High Risk Programs in HMO's and Daycare

Hopefully I won't need to take advantage of this but I thought I'd give you all a "head's up" about it in case you want to check with your insurance. My OB filled out an insurance paper with me a couple months ago. Because my DD was born at 36w3d due to PIH and this time around I am carrying twins, the paper got me "flagged" by the insurance company (Tufts HMO in Massachusetts) as high risk. They invited me to participate in the "Healthy Birthdays" program and I received a very vague letter and brochure. Then a few weeks ago I got a call from the Nurse Manager of the program. She was very nice and we chatted for about 20 minutes about my last PG, this one and my concerns.

One of my big concerns is my 3.5 year old daughter. I'm a full-time SAHM and own my own home quilting business. The business is being wrapped up for 6 months but there's no way to care for my daughter if I need to go on bedrest. We simply don't have the money for full-time care for her right now. As well, she's in preschool twice a week and we'd have to find her transportation to and from school since her teacher does not provide full-day child care. When I mentioned this concern to the nurse, she told me that if I were placed on full bedrest at some point to let her know and that my child care for my DD would be reimbursed by insurance! I could pay whomever I wanted, even family members and multiple people for different days of the week up to $250 a week total and they'd reimburse me. Very cool! I know there is a list of requirements that has to be met but I'm relieved to know that if I need the bedrest then we have some financial help with this.

Just thought I'd mention it in case someone out there is in a similar situation or has similar concerns!

 

WOW, that's terrific!! I've always heard great things about Tufts. Sounds like you have a great insurance.

 

That is fantastic, definitely sooo reassuring should the need for bedrest arise (hopefully it won't ).

 

Wow, that's great! I've never heard of that. I used to have Tufts before I got married, I always liked them.

 

The nurse told me that it's because I was targeted and enrolled in their "high risk" program. There are a bunch of restrictions but it's definitely something that people might want to check on with their insurance. I'd ask if there's a high-risk program within the insurance, what requirements have to be met for enrollment and what benefits are there to enrolling. I never would have known about it if I hadn't brought up my concerns about my rising blood pressure and the possibility of bed rest. If Tufts does this then it's possible other HMO's have similar programs with similar benefits.

 

that's fantastic!!! I've never heard anything like that but it's got to bring you so much peace of mind to know that's one thing that you won't have to panic too much about. Here's hoping you never get to use it

 

That's fantastic! I really like Tufts and I'm very glad I have it with all the complications I'm having. Even though it's pretty expensive, it's good to know I don't have to pay a fortune out of pocket and they offer great programs.