For parents, the gray area between childhood and adulthood can be full of unexpected perils. As children move more firmly into the adult world, by moving away to attend school or into the workplace, there are some key healthcare discussions that parents should consider having with their child (and children should have with their parents). (Yes, I know she is an adult but for purposes of this discussion, she will be referred to as the child.)
1. HOW DOES HEALTH INSURANCE WORK?
The increased availability of insurance coverage for adult children under insurance plans that cover Mom and Dad is a wonderful thing. However, it is important that we explain how the insurance plan works. This means that someone needs to sit with your child and review the key provisions of the health insurance plan. Explain the differences between in-network and out-of-network care, whether the plan requires referrals from a primary care physician before seeing a specialist, and when to use an urgent care center or an emergency room. (This can be really confusing when there are two insurance plans that provide coverage and coordination of benefits issues kick in.) You should also discuss insurance coverage for prescriptions and the issues concerning generics and drugs that are covered or not covered (formularies). And, don’t forgot co-pays and the like.
If your child is going to be away at school, make sure that you have checked how out-of-network coverage works under those circumstances. Also, understand the role that the health clinic on campus plays.
2. DO I / SHOULD I HAVE ACCESS TO YOUR HEALTH INFORMATION?
Your child is now an adult. That means that, in most circumstances, his or her healthcare information is confidential, even from you! You may consider having a HIPAA release that allows medical personnel to talk to you. This is particularly important if your child has had significant medical or mental health issues, where you may have information that should be communicated to a treating physician. It may also greatly uncomplicate efforts to deal with medical offices if you have to deal with bills and insurance claims paperwork.
This does not mean that you won’t learn things. If you deal with the explanation of benefits documents for the insurance, you will get information that your child may not have chosen to share with you. Those statements do need to be reviewed and, sometimes challenged to obtain appropriate coverage. If your child understands that in advance, it may make things easier. Also, now is the time to start repeating ten times, “She is an adult” “She is an adult.” It might help, it might not.
3. THE SKELETONS IN THE FAMILY CLOSET
It may be time to come clean, or at least to think about it. A complete and accurate health history may be critical if your child becomes ill or is injured. And, it may be important to his ongoing healthcare. But does he know everything that he needs to know. Families frequently choose what information they share with younger children but at some point, that silence needs to be reconsidered.
Any person seeking healthcare should have a reasonable understanding of what diseases are found in the family. Children may have only a very vague recollection of diseases that affected grandparents, aunts and uncles, and even their own parents. A heart problem may be sufficient to a child, but a history of significant heart disease in a parent at a young age may be significant information for a treating physician. Importantly, a history of alcoholism, drug abuse, or mental illness in family members may not have been discussed, but it may be time to share this important information.
It may be time to tell a child things that you know or suspect about her health. Were there diseases in her childhood that have a lasting significance? Survivors of childhood cancers may face other health challenges when they become adults and parents may have been selective in tharing those details. What about consequences of an accident? If you or a family member has tested positively with a genetic disease or as a carrier of a genetic disease, it might be time to discuss that information with your child.
4. WHO MAKES DECISIONS NOW? ABOUT WHAT?
It is so hard to talk about end of life decisions with our parents, but we also need to have those conversations with our adult kids. They have accidents, they become sick, and you may be called upon to make important decisions about care. Every adult should have appropriate documents, including a durable power of attorney for healthcare appropriate to the state where they live, and a living will. You should, at the very least, know if your child has executed such documents and where they are kept. If you are designated under those documents, it can be useful to talk about his wishes. (Starting this conversation can be very difficult, but can also open the door to share your own wishes.)
It is also important to know whether your child wants to be an organ donor. Although driver license checkoffs have made those wishes more clear, families are still frequently asked to give permission. Knowing what your child would have wanted may make those discussions a little easier.
5. IT’S YOUR JOB NOW!
At some point in this process, it is time to let go. Give your child a copy of the immunization records that you have so carefully kept over all these years, a list of the phone numbers for the providers (doctors, dentist, opthamologists, etc.) that they have seen, and copies of the insurance cards. You might also want to review the lags that exist between calling for an appointment and getting an appointment with any of these professionals. And, then, it is time to bid that task of parenting GOODBYE. (Or, maybe not so much. My adult child still asks me to call her doctor’s office and schedule appointments for her because of the differences in our work schedules and work conditions. But she makes me great brownies for doing it.)
Obviously, not all of these conversations can or should happen at once. And, they do not need to wait until some magic age or life event. But, these topics should be on your To-Do as your child prepares to go out in the world on his own.