then retired for the night, looking forward to the next day.

Ethiopia Day 1: A False Start and a Preview

Note: This particular post was written on the day it occurred.  Most of my future posts about our Ethiopia trip will be written retrospectively.

We woke this morning about 7 a.m. so that we could be ready for breakfast at 8.  Three couples that arrived the same night as us had had to leave early that morning to head to the south to visit the orphanage that was caring for their kids.  For breakfast, we had delicious french toast, banaas, coffee, orange/banana juice, and tea prepared by the wonderfully gracious staff of the Morning Coffee Guest House.    Shortly after breakfast Abel arrived to take us to the orphanage where we were supposed to meet our son.  We arrived at the orphanage but soon discovered that there had been a miscommunication which resulted in A being sent to school for the day.  We were able to stay at the orphanage for a little while and play with the wonderful, smiling kids there.  Snack time arrived and we were allowed to go inside and help feed some of the little ones their snack before it was time to head out.

It was decided that we would leave the orphanage and return the next day, when they assured us that A would be there.  From there, we traveled with another adoptive mother to pick up her children from their orphanage.  We had the privilege of witnessing the reunion of the mother with her 2 adoptive kids as she was able to take custody.  It was like a little preview of what will be coming for us in the next few months when we return for A.  We returned the mother and her new children to the guest house and went to the agency office for orientation and then lunch with another couple (the great couple from North Carolina) who are adopting. 

Me, with that great couple from NC (Mitchell and Teresa)

 Lunch was at a nice restaurant with outdoor seating called Tivoli.  There was a good variety American and European dishes from which to choose.  After a filling lunch, we were given a tour of different areas of Addis and then visited Trinity Church.  Abel gave us a very informative tour of the church and instructed us to sit in the emperor's and empress's seats, for which we were scolded by a lady associated with the church.

Amy, quickly exiting the empress's seat upon being scolded

We then headed back to the guest house for a little down time and then out to dinner at a traditional Ethiopian restaurant (Yod Abysinia).  We were able to sample a variety of Ethiopian dishes while we were entertained with traditional Ethiopian song and dance.  Abel was again tremendously gracious, fun, and informative.

Traditional Ethiopian food: wat on injera

It was a full and enjoyable first day here in Ethiopia.  We can't wait to meet our son tomorrow.

Ethiopia Court Trip - Part 1: Travel

Well, the big day finally arrived and we headed to Atlanta to catch our flight to Addis Ababa via Frankfurt. Because we like to keep our lives as exciting as possible, we left Athens about 3:45 so that we would need a perfectly eventless drive into Atlanta at rush hour in order to make the flight on time. Thankfully, the sailing was smooth on I-20 and I-85. We received a recommendation from my partner that Peachy Parking was a convenient and less expensive place to park for the new International Terminal at Hartsfield. For anyone flying out of ATL, I would highly recommend them. Pulling into Peachy Parking with less than 90 minutes until flight time, they had a shuttle waiting for us, grabbed our bags, and immediately took us to the terminal and dropped us off. On return, you text them when you make it through Customs and they send the shuttle to come get you. This was also flawless.


Anyway, we enter the terminal and headed to the Lufthansa desk and checked in. Once we got through security we had about 30 minutes until time to board, so we grabbed a bite to eat. We chose the Chinese restaurant and this was in my fortune cookie:







Now, I'm not superstitious (though, I am a little stitious), except that I never step on the foul line, and I always tap the plate before each pitch, and I dribble twice before shooting a free throw, but sports don't count, right? Oh yeah, and I never talk about how easy a call night is until the call night is over. I did think this was a fun little fortune to receive just as we were heading out to Ethiopia.


We left Atlanta at about 6:45 p.m. on Tuesday, October 30 and arrived (after a short layover in Frankfurt) in Addis Ababa at about 8 p.m. on Wednesday, October 31. I don't enjoy being cooped up on the airplane for so long, but the trip went fine. We changed money at the AA airport (Rates weren't posted, so I took what they gave me. How's that for good financial management? I did calculate it a little later and they gave me a fair rate.) and headed to the back of the line to get our visas. The time between the invitation for court and the travel date was so short that it was risky to send our passports away to get visas ahead of time, so we had to get them at the airport. I couldn't help but think, what if they didn't give us a visa?


After getting the visas and collecting our bags, we were supposed to look for someone with a sign from our agency as we exited the baggage claim area (but still inside the airport). We looked around at all the folks holding signs, but there was no one from our agency. We patiently waited for about 30-45 minutes and still no one came. We finally decided that we better call our contact at the agency and see what was up. Problem was, we had to find a phone and figure out how to use it. We were approached several times by people in the airport, which we weren't sure we could trust, but we finally agreed to let a woman (a taxi driver, I think) call the number for us on her cell phone and we were able to talk with one of the agency workers, who called the guy who was picking us up. The lady with the phone did ask for a tip for the use of the phone, which was certainly a reasonable thing to ask. Our agency contact appeared in the terminal about 2-3 minutes later with apologies for the delay. The information he had received said we were arriving about 11 p.m. He had actually already picked up two other couples who were on our flight (and made it through the visa line before us) and taken them to the guest house.


