This post is comprehensive and complicated. Take your time reading it. H/T to Palinoia for sharing her expertise in the insurance industry. These are her views and her assumptions. But she has built this post like a page-turning mystery. Take it away, Palinoia:
Who paid for Trig's Medical Costs? Some possible answers, and as always, more unanswered questions (surprise!), Part I
Presented by Palinoia who has worked for the past 27 years in some area of healthcare, with most of those years within the range of health insurance benefits and coverage in the following settings:
Acute care / hospitals; skilled nursing facilities; case management and discharge planning; major insurance carriers and insurance brokerages dealing with insurance benefits, eligibility, authorizations, claims, and sales.
Updated Insurance Info, September 2011.
Original research completed: January 2009.
To date, I don't believe there has ever been a comprehensive deep-dive examination of the insurance questions around Trig. I believe that insurance coverage or lack thereof, may have played a significant factor in the birth of the pregnancy hoax - which is the only birthin' Sarah did, in my humble opinion. When you are done wading through this very lengthy post, I think you'll see WHY no comprehensive posts have been made regarding the insurance and coverage questions!
Before diving into the potential unpaid medical bills and the AFT connection, the bulleted information below is the basis on which this connection rests. There are some things to remember as you read along (supported by photographic evidence and preponderance of circumstantial evidence, and well documented statements by Sarah Palin that strongly contradict reality):
1. Sarah Palin did not give birth to the child known as Trig Palin on 4/18/2008, nor any other date.
· Review all the shape shifting photos of the 3 week pregnancy
· Review the ludicrous "Wild Ride" story
· Review all of Sarah's revisions to the "Wild Ride" story
2. Sarah Palin appears to lie with ease, proven time and time again, even over inconsequential things (like the weather!)
· Way too many instances of lying to document fully/reference here
3. Sarah Palin seems incurious and uninterested in learning, and routinely makes up her own reality of any given situation, including Paul Revere's Ride.
4. Sarah Palin has a sense of entitlement and no regard for ethics, personal boundaries, laws and regulations, i.e., "I'm the mayor, I can do whatever I want until the courts tell me I can't."
· Again, way too many instances to document here
Assumptions (based on the preponderance of circumstantial evidence)
1. Bristol Palin may have given birth to child known as Trig Palin.
· Rumors of her being pregnant during the suspect time frame, well ahead of Palin's VP candidacy
· 5 month absence compatible with pregnancy time frame of Trig
· Proof per her My Space comments and her own ghost written narrative of being sexually active starting at age 15.
2. Trig Palin was likely born much earlier than the stated 4/18/2008 DOB. Possibly January, February, or early March. I lean towards a late January / Early February 2008 date of birth, prior to Bristol's auto accident 2/8/08.
· We now have proof that Sarah "pre-wrote" her "Heavenly Creator" Trig letter, well before his stated date of birth. She wrote it and sent it to herself on 4/7/08, 11 days before he supposedly arrived. This lends more credence to her knowing all the details and his condition prior to 4/18/08.
· I believe she knew his condition because he was already born, not because of pre-natal testing.
3. Trig Palin was born prematurely, and possibly very premature, and may have had significant health issues, requiring an NICU stay.
· It would not be hard to believe the pre-maturity assumption if "Ruffles" was the original baby born to Bristol, based on his/her delicate fragile appearing condition, and birth defect ear.
· One photo seems to show the lines of a nasal canula on Trig, and it appears this is a photo of the baby called "Ruffles".
4. Trig Palin may have been adopted by Sarah & Todd Palin (or not).
· Levi says she "nagged" him and Bristol about adopting their child. He states she wanted to adopt Tripp, but there may be reason to believe it was actually Trig she was trying to adopt, since the timing of a Tripp adoption didn't make sense to many of us.
· Sarah may have had insurance reasons to adopt Trig, aside from all the political bonus points of faking the pregnancy, explained later in this document.
5. Neither here nor there, but my assumption: if Bristol is the birth mother, then I also believe she did not know of the DS diagnosis prior to his birth, and it came as a surprise to all.
· It would not be common to have anything other than the routine pre-natal testing done due to Bristol's age and certainly not an Amnio.
· Hardly any of Sarah's DS diagnosis narrative lines up re: ultrasound thick neck statement; having an Amnio at all, much less at 13 weeks, etc.
With the assumption that Bristol is the birth mother and that Trig was born prematurely prior to 4/18/08, I'll outline how I arrived at the possibility of large uninsured medical bills for Trig. Not everyone will buy into this line of thinking but after a very long career in health insurance, I feel I have at least some level of expertise in reading insurance summaries, requirements, etc. I will reference all the documents and/or web links so you can read for yourselves.
First, I will talk about "industry standards" for health insurance, particularly employer group insurance. Even though group insurance contracts and benefits can vary from state to state, there are some common elements to every group insurance contract. It is VERY common for employer group insurance to provide maternity benefits (some/most states require this for group coverage). Because of that, plans that cover maternity also cover maternity/delivery costs for pregnant dependents. This means that when your 16-year-old daughter turns up pregnant, their maternity and delivery will be covered by your group plan, provided she is already on the plan as your dependent child. What 99% of insurance contracts will NOT allow is adding the newborn of your daughter (or son for that matter) to your coverage without you, the grandparent, having legal custody/guardianship/adoption of said grandchild. In my entire career, I have yet to come across an individual medical plan or employer group plan that allows adding grandchildren as eligible dependents absent the legal arrangements outlined above. Granted, there could be some plans in some states that would allow it, but it would be way outside what the industry standard is for definitions of eligible dependents. Please remember, also, too, Trig was born before the healthcare reform bill, so none of that would have applied at the time Trig was born (like requiring coverage to age 25, etc).
With that said, I did lots of research in early 2009 regarding the potential health insurance coverage options for Trig if he was born to Bristol. I'm not going to bore you with the full on details, as you'd probably go cross-eyed reading it all and probably will anyway. I investigated the following potential insurance coverage for him:
1. Todd's BP/Union Coverage via United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied Industrial & Service Workers International Union (USW) (multiple sources via Google cite Todd Palin as a member of this union):
We simply do not know if Todd had their children covered on his plan. I did find documentation that he took a leave from BP when Sarah started her Half-Governorship, but he returned to work later in 2007, so I think it is safe to guess that if he didn't waive coverage in lieu of pay, he was probably covered by his Union plan. That still doesn't answer whether the kids were covered on his plan or not. I was able to find the USW (the main parent union of his subset union) plan document, and in it, the definition of “dependent”, Article I, Section 1.05, Page 3. It clearly does NOT include “grandchild” as an eligible dependent, so even if Bristol was covered on his plan, they could not have added Trig to his plan without some kind of legal action such as an adoption:
http://assets.usw.org/Health_and_Wellfare/Fund_Documents/plandocument.pdf
I also just found some more information right on BP's own website regarding their employee medical plan, which is probably what Todd's Union/BP coverage is patterned after. Since at least 2003, BP has contributed 80% of the premium cost towards employees and dependents, with the employee having a cost share of 20%. Additionally, I found more information on eligible dependents on BP's website, which does include grandchildren, but in this narrow circumstance:
"A grandchild who lives with you in a regular parent/child relationship for at least half the year and receives at least 50% of his/her financial support from you. This includes only a grandchild related to you by blood, marriage or domestic partnership whose parents do not live with the child and for whose daily care and guidance you are legally responsible."
