Appointments with an Entourage: Medical Care and Foster Care

When it comes to medical care, foster parents operate in a strange sphere – a kind of medical no man’s land! Because I have two biological kids, I was accustomed to a fairly standard procedure when it came to the seeing the doctor. When they were sick or needed a well-check, I’d call ahead to the doctor to schedule and appointment. On the day of, we’d check in, show an insurance card, see the doctor, pay a co-pay, and come home with a sticker (sometimes multiple stickers). It was pretty standard. Now that I’m a foster parent, the relative simplicity of those visits is now a thing of the past. Those were the good ol’ days!

Now, I’m sure the rules vary from state-to-state (as everything in the foster care system does), but in my home state of Pennsylvania, here’s how it looks…

First, birth parents have the right to always be present at medical appointments (as they should). But, honestly, it can be awkward. The kid might be cranky, the doctor NEVER knows who to talk to, and it can easily descend into an opportunity for the bio parents to visit with their child instead of participating or engaging in the appointment.

Some of the best advice I ever received in terms of drawing everyone’s focus back to the medical appointment at hand was to earnestly ask for the birth parent’s opinion on something. For example,

“Have you had any luck getting your little cutie to eat broccoli?”

A simple question like this accomplishes multiple things: it acknowledges their position as the parent, compliments the child, and puts you on equal terms. From my experience, it has been easy for a doctor to unintentionally create a power dynamic where the person the child lives with (meaning me, the foster parent) has all the answers and the bio parent has nothing to offer. Try to casually direct the doctor to include them in the appointment and make them an equal participant. At the same time, if the doctor asks a question that only you know the answer to, be sure to speak up. The child’s medical needs being adequately addressed is more important than a recently-graduated-out-to-save-the-world caseworker’s admonition in the waiting room that “you need to just observe and let his mom lead this appointment.”

Second, as the foster parent you don’t get to pick the doctor. If the child already has a PCP, you’ll likely be going there regardless of whether or not you have another doctor you’d prefer. If the child needs to see any specialists – someone else will pick who that specialist will be. We live in Lancaster County, and our child has had appointments in Philadelphia, Exton, King of Prussia, Sinking Spring, and Harrisburg. If you aren’t familiar with that part of the country, that means we drive miles and miles, hours and hours…

Next, as you may have guessed, kids in the system are on government insurance (Medicaid). This was a whole new beast for me to meet including required referrals and suddenly learning that not every doctor will see your kid! Fortunately for me, the pediatrician my bio babies go to was happy to waive their office policy that this particular insurance provider was not accepted. They only did this because our family already comes to their practice, and many foster parents are not that lucky. Expect to make several calls before any appointment unless your case worker is willing to do that legwork for you. If you are able, though I’d advise you to handle all these calls yourself. That way you get to pick the appointment dates and times that suit your schedule instead of just being told when to show up (which might be in the middle of nap time or when you’re supposed to be picking big brother up from school).

At the actual appointment, check-in seems like it would be an easy thing, but it isn’t. You can’t just walk up and say “Freddie’s here to see Dr. Jim!” and enjoy the waiting room toys. First, you’ll usually need to have a letter from the county saying that you have permission to bring the child for medical care. Next, the well-meaning check-in clerk will have a dozen questions:

Question: “I have three addresses in here, which is correct?”

Answer: “They all are. One is his birth mother’s address that you already had on record, one is children and youth’s since they are his legal guardians at this time, and one is his place of residence, my house.”

Question: “Where do I send paperwork?”

Answer: “You need to send copies to all three addresses.”

Question: “What phone number do I call for appointment reminders?”

Answer: “Mine, foster mom.”

Question: “Can you sign here please?”

Answer: “No, I can’t sign anything.”

This brings me to my last point: the entourage. Because my family works with a private agency, we have an agency case worker and a county case worker at many medical appointments. They are the ones who can sign things. Foster parents generally can’t sign anything — not financial or liability or consent to treat. All the paperwork either needs to be faxed ahead of time to the county agency, or the case worker must be present. I’ve generally been lucky and someone from the agency usually comes, which alleviates some of the upfront legwork. Bonus: someone else to take notes on anything that’s said as well as distract a cranky kiddo.

It’s true; foster care medical appointments can be one big clown car.  I actually had a child’s birth parent show up with balloons (yes, plural) in a doctor’s office! (Not kidding; the date was near his birthday.) In addition to me and “the patient,” a biological parent usually comes, plus two caseworkers, and sometimes I have to bring a big brother or two. We are QUITE the parade walking down the hallway to the exam room which inevitably ends up being a teeny 4-foot-square. Sigh. There are never enough seats, but I try to take one for the team and climb up to sit on the wrinkly, paper-covered-table.