Abel, our fantastic agency worker, led us to the van and took us to the guest house, where we hurriedly unpacked and finally fell into bed, exhausted form the journey and ready to sleep. We were looking forward to the charm and beauty that was yet to come, but the adventure had certainly already begun.

Another 17(ish) Hours On A Plane

For those of you who have read my blog for a while, you may remember the post I wrote shortly before our medical mission trip to Kenya in 2010.  In it I mentioned how much I hate being stuck on airplanes and how I had nevertheless signed up for a Kenya trip that would put me on the dreaded beasts for about 17 hours each way.  Well, here we go again.

Image from Lonely Planet

My wife, Amy, and I are about to make the first of two trips to Ethiopia to complete the adoption of our son and bring him home with us.  The air time will be about the same as when we flew to Kenya.  Although I still do not like being cooped up in a plane, I survived the lengthy journey to Kenya and back, so I know I will be able to handle the flights to Ethiopia.  We are excited to take the next step towards completing our adoption and to meet our son for the first time.  We hope to give an update or two while in Ethiopia, but that will depend on time and internet access/reliability.

Image from crwflags.com

Happy Birthday to the Son I Haven't Met (Yet)

I'm kind of cheating on this post, since I am really just sharing with you the link to our adoption blog.  We are just really getting going on it and have lots more to share.  Our process has been moving pretty fast, which is good, but it has left us little time to write about the process so far.

Without further ado, the link is http://sprayblogadoption.blogspot.com/

Today's post addresses the fact that tomorrow is our son's birthday and we won't be able to celebrate this one with him.  We look forward to many future birthday celebrations with him.

Also, if you have an interest in supporting orphan care and adoption, visit our fundraising site: http://www.youcaring.com/fundraiser_details?fundraiser_id=7192&url=ch
Half the profits will go to help defray the expenses of our adoption and half will go to support organizations that provide orphan care or support adoption.

My Insurance Company Said Well Visits Are Free. Why Did I Get a Bill?

In a previous post, I tackled the subject of what constitutes a well visit.  Today I will try to explain the way well visits are billed and what happens if a problem is found and/or addressed at the same visit.  Medical billing is quite complex and is based on a process called coding.  I will see if I can explain it in a way that makes sense.  Let me know if I was successful.

Think of your medical bill for an office visit as being similar to the bill you receive at a restaurant.  Each service, procedure, lab, and screen is billed separately just like each menu item is billed separately at a restaurant.

When you go to your doctor for a visit, he or she is required to follow certain rules, called CPT and ICD-9 rules, for describing what happened during the visit (unless he does not accept any insurance and is paid directly by the patient for the visit).  Each thing that is done during the visit has a code and each diagnosis has a code.  The physician must report these codes to the insurance company in order to get paid for the work that was done.  There are codes for well visits, codes for sick or problem visits, codes for each test, codes for each vaccine, and codes for each procedure.  If these codes are not reported correctly, your doctor will not be paid for the visit.  Many times they are reported correctly and your doctor still does not get paid correctly by the insurance company (which is generally due to a "mistake" by the insurance company).  Most medical offices have one or more employees whose entire job is to report these codes and to make sure the insurance company or patient actually pays correctly for them.

At a well visit, the typical codes that are reported to the insurance company are the well visit code, codes for each vaccine, codes for the administration of each vaccine, and codes for each test or procedure (like hearing, vision, hemoglobin, lead testing, developmental screening).   These codes are all linked to the diagnosis "well child".  Depending on the insurance plan, some or all of these codes are "covered services" and are paid by the insurance company.  Sometimes the insurance company requires the patient/parent to pay for all or part of a visit (either in the form of a co-pay, deductible, or because the insurance company doesn't cover a particular service).  This depends completely on the contract between the patient/parent and the insurance company.  The physician's office is required to collect from the patient/parent whatever the insurance company didn't pay.

What often causes confusion is when there is an illness or other problem that is addressed or treated at the same visit.  For example, if I were to find an ear infection and treat it, I would be required to submit a code that told the insurance company I had taken care of a problem and done more than just the well visit.  This is where the confusion for parents may start and here's why:

Many, if not most, insurance plans require the patient to pay for a portion of any services that are not part of the well visit.  Depending on the plan, the patient may need to pay a co-pay or may pay the entire amount of the extra service if they have not met their deductible.  Whether they need to pay this is determined by their insurance company, not their physician.  The insurance companies have intentionally designed this system to create tension between the patient and physician, when, in reality, the insurance company has caused the need for the parent to pay the extra amount.  The physician merely did her job and described the visit accurately to the insurance company.

To summarize, the physician reports the codes that describe what occurred at the visit to the insurance company.  The insurance company reviews the codes and determines if the patient owes any additional fee to the physician.  Whether the patient owes anything depends entirely on the patient's contract with the insurance company, not the physician.

I hope this helps clarify the issue.  Please feel free to share your comments or questions.