That would seem to preclude adding Trig to Todd's coverage as a grandchild, since Bristol did live with them, and one could guess that BP would require proof of the grandparent's legal responsibility for their grandchild.
http://hr.bpglobal.com/LifeBenefits/Sites/Core/BP-Life-benefits/Employee-benefits-handbook/BP-Medical-Program/Eligibility-and-participation.aspx
2. Medicaid / DenaliCare:
This option would appear to be a dead end, as Bristol would have been a minor child, wherein family income guidelines to qualify for coverage would be followed. Without question, SP & Todd’s income level would disqualify Bristol from coverage, even if pregnant, and is evident if one reads the income guidelines shown here (2009 shown, but 2008 income levels would have been the same, or lower, not more):
http://www.hss.state.ak.us/dhcs/denalikidcare/pdfs_denalikidcare_misc/dkc09Incomeguidelines.pdf
3. ACHIA (Alaska Comprehensive Health Insurance Assoc) State High Risk Pool
Trig would not have had coverage through ACHIA due to their clear 6-month pre-existing condition language and his lack of eligibility under the Federally Defined Eligibility rules (Federally Defined Eligibility requires 18 months prior coverage, impossible for a newborn) that would have waived the pre-existing condition waiting period. Sourced from the ACHIA website eligibility guidelines.
4. IHS (Indian Health Services) Federally Sponsored Native Coverage
This section was the MOST difficult to research of all. More information has since come to light since I did the original research, namely the statement in Bristol's custody paperwork that Tripp is an enrolled member of the Curyung Tribal Council, and his medical is covered by IHS and the Alaska Native Medical Center. Of course, we would hope that this coverage for Tripp is factual since it was in legal documents, but who really knows? Sarah and Bristol didn't seem to have any problem with perjury (my opinion) when it came to Troopergate and the Kernell trial, so I have to wonder whether this was a true statement or not, in spite of being in court submitted legal documents.
We could assume that if Tripp (Bristol's son) is a tribal member, and Trig was also her son, then he could have also been a member and entitled to medical services. There is much to research about tribal membership / quantum blood requirements, etc. I have seen comments in one blog that there is no quantum blood requirement for membership in the Curyung Tribal Council if the dependent is a lineal descendent of a tribal member. Maybe someone could actually research and get the definitive answer. If that isn't true and if there IS a quantum blood requirement, how much is required for membership in this tribe? Even so, would IHS / ANMC have covered Trig on a retroactive basis if he was entitled to IHS coverage as a tribal member, if it wasn't found out until later that he couldn't be added to any other coverage and was then added to tribal membership?
We have it fairly well documented that Todd is 1/8 Yup'ik per his own grandmother (ADN article quote). That would make Bristol 1/16, and Trig, if born to her, a mere 1/32nd. Many tribes require a minimum 1/4 Quantum Blood on a CIB card from the Bureau of Indian Affairs for membership. The requirement is up to the individual Tribal Councils. Again, is this a requirement or not, and if so, what is the Quantum Blood requirement for the Curyung Tribal Council? If they do have a Quantum Blood requirement requiring a CIB card from IHS, how long does it take to get a CIB card?
In spite of the questions regarding the native coverage outlined above and Tripp's apparent enrollment, I actually feel fairly safe in saying Trig was not covered by IHS, at least not initially, even if he was eligible. Why do I say this?
Let's go back to Sarah's work history for a moment, and Todd's as well. They both (prior to Quit Date) have a fairly long work history in the private / government sector that afforded each of them employer group medical insurance. Per IHS rules, ANY other insurance will be primary over the Native Coverage, including Medicaid. That means that IHS coverage is always the last to pay if there is other insurance. One also has to seek care from an IHS facility or get approval from IHS to go to a contract facility. Let's not forget Sarah's anti-Native stance, and underlying racist tendencies. She only threw out Todd's native heritage as a political ploy to paint a different image of herself, per her usual M.O. I think her record towards anything to do with the Native population is clear and the reality is much different than the image she has tried to put forth (think cookies on a plate). I can completely see Sarah using hers or Todd's employer group insurance for Bristol and the rest of their children to avoid having to use anything that was "Native". Given this, and the likelihood that either (or both) her State plan or Todd's plan was covering Bristol's maternity care as a covered dependent, she would never have utilized the IHS coverage.
Let's also review Sarah's sense of entitlement and incuriosity and how that factors into the whole equation. Having spent so many years in health insurance, every year I get at least 2-3 calls wanting to know how policy holders can add a grandchild to a policy. "My daughter just had her baby", or "my daughter is pregnant and about to deliver, will she be able to add the baby to my policy", often at the last minute or after the baby is delivered when the claims start being denied. Many parents just assume that their insurance carrier will add the newborn for them, even if it isn't a grandchild, and is their own child - not true! It varies by plan/insurance carrier, but to add your own child to your plan, at least a phone call at minimum is required, and more often than not, a dependent enrollment form is required. Again, that is when it is your own child, not your grandchild.
Why do people think they can add a grandchild? Because their daughter's maternity has been covered for the duration of the pregnancy, per plan benefits, and people just assume since the pregnancy/delivery is covered, so will the baby. Also, few people ever really read their insurance contracts/evidence of coverage (imagine Sarah reading her plan documents...yeah, I didn't think so...). The catch is that said baby has to be an eligible dependent to be added to the coverage. It just isn't that far of a reach to think that Sarah would assume she could add her first grandchild to her policy and not check into it before hand. Add in an unexpected premature birth and complications on top of it, and I am surmising that IHS/Native Coverage was never involved initially, and Sarah didn't worry about adding the baby until later...much later, once she found out there was a pile of unpaid medical bills and by then, to align with her official stated date of birth for Trig and cover her fake pregnancy.
On a side note, Alaska Native Medical Center does have an NICU, but I believe given the probable use of private insurance, Trig was not born at ANMC. He may have been born at Providence instead which also has an NICU. And if Providence or any hospital other than ANMC is where he began his life, then IHS probably didn't enter the picture until much later, if at all. I believe that Providence would be considered a CHS facility (Contract Health Services) and according to IHS, even eligible members have to contact their home tribe within 72 hours of emergency admittance to a CHS facility. How many of us think Sarah (or Bristol) would have done that if they had every intention of using private insurance? I think that may answer the retroactive coverage question. It could be they tried to enroll Trig much later than his birth (based on unpaid medical bills) to try and get IHS to cover the outstanding bills to no avail if they didn't notify within the 72-hour period.
See more info in the FAQ's here, the 72-hour notification information is in bold in the Health Care Away From Home Reservation:
http://www.ihs.gov/GeneralWeb/HelpCenter/CustomerServices/FAQ/
5. Sarah Palin’s State of Alaska Health Insurance
After scouring the web, I actually came up with pretty definitive proof that Sarah,Todd, and their children were covered on her State of Alaska medical insurance.
You can see the proof of their coverage in an excel spreadsheet that is still publicly available on the State's website. It is the Request For Proposal for the state's health insurance contract for 2009. This RFP was posted on 10/16/2008, along with a current census of state employees, their birthdates, and zip codes.Follow the link below and the document to open is on the right hand side attachment 9-1 TPA Census-Active - Redacted.xls You'll find Sarah as employee number #3161, date of birth 19640211 (YYYY/MM/DD), Zip 99654, in the center list for Standard Medical. She also appears in the Dental and Vision tabs also, but with different employee #'s. Website linked below:
http://notes3.state.ak.us/pn/pubnotic.nsf/0/c793a11cec100748892574e40072a993?OpenDocument
Also, I located the actual premiums that Sarah would have paid from July 2008 to July 2009 for her medical, dental, and vision family rates. Important note: These premium cards (URL's are linked below) and the excel spreadsheet above are PROOF that her children were covered on her medical plan. Originally I was bummed because the Excel Employee Census above did not have dependents shown so I couldn't be sure if Todd and Sarah's children were covered on her plan or not, but then I noticed something else when reviewing the State's premium cards/rate information. Note that all premiums are for Employee AND family. There is only one single rate for the whole family and no other option. Some health plans (many or even most, in fact) would list an Employee only rate, Employee + Spouse rate, Employee + Child(ren) rate, and then the Family rate, for example. It is very clear that the State of Alaska does not offer employees any other choice than the whole family rate, which proves that Sarah would have had all of her children plus Todd on this coverage! I hate to even admit how long it took me to "see" this extra tiny little detail. I can't stress the importance of repeatedly going over every aspect of this pregnancy and unbelievable story, because you never know when you'll finally find something really important (like ears for example, or family rate only premiums) that you missed the first, second, third time around.
Her medical alone would have been $953.00 per month for the Standard medical plan. The rate for Standard Dental was $105.00 per month, and the Standard Vision was another $33.00 for a grand total of $1091.00 per month for her family's medical, dental, and vision benefits. You can see the premium card for July 2008 to July 2009 showing the exempt/executive employee cost on the Wayback Machine (URL below). I could not locate the 2007/2008 Premium Card for exempt/executive employees, which is what she would have been paying at the time of Trig's arrival. I did find the 2006/2007 premium card and the total would have been $1054.00 for medical/dental/vision, so we can assume that 2007/2008 premiums would have fallen somewhere between the $1054.00 and $1091.00 amounts.
http://web.archive.org/web/20090501182548/http://www.state.ak.us/drb/ghlb/select-premcard-2008-2009.pdf
I also located the amount of benefit credits Sarah received from the state towards her benefit package. She received $851.00 per month in 2007/2008 as an exempt/executive employee (linked in the WayBack URL below). If the 2007/2008 premium costs were the same as the 2008/2009 premiums, she would have had to pay $240 out of her own paychecks to cover the difference. This would have been deducted on a pre-tax basis. Hey, think about it: this could have been yet another reason she collected so many days per diem for working in her house. That per diem money certainly would have helped offset most, if not all, of her extra benefits cost. Things that make you go hmmm....
http://web.archive.org/web/20080415185419/http://www.state.ak.us/drb/ghlb/2007-2008-benefit-credits.shtml
Now we'll continue looking into Sarah's actual benefits, and eligibility requirements on her State of Alaska coverage.
When I originally researched this option back in January 2009, I did find on the SOA (State of Alaska) website, actual eligibility requirements and required documentation to add dependents. In that document, it clearly stated that children added due to adoption, had to have their legal adoption paperwork submitted with their enrollment. It also stated that natural children required a birth certificate. That document, as a stand alone document, disappeared from the SOA website a long time ago. Just as many readers remember there being a lot more photos on the SOA website that disappeared, I distinctly remember this document being on the website as well. Unfortunately, I didn't record the link I found it on, so I can't locate via the WayBack Machine. I did find the document again in two other locations. One was embedded to the state's special open enrollment paperwork for same sex partners; the other place was embedded to enrollment paperwork for Alaska Teachers.
Not too long ago, Blade at Sarah's Scandal's revisited the requirement of a providing a birth certificate to enroll Trig into Sarah's medical plan in a couple of blog posts. Several posters there doubted that a birth certificate was required because the Dependent Verification Document form was embedded to other documents, when I finally relocated it. See discussions at these links:
http://shesnohockeymom.blogspot.com/2010/12/email-revisited.html
http://shesnohockeymom.blogspot.com/2010/12/more-on-alaskas-birth-certificate.html
Yes!!! I just finally found the link where I originally found this Dependent Verification Form as a stand alone document, not embedded to any "special enrollment" forms. I believe originally it was right in the same section of the state's website that had the dependent enrollment add/change form. I had to scour Palin's Deceptions for my original "anonymous" post there and I actually did link to the document when it was a stand alone document on the SOA website. I originally posted it on Palin's Deceptions on January 11, 2009.
Using the WayBack Machine, you can view it here:
http://web.archive.org/web/20090501182917/http://www.state.ak.us/drb/ghlb/dependent-eligibility-documentation.pdf
I fully believe, still to this day, that the SOA DID require birth certificates (in addition to the enrollment form) to add newborns and legal paperwork plus a birth certificate for adopted children, and that is why the State emailed Sarah for a birth certificate. More on the birth certificate requirement coming up in Part II. Let's review the rest of what I found with regard to Sarah's state health plan and whether Trig could have been covered if she had tried to add him as her own, as her grandchild, or as an adopted child.
First we will start with the language on the Dependent Enrollment Form for AlaskaCare SelectBenefits, the state’s health insurance.
“Your dependent children up to 23 years of age only if they are:
➢ Your natural children, stepchildren, children of your same-sex partner, foster children placed through a State foster
child program, legally adopted children, children in your physical custody and for whom bona fide adoption proceedings
are underway, or children for whom you are legal, court-appointed guardian (if the child is not your or your same-sex partner’s natural born child, please include a copy of the adoption paper work or court orders);
➢ Unmarried and chiefly dependent upon the employee for support;
➢ Living with you in a normal parent-child relationship”
This language for dependent eligibility is stated on page 2 of the enrollment form here:
Located via wayback machine here:
http://web.archive.org/web/20090502135528/http://www.state.ak.us/drb/forms/ben032.pdf
Clearly, the language does not include “grandchild” or “dependent’s child”. Based on this, Trig is not eligible to be added to Sarah’s plan if he was really Bristol's baby, unless he was adopted, or had adoption proceedings in process, or court appointed guardianship by Sarah and Todd.
Also, there is a 30-day enrollment opportunity based on a “qualified event” in addition to the plan’s annual open enrollment period. The State of Alaska annual open enrollment is in May/June, for a July 1st effective date every year. The point being, if Trig was not added in the original 30 day period (from when he was supposedly born) where he would have been given a retro effective date starting with date of birth, the next available enrollment date would have been under the annual open enrollment for coverage that would begin on July 1st, 2008, subject to the same eligibility criteria for dependents as stated above.
“Qualified Events” are explained in the Enrollment Guide here on Page 2:
http://web.archive.org/web/20090510022757/http://www.state.ak.us/drb/ghlb/select/enrollment-guide-2009-2010.pdf
I also located the State’s SelectBenefits Insurance Handbook, and in it is some VERY interesting language. Page numbers referenced are the Adobe PDF page #’s, not the actual document page numbers.
From page 24 pdf / Page 4 document page number, Dependent Eligibility:
Your eligible dependents for health insurance benefits
include:
• Your spouse. You may be legally separated but not
divorced.
• Your children from birth up to 23 years of age only if they
are:
— your natural children, stepchildren, foster children
placed through a State foster child program, legally
adopted children, children in your physical custody and
for whom bona fide adoption proceedings are underway,
or children for whom you are the legal, court appointed
guardian;
— unmarried and chiefly dependent upon you for support;
— living with you in a normal parent-child relationship;
This further confirms the information for dependent eligibility included on the Dependent Enrollment form. Grandchildren and dependents of dependent children are not allowed to be added to coverage, without benefit of formal adoption or legal guardianship.
From Page 66 pdf / Page 46 document page number, Pregnancy:
Pregnancy
Pregnancy and childbirth are covered like any other medical
condition as long as you are covered under the medical plan.
No pre-existing conditions limitations are applied.
Coverage is provided for a hospital stay for childbirth for at
least 48 hours following a normal delivery or 96 hours following
a cesarean delivery.
This clause means that Bristol, as a legally covered dependent on Sarah’s plan would have had her maternity and delivery costs covered, even if there were complications. This would have applied to Todd’s union coverage as well. It is standard insurance fare for dependent children’s maternity to be covered, if maternity coverage is provided by the plan and is not a plan exclusion.
From Page 67 pdf / Page 47 document page number, coverage of Newborn Care:
Newborn Care
Newborn care provided within the first 72 hours after birth is
covered. This includes nursery charges, physician’s services
and other routine care for a newborn child and is limited to 72
hours following the birth. Newborn services provided after 72
hours are not covered.
Charges for a newborn who has suffered an accidental injury,
illness, premature birth or other abnormal condition are
covered like any other medically necessary services.
This clause provides for Newborn Care / Coverage for 72 hours, including complications, even if the newborn is NEVER added/enrolled on the plan. So, this would mean that at most, Trig would have had 72 hours of coverage, provided the insurer didn’t enforce non-coverage because he was the “dependent of a dependent” vs. a dependent of the employee or employee’s spouse. The only way to get continued coverage for him after the 72 hours is over, is to have officially added him to coverage within the 30 day qualified event period.
This next section is where things get the most interesting of all. This next statement is HUGE, even if Sarah and Todd legally adopted Trig, or had legal guardianship.
From page 39 pdf / Page 19 document page number (and lots of other places in this document) regarding “Start of Coverage” (emphasis mine in the excerpt below).
New Dependents (emphasis added)
If you add new dependents, they are eligible for benefits immediately
unless they are confined in a hospital or a similar
institution (except for newborn natural children). Coverage
then begins when they are released from the facility.
So if you read this carefully, and JUST exactly as stated, imagine…. you have a premature baby (grandchild), whom you plan on adopting and who will be in the hospital facility for some time due to premature birth….Down Syndrome…jaundice…hole in his heart…and he is not your “natural” child…coverage would not begin until release from the facility…it sounds like a big fat unpaid hospital stay to me. If Trig was very pre-mature, this could have been hugely expensive. To read more about pre-mature NICU costs, here is a good case study and the cost involved to the family:
http://www.businessweek.com/magazine/content/08_25/b4089046084131.htm
As stated in the employee insurance handbook and according to AlaskaCare’s guidelines, coverage does not start until after discharge from the facility - “EXCEPT FOR NEWBORN NATURAL CHILDREN”. This clause clearly does not say natural OR adopted children, or children for whom one has legal guardianship. Only the words newborn “natural” children appears as the exception to this rule. This is extremely important language, because even if Sarah and Todd legally adopted Trig so they could add him as Sarah’s dependent, he would NOT be their “natural child”, and therefore coverage would not start until he was discharged from the facility. Just how long could he have been in the hospital? Do we believe Sarah’s version of events? Or something closer to the probable reality of a birth earlier than April 18th, with a longer hospital stay (possibly MUCH longer) including NICU time? Even if they had all the adoption paperwork in place almost immediately after his unexpected pre-mature birth, he would still not be covered until his release from the facility. OUCH!
I'd like to insert some additional food for thought here as well: Levi's claim that Sarah and Todd wanted to adopt Bristol's baby. If he was really talking about Trig (rather than Tripp), the fact that Sarah's grandchild could not be added to her policy without benefit of adoption could have been a compelling factor in her quest for adoption, especially if adopting would allow insurance coverage for otherwise uninsured medical bills. Again, I have to re-iterate here, once Sarah found out that the grandchild couldn't be added to her policy, and she needed to adopt instead so she could add him to coverage, this very well could have led her to start thinking up a fake pregnancy. This would allow her to present said infant as her own, save face of having an unwed teen daughter while she was on the short list for VP, as well as her reinforce her "pro-life" creds with the right wing since she knew of the DS after the birth. Also, too, the timing just makes sense. If Trig appeared late Jan/Early Feb, or prior to Valentine's according to Anon238, Sarah started her scarf wearing on 2/19. Just about the time she would have started finding out there was no coverage for Trig. Suffice it to say, I still can't see Sarah reading and interpreting the CLEAR language in her benefits booklet with regard to Start of Coverage and the requirement around "newborn natural child" vs. coverage starting upon release from facility, once she figured out the grandchild couldn't be added. I surmise she viewed the adoption piece as the be-all-end-all to get these bills paid...but as unaware as she is, she wouldn't have realized that wouldn't have worked until Trig was on his way home from the facility, after who-knows-how-long, still leaving her with a big pile of unpaid medical bills.
You can read all of these passages here in the SOA SelectBenefits Insurance Information Booklet. Please note, at the beginning of the document, all of the amendments made to benefits or language in this booklet since 2001 are listed. Nowhere in these amendments does it reflect any language change regarding the “start of coverage” clause with regard to the words “newborn natural children”. There is no evidence that this clause ever read anything else, so we can safely assume that it had the same language in 2008 just as it does now:
http://web.archive.org/web/20090509131535/http://www.state.ak.us/drb/ghlb/select/s_bw.pdf
My final conclusions regarding insurance coverage of Trig, provided he is Bristol's baby:
1. Based on documentation, Bristol's maternity and delivery costs would have been covered by either or both Sarah's or Todd's employer plans as a covered dependent.
2. Trig could not be added to either Sarah's or Todd's plans as their grandchild unless they made legal arrangements for guardianship or adoption.
3. Trig would have had at most 72 hours of coverage per Sarah's insurance coverage.
4. Even if Trig were adopted, coverage would not have started until he was released from the hospital.
5. There is every potential for some very large uninsured medical bills, depending on how pre-mature Trig was.
That's it for now. I truly apologize if your heads are swimming, but I'll leave final blame with Sarah herself for that, since we all KNOW she could have stopped all the questions a long time ago. Part II will be a dissection of the "birth certificate" email from the State to Sarah, and the possible AFT connection.
Presented by Palinoia who has worked for the past 27 years in some area of healthcare, with most of those years within the range of health insurance benefits and coverage in the following settings:
Acute care / hospitals; skilled nursing facilities; case management and discharge planning; major insurance carriers and insurance brokerages dealing with insurance benefits, eligibility, authorizations, claims, and sales.
Updated Insurance Info, September 2011.
Original research completed: January 2009.
To date, I don't believe there has ever been a comprehensive deep-dive examination of the insurance questions around Trig. I believe that insurance coverage or lack thereof, may have played a significant factor in the birth of the pregnancy hoax - which is the only birthin' Sarah did, in my humble opinion. When you are done wading through this very lengthy post, I think you'll see WHY no comprehensive posts have been made regarding the insurance and coverage questions!
Before diving into the potential unpaid medical bills and the AFT connection, the bulleted information below is the basis on which this connection rests. There are some things to remember as you read along (supported by photographic evidence and preponderance of circumstantial evidence, and well documented statements by Sarah Palin that strongly contradict reality):
1. Sarah Palin did not give birth to the child known as Trig Palin on 4/18/2008, nor any other date.
· Review all the shape shifting photos of the 3 week pregnancy
· Review the ludicrous "Wild Ride" story
· Review all of Sarah's revisions to the "Wild Ride" story
2. Sarah Palin appears to lie with ease, proven time and time again, even over inconsequential things (like the weather!)
· Way too many instances of lying to document fully/reference here
3. Sarah Palin seems incurious and uninterested in learning, and routinely makes up her own reality of any given situation, including Paul Revere's Ride.
4. Sarah Palin has a sense of entitlement and no regard for ethics, personal boundaries, laws and regulations, i.e., "I'm the mayor, I can do whatever I want until the courts tell me I can't."
· Again, way too many instances to document here
Assumptions (based on the preponderance of circumstantial evidence)
1. Bristol Palin may have given birth to child known as Trig Palin.
· Rumors of her being pregnant during the suspect time frame, well ahead of Palin's VP candidacy
· 5 month absence compatible with pregnancy time frame of Trig
· Proof per her My Space comments and her own ghost written narrative of being sexually active starting at age 15.
2. Trig Palin was likely born much earlier than the stated 4/18/2008 DOB. Possibly January, February, or early March. I lean towards a late January / Early February 2008 date of birth, prior to Bristol's auto accident 2/8/08.
· We now have proof that Sarah "pre-wrote" her "Heavenly Creator" Trig letter, well before his stated date of birth. She wrote it and sent it to herself on 4/7/08, 11 days before he supposedly arrived. This lends more credence to her knowing all the details and his condition prior to 4/18/08.
· I believe she knew his condition because he was already born, not because of pre-natal testing.
3. Trig Palin was born prematurely, and possibly very premature, and may have had significant health issues, requiring an NICU stay.
· It would not be hard to believe the pre-maturity assumption if "Ruffles" was the original baby born to Bristol, based on his/her delicate fragile appearing condition, and birth defect ear.
· One photo seems to show the lines of a nasal canula on Trig, and it appears this is a photo of the baby called "Ruffles".
4. Trig Palin may have been adopted by Sarah & Todd Palin (or not).
· Levi says she "nagged" him and Bristol about adopting their child. He states she wanted to adopt Tripp, but there may be reason to believe it was actually Trig she was trying to adopt, since the timing of a Tripp adoption didn't make sense to many of us.
· Sarah may have had insurance reasons to adopt Trig, aside from all the political bonus points of faking the pregnancy, explained later in this document.
5. Neither here nor there, but my assumption: if Bristol is the birth mother, then I also believe she did not know of the DS diagnosis prior to his birth, and it came as a surprise to all.
· It would not be common to have anything other than the routine pre-natal testing done due to Bristol's age and certainly not an Amnio.
· Hardly any of Sarah's DS diagnosis narrative lines up re: ultrasound thick neck statement; having an Amnio at all, much less at 13 weeks, etc.
With the assumption that Bristol is the birth mother and that Trig was born prematurely prior to 4/18/08, I'll outline how I arrived at the possibility of large uninsured medical bills for Trig. Not everyone will buy into this line of thinking but after a very long career in health insurance, I feel I have at least some level of expertise in reading insurance summaries, requirements, etc. I will reference all the documents and/or web links so you can read for yourselves.
First, I will talk about "industry standards" for health insurance, particularly employer group insurance. Even though group insurance contracts and benefits can vary from state to state, there are some common elements to every group insurance contract. It is VERY common for employer group insurance to provide maternity benefits (some/most states require this for group coverage). Because of that, plans that cover maternity also cover maternity/delivery costs for pregnant dependents. This means that when your 16-year-old daughter turns up pregnant, their maternity and delivery will be covered by your group plan, provided she is already on the plan as your dependent child. What 99% of insurance contracts will NOT allow is adding the newborn of your daughter (or son for that matter) to your coverage without you, the grandparent, having legal custody/guardianship/adoption of said grandchild. In my entire career, I have yet to come across an individual medical plan or employer group plan that allows adding grandchildren as eligible dependents absent the legal arrangements outlined above. Granted, there could be some plans in some states that would allow it, but it would be way outside what the industry standard is for definitions of eligible dependents. Please remember, also, too, Trig was born before the healthcare reform bill, so none of that would have applied at the time Trig was born (like requiring coverage to age 25, etc).
With that said, I did lots of research in early 2009 regarding the potential health insurance coverage options for Trig if he was born to Bristol. I'm not going to bore you with the full on details, as you'd probably go cross-eyed reading it all and probably will anyway. I investigated the following potential insurance coverage for him:
- Todd’s Union BP/USW Coverage (United Steel Workers)
- Medicaid / DenaliCare
- ACHIA (Alaska's State High Risk Pool)
- IHS / Native coverage
- Sarah’s State of Alaska Health Insurance Coverage
1. Todd's BP/Union Coverage via United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied Industrial & Service Workers International Union (USW) (multiple sources via Google cite Todd Palin as a member of this union):
We simply do not know if Todd had their children covered on his plan. I did find documentation that he took a leave from BP when Sarah started her Half-Governorship, but he returned to work later in 2007, so I think it is safe to guess that if he didn't waive coverage in lieu of pay, he was probably covered by his Union plan. That still doesn't answer whether the kids were covered on his plan or not. I was able to find the USW (the main parent union of his subset union) plan document, and in it, the definition of “dependent”, Article I, Section 1.05, Page 3. It clearly does NOT include “grandchild” as an eligible dependent, so even if Bristol was covered on his plan, they could not have added Trig to his plan without some kind of legal action such as an adoption:
http://assets.usw.org/Health_and_Wellfare/Fund_Documents/plandocument.pdf
I also just found some more information right on BP's own website regarding their employee medical plan, which is probably what Todd's Union/BP coverage is patterned after. Since at least 2003, BP has contributed 80% of the premium cost towards employees and dependents, with the employee having a cost share of 20%. Additionally, I found more information on eligible dependents on BP's website, which does include grandchildren, but in this narrow circumstance:
"A grandchild who lives with you in a regular parent/child relationship for at least half the year and receives at least 50% of his/her financial support from you. This includes only a grandchild related to you by blood, marriage or domestic partnership whose parents do not live with the child and for whose daily care and guidance you are legally responsible."
That would seem to preclude adding Trig to Todd's coverage as a grandchild, since Bristol did live with them, and one could guess that BP would require proof of the grandparent's legal responsibility for their grandchild.
http://hr.bpglobal.com/LifeBenefits/Sites/Core/BP-Life-benefits/Employee-benefits-handbook/BP-Medical-Program/Eligibility-and-participation.aspx
2. Medicaid / DenaliCare:
This option would appear to be a dead end, as Bristol would have been a minor child, wherein family income guidelines to qualify for coverage would be followed. Without question, SP & Todd’s income level would disqualify Bristol from coverage, even if pregnant, and is evident if one reads the income guidelines shown here (2009 shown, but 2008 income levels would have been the same, or lower, not more):
http://www.hss.state.ak.us/dhcs/denalikidcare/pdfs_denalikidcare_misc/dkc09Incomeguidelines.pdf
3. ACHIA (Alaska Comprehensive Health Insurance Assoc) State High Risk Pool
Trig would not have had coverage through ACHIA due to their clear 6-month pre-existing condition language and his lack of eligibility under the Federally Defined Eligibility rules (Federally Defined Eligibility requires 18 months prior coverage, impossible for a newborn) that would have waived the pre-existing condition waiting period. Sourced from the ACHIA website eligibility guidelines.
4. IHS (Indian Health Services) Federally Sponsored Native Coverage
This section was the MOST difficult to research of all. More information has since come to light since I did the original research, namely the statement in Bristol's custody paperwork that Tripp is an enrolled member of the Curyung Tribal Council, and his medical is covered by IHS and the Alaska Native Medical Center. Of course, we would hope that this coverage for Tripp is factual since it was in legal documents, but who really knows? Sarah and Bristol didn't seem to have any problem with perjury (my opinion) when it came to Troopergate and the Kernell trial, so I have to wonder whether this was a true statement or not, in spite of being in court submitted legal documents.
We could assume that if Tripp (Bristol's son) is a tribal member, and Trig was also her son, then he could have also been a member and entitled to medical services. There is much to research about tribal membership / quantum blood requirements, etc. I have seen comments in one blog that there is no quantum blood requirement for membership in the Curyung Tribal Council if the dependent is a lineal descendent of a tribal member. Maybe someone could actually research and get the definitive answer. If that isn't true and if there IS a quantum blood requirement, how much is required for membership in this tribe? Even so, would IHS / ANMC have covered Trig on a retroactive basis if he was entitled to IHS coverage as a tribal member, if it wasn't found out until later that he couldn't be added to any other coverage and was then added to tribal membership?
We have it fairly well documented that Todd is 1/8 Yup'ik per his own grandmother (ADN article quote). That would make Bristol 1/16, and Trig, if born to her, a mere 1/32nd. Many tribes require a minimum 1/4 Quantum Blood on a CIB card from the Bureau of Indian Affairs for membership. The requirement is up to the individual Tribal Councils. Again, is this a requirement or not, and if so, what is the Quantum Blood requirement for the Curyung Tribal Council? If they do have a Quantum Blood requirement requiring a CIB card from IHS, how long does it take to get a CIB card?
In spite of the questions regarding the native coverage outlined above and Tripp's apparent enrollment, I actually feel fairly safe in saying Trig was not covered by IHS, at least not initially, even if he was eligible. Why do I say this?
Let's go back to Sarah's work history for a moment, and Todd's as well. They both (prior to Quit Date) have a fairly long work history in the private / government sector that afforded each of them employer group medical insurance. Per IHS rules, ANY other insurance will be primary over the Native Coverage, including Medicaid. That means that IHS coverage is always the last to pay if there is other insurance. One also has to seek care from an IHS facility or get approval from IHS to go to a contract facility. Let's not forget Sarah's anti-Native stance, and underlying racist tendencies. She only threw out Todd's native heritage as a political ploy to paint a different image of herself, per her usual M.O. I think her record towards anything to do with the Native population is clear and the reality is much different than the image she has tried to put forth (think cookies on a plate). I can completely see Sarah using hers or Todd's employer group insurance for Bristol and the rest of their children to avoid having to use anything that was "Native". Given this, and the likelihood that either (or both) her State plan or Todd's plan was covering Bristol's maternity care as a covered dependent, she would never have utilized the IHS coverage.
Let's also review Sarah's sense of entitlement and incuriosity and how that factors into the whole equation. Having spent so many years in health insurance, every year I get at least 2-3 calls wanting to know how policy holders can add a grandchild to a policy. "My daughter just had her baby", or "my daughter is pregnant and about to deliver, will she be able to add the baby to my policy", often at the last minute or after the baby is delivered when the claims start being denied. Many parents just assume that their insurance carrier will add the newborn for them, even if it isn't a grandchild, and is their own child - not true! It varies by plan/insurance carrier, but to add your own child to your plan, at least a phone call at minimum is required, and more often than not, a dependent enrollment form is required. Again, that is when it is your own child, not your grandchild.
Why do people think they can add a grandchild? Because their daughter's maternity has been covered for the duration of the pregnancy, per plan benefits, and people just assume since the pregnancy/delivery is covered, so will the baby. Also, few people ever really read their insurance contracts/evidence of coverage (imagine Sarah reading her plan documents...yeah, I didn't think so...). The catch is that said baby has to be an eligible dependent to be added to the coverage. It just isn't that far of a reach to think that Sarah would assume she could add her first grandchild to her policy and not check into it before hand. Add in an unexpected premature birth and complications on top of it, and I am surmising that IHS/Native Coverage was never involved initially, and Sarah didn't worry about adding the baby until later...much later, once she found out there was a pile of unpaid medical bills and by then, to align with her official stated date of birth for Trig and cover her fake pregnancy.
On a side note, Alaska Native Medical Center does have an NICU, but I believe given the probable use of private insurance, Trig was not born at ANMC. He may have been born at Providence instead which also has an NICU. And if Providence or any hospital other than ANMC is where he began his life, then IHS probably didn't enter the picture until much later, if at all. I believe that Providence would be considered a CHS facility (Contract Health Services) and according to IHS, even eligible members have to contact their home tribe within 72 hours of emergency admittance to a CHS facility. How many of us think Sarah (or Bristol) would have done that if they had every intention of using private insurance? I think that may answer the retroactive coverage question. It could be they tried to enroll Trig much later than his birth (based on unpaid medical bills) to try and get IHS to cover the outstanding bills to no avail if they didn't notify within the 72-hour period.
See more info in the FAQ's here, the 72-hour notification information is in bold in the Health Care Away From Home Reservation:
http://www.ihs.gov/GeneralWeb/HelpCenter/CustomerServices/FAQ/
5. Sarah Palin’s State of Alaska Health Insurance
After scouring the web, I actually came up with pretty definitive proof that Sarah,Todd, and their children were covered on her State of Alaska medical insurance.
You can see the proof of their coverage in an excel spreadsheet that is still publicly available on the State's website. It is the Request For Proposal for the state's health insurance contract for 2009. This RFP was posted on 10/16/2008, along with a current census of state employees, their birthdates, and zip codes.Follow the link below and the document to open is on the right hand side attachment 9-1 TPA Census-Active - Redacted.xls You'll find Sarah as employee number #3161, date of birth 19640211 (YYYY/MM/DD), Zip 99654, in the center list for Standard Medical. She also appears in the Dental and Vision tabs also, but with different employee #'s. Website linked below:
http://notes3.state.ak.us/pn/pubnotic.nsf/0/c793a11cec100748892574e40072a993?OpenDocument
Also, I located the actual premiums that Sarah would have paid from July 2008 to July 2009 for her medical, dental, and vision family rates. Important note: These premium cards (URL's are linked below) and the excel spreadsheet above are PROOF that her children were covered on her medical plan. Originally I was bummed because the Excel Employee Census above did not have dependents shown so I couldn't be sure if Todd and Sarah's children were covered on her plan or not, but then I noticed something else when reviewing the State's premium cards/rate information. Note that all premiums are for Employee AND family. There is only one single rate for the whole family and no other option. Some health plans (many or even most, in fact) would list an Employee only rate, Employee + Spouse rate, Employee + Child(ren) rate, and then the Family rate, for example. It is very clear that the State of Alaska does not offer employees any other choice than the whole family rate, which proves that Sarah would have had all of her children plus Todd on this coverage! I hate to even admit how long it took me to "see" this extra tiny little detail. I can't stress the importance of repeatedly going over every aspect of this pregnancy and unbelievable story, because you never know when you'll finally find something really important (like ears for example, or family rate only premiums) that you missed the first, second, third time around.
Her medical alone would have been $953.00 per month for the Standard medical plan. The rate for Standard Dental was $105.00 per month, and the Standard Vision was another $33.00 for a grand total of $1091.00 per month for her family's medical, dental, and vision benefits. You can see the premium card for July 2008 to July 2009 showing the exempt/executive employee cost on the Wayback Machine (URL below). I could not locate the 2007/2008 Premium Card for exempt/executive employees, which is what she would have been paying at the time of Trig's arrival. I did find the 2006/2007 premium card and the total would have been $1054.00 for medical/dental/vision, so we can assume that 2007/2008 premiums would have fallen somewhere between the $1054.00 and $1091.00 amounts.
http://web.archive.org/web/20090501182548/http://www.state.ak.us/drb/ghlb/select-premcard-2008-2009.pdf
I also located the amount of benefit credits Sarah received from the state towards her benefit package. She received $851.00 per month in 2007/2008 as an exempt/executive employee (linked in the WayBack URL below). If the 2007/2008 premium costs were the same as the 2008/2009 premiums, she would have had to pay $240 out of her own paychecks to cover the difference. This would have been deducted on a pre-tax basis. Hey, think about it: this could have been yet another reason she collected so many days per diem for working in her house. That per diem money certainly would have helped offset most, if not all, of her extra benefits cost. Things that make you go hmmm....
http://web.archive.org/web/20080415185419/http://www.state.ak.us/drb/ghlb/2007-2008-benefit-credits.shtml
Now we'll continue looking into Sarah's actual benefits, and eligibility requirements on her State of Alaska coverage.
When I originally researched this option back in January 2009, I did find on the SOA (State of Alaska) website, actual eligibility requirements and required documentation to add dependents. In that document, it clearly stated that children added due to adoption, had to have their legal adoption paperwork submitted with their enrollment. It also stated that natural children required a birth certificate. That document, as a stand alone document, disappeared from the SOA website a long time ago. Just as many readers remember there being a lot more photos on the SOA website that disappeared, I distinctly remember this document being on the website as well. Unfortunately, I didn't record the link I found it on, so I can't locate via the WayBack Machine. I did find the document again in two other locations. One was embedded to the state's special open enrollment paperwork for same sex partners; the other place was embedded to enrollment paperwork for Alaska Teachers.
Not too long ago, Blade at Sarah's Scandal's revisited the requirement of a providing a birth certificate to enroll Trig into Sarah's medical plan in a couple of blog posts. Several posters there doubted that a birth certificate was required because the Dependent Verification Document form was embedded to other documents, when I finally relocated it. See discussions at these links:
http://shesnohockeymom.blogspot.com/2010/12/email-revisited.html
http://shesnohockeymom.blogspot.com/2010/12/more-on-alaskas-birth-certificate.html
Yes!!! I just finally found the link where I originally found this Dependent Verification Form as a stand alone document, not embedded to any "special enrollment" forms. I believe originally it was right in the same section of the state's website that had the dependent enrollment add/change form. I had to scour Palin's Deceptions for my original "anonymous" post there and I actually did link to the document when it was a stand alone document on the SOA website. I originally posted it on Palin's Deceptions on January 11, 2009.
Using the WayBack Machine, you can view it here:
http://web.archive.org/web/20090501182917/http://www.state.ak.us/drb/ghlb/dependent-eligibility-documentation.pdf
I fully believe, still to this day, that the SOA DID require birth certificates (in addition to the enrollment form) to add newborns and legal paperwork plus a birth certificate for adopted children, and that is why the State emailed Sarah for a birth certificate. More on the birth certificate requirement coming up in Part II. Let's review the rest of what I found with regard to Sarah's state health plan and whether Trig could have been covered if she had tried to add him as her own, as her grandchild, or as an adopted child.
First we will start with the language on the Dependent Enrollment Form for AlaskaCare SelectBenefits, the state’s health insurance.
“Your dependent children up to 23 years of age only if they are:
➢ Your natural children, stepchildren, children of your same-sex partner, foster children placed through a State foster
child program, legally adopted children, children in your physical custody and for whom bona fide adoption proceedings
are underway, or children for whom you are legal, court-appointed guardian (if the child is not your or your same-sex partner’s natural born child, please include a copy of the adoption paper work or court orders);
➢ Unmarried and chiefly dependent upon the employee for support;
➢ Living with you in a normal parent-child relationship”
This language for dependent eligibility is stated on page 2 of the enrollment form here:
Located via wayback machine here:
http://web.archive.org/web/20090502135528/http://www.state.ak.us/drb/forms/ben032.pdf
Clearly, the language does not include “grandchild” or “dependent’s child”. Based on this, Trig is not eligible to be added to Sarah’s plan if he was really Bristol's baby, unless he was adopted, or had adoption proceedings in process, or court appointed guardianship by Sarah and Todd.
Also, there is a 30-day enrollment opportunity based on a “qualified event” in addition to the plan’s annual open enrollment period. The State of Alaska annual open enrollment is in May/June, for a July 1st effective date every year. The point being, if Trig was not added in the original 30 day period (from when he was supposedly born) where he would have been given a retro effective date starting with date of birth, the next available enrollment date would have been under the annual open enrollment for coverage that would begin on July 1st, 2008, subject to the same eligibility criteria for dependents as stated above.
“Qualified Events” are explained in the Enrollment Guide here on Page 2:
http://web.archive.org/web/20090510022757/http://www.state.ak.us/drb/ghlb/select/enrollment-guide-2009-2010.pdf
I also located the State’s SelectBenefits Insurance Handbook, and in it is some VERY interesting language. Page numbers referenced are the Adobe PDF page #’s, not the actual document page numbers.
From page 24 pdf / Page 4 document page number, Dependent Eligibility:
Your eligible dependents for health insurance benefits
include:
• Your spouse. You may be legally separated but not
divorced.
• Your children from birth up to 23 years of age only if they
are:
— your natural children, stepchildren, foster children
placed through a State foster child program, legally
adopted children, children in your physical custody and
for whom bona fide adoption proceedings are underway,
or children for whom you are the legal, court appointed
guardian;
— unmarried and chiefly dependent upon you for support;
— living with you in a normal parent-child relationship;
This further confirms the information for dependent eligibility included on the Dependent Enrollment form. Grandchildren and dependents of dependent children are not allowed to be added to coverage, without benefit of formal adoption or legal guardianship.
From Page 66 pdf / Page 46 document page number, Pregnancy:
Pregnancy
Pregnancy and childbirth are covered like any other medical
condition as long as you are covered under the medical plan.
No pre-existing conditions limitations are applied.
Coverage is provided for a hospital stay for childbirth for at
least 48 hours following a normal delivery or 96 hours following
a cesarean delivery.
This clause means that Bristol, as a legally covered dependent on Sarah’s plan would have had her maternity and delivery costs covered, even if there were complications. This would have applied to Todd’s union coverage as well. It is standard insurance fare for dependent children’s maternity to be covered, if maternity coverage is provided by the plan and is not a plan exclusion.
From Page 67 pdf / Page 47 document page number, coverage of Newborn Care:
Newborn Care
Newborn care provided within the first 72 hours after birth is
covered. This includes nursery charges, physician’s services
and other routine care for a newborn child and is limited to 72
hours following the birth. Newborn services provided after 72
hours are not covered.
Charges for a newborn who has suffered an accidental injury,
illness, premature birth or other abnormal condition are
covered like any other medically necessary services.
This clause provides for Newborn Care / Coverage for 72 hours, including complications, even if the newborn is NEVER added/enrolled on the plan. So, this would mean that at most, Trig would have had 72 hours of coverage, provided the insurer didn’t enforce non-coverage because he was the “dependent of a dependent” vs. a dependent of the employee or employee’s spouse. The only way to get continued coverage for him after the 72 hours is over, is to have officially added him to coverage within the 30 day qualified event period.
This next section is where things get the most interesting of all. This next statement is HUGE, even if Sarah and Todd legally adopted Trig, or had legal guardianship.
From page 39 pdf / Page 19 document page number (and lots of other places in this document) regarding “Start of Coverage” (emphasis mine in the excerpt below).
New Dependents (emphasis added)
If you add new dependents, they are eligible for benefits immediately
unless they are confined in a hospital or a similar
institution (except for newborn natural children). Coverage
then begins when they are released from the facility.
So if you read this carefully, and JUST exactly as stated, imagine…. you have a premature baby (grandchild), whom you plan on adopting and who will be in the hospital facility for some time due to premature birth….Down Syndrome…jaundice…hole in his heart…and he is not your “natural” child…coverage would not begin until release from the facility…it sounds like a big fat unpaid hospital stay to me. If Trig was very pre-mature, this could have been hugely expensive. To read more about pre-mature NICU costs, here is a good case study and the cost involved to the family:
http://www.businessweek.com/magazine/content/08_25/b4089046084131.htm
As stated in the employee insurance handbook and according to AlaskaCare’s guidelines, coverage does not start until after discharge from the facility - “EXCEPT FOR NEWBORN NATURAL CHILDREN”. This clause clearly does not say natural OR adopted children, or children for whom one has legal guardianship. Only the words newborn “natural” children appears as the exception to this rule. This is extremely important language, because even if Sarah and Todd legally adopted Trig so they could add him as Sarah’s dependent, he would NOT be their “natural child”, and therefore coverage would not start until he was discharged from the facility. Just how long could he have been in the hospital? Do we believe Sarah’s version of events? Or something closer to the probable reality of a birth earlier than April 18th, with a longer hospital stay (possibly MUCH longer) including NICU time? Even if they had all the adoption paperwork in place almost immediately after his unexpected pre-mature birth, he would still not be covered until his release from the facility. OUCH!
I'd like to insert some additional food for thought here as well: Levi's claim that Sarah and Todd wanted to adopt Bristol's baby. If he was really talking about Trig (rather than Tripp), the fact that Sarah's grandchild could not be added to her policy without benefit of adoption could have been a compelling factor in her quest for adoption, especially if adopting would allow insurance coverage for otherwise uninsured medical bills. Again, I have to re-iterate here, once Sarah found out that the grandchild couldn't be added to her policy, and she needed to adopt instead so she could add him to coverage, this very well could have led her to start thinking up a fake pregnancy. This would allow her to present said infant as her own, save face of having an unwed teen daughter while she was on the short list for VP, as well as her reinforce her "pro-life" creds with the right wing since she knew of the DS after the birth. Also, too, the timing just makes sense. If Trig appeared late Jan/Early Feb, or prior to Valentine's according to Anon238, Sarah started her scarf wearing on 2/19. Just about the time she would have started finding out there was no coverage for Trig. Suffice it to say, I still can't see Sarah reading and interpreting the CLEAR language in her benefits booklet with regard to Start of Coverage and the requirement around "newborn natural child" vs. coverage starting upon release from facility, once she figured out the grandchild couldn't be added. I surmise she viewed the adoption piece as the be-all-end-all to get these bills paid...but as unaware as she is, she wouldn't have realized that wouldn't have worked until Trig was on his way home from the facility, after who-knows-how-long, still leaving her with a big pile of unpaid medical bills.
You can read all of these passages here in the SOA SelectBenefits Insurance Information Booklet. Please note, at the beginning of the document, all of the amendments made to benefits or language in this booklet since 2001 are listed. Nowhere in these amendments does it reflect any language change regarding the “start of coverage” clause with regard to the words “newborn natural children”. There is no evidence that this clause ever read anything else, so we can safely assume that it had the same language in 2008 just as it does now:
http://web.archive.org/web/20090509131535/http://www.state.ak.us/drb/ghlb/select/s_bw.pdf
My final conclusions regarding insurance coverage of Trig, provided he is Bristol's baby:
1. Based on documentation, Bristol's maternity and delivery costs would have been covered by either or both Sarah's or Todd's employer plans as a covered dependent.
2. Trig could not be added to either Sarah's or Todd's plans as their grandchild unless they made legal arrangements for guardianship or adoption.
3. Trig would have had at most 72 hours of coverage per Sarah's insurance coverage.
4. Even if Trig were adopted, coverage would not have started until he was released from the hospital.
5. There is every potential for some very large uninsured medical bills, depending on how pre-mature Trig was.
That's it for now. I truly apologize if your heads are swimming, but I'll leave final blame with Sarah herself for that, since we all KNOW she could have stopped all the questions a long time ago. Part II will be a dissection of the "birth certificate" email from the State to Sarah, and the possible AFT connection.
Thank you again, Palinoia, for sharing your expertise, and for taking us through your thesis carefully and methodically. Palinoia will be checking in to comments to converse with everyone.
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