sunshine health breast pump coverage sunshine health breast pump coverage

Medical equipment is used to manage and treat a condition, illness, or injury. Download the free version of Adobe Reader. Education and support for you and your family or caregiver about your diet and the foods you need to eat to stay healthy. This service is for drugs that are prescribed to you by a doctor or other health care provider. Breast pumps that are hospital-grade are specifically designed for multiple users, with a special closed system that makes the pump safe for moms to share. Producing milk burns calories and helps you return faster to your pre-baby weight. Sunshine Health is a managed care plan with a Florida Medicaid contract. One evaluation of oral pharyngeal swallowing per calendar year. Services for women who are pregnant or want to become pregnant. Services to help people who are in recovery from an addiction or mental illness. Services that treat the heart and circulatory (blood vessels) system. We cover medically necessary family planning services. Health care providers and DME vendors must review the specifications and determine if the pumps they prescribe/issue to postpartum women qualify to be reimbursed. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. Contact lens types: spherical, PMMA, toric or prism ballast, gas permeable, extended wear, hydrophilic, spherical, toric or prism ballast; and hydrophilic extended wear, other types. We will work with your insurance company to determine benefits for your insurance covered breast pump and file an insurance claim on your behalf. Our Start Smart for Your Baby program provides customized support and care for pregnant women and new moms. Many women find it helpful to use a breast pump. SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. Check Your Eligibility In 3 easy steps! If you have any questions about any of the covered services, please call your care manager or Member Services. This can be a short-term or long- term rehabilitation stay. EdgePark www . You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. We cover the following services for members who have no transportation: Medical care or nursing care that you get while living full-time in a nursing facility. A health and wellness program for birth, baby and beyond. Services provided to children (ages 020) who use medical foster care services. Home Here are some resources that can help. Call us. They also help make sure your baby is growing and developing properly. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. If you are a new or expecting mother, be sure to take advantage of the breast pump coverage your insurance provider offers you. Children under age 21 can receive swimming lessons. There may be some services that we do not cover, but might still be covered by Medicaid. Services used to detect or diagnose mental illnesses and behavioral health disorders. * Limitations do not apply to SMI Specialty Plan. They also include portable x- rays. One communication evaluation per five calendar years. Services for people to have one-on-one therapy sessions with a mental health professional. Up to two office visits per month for adults to treat illnesses or conditions. Unlimited hypoallergenic bedding and one (1) HEPA filter vacuum cleaner for members diagnosed with asthma. Call Member Services to ask about getting expanded benefits. This service helps you with general household activities, like meal preparation and routine home chores. Talk to your doctor if you're having a lot of pain or feel like your baby isn't getting enough to eat. These services are voluntary and confidential, even if you are under 18 years old. All at the touch of a button! Medical care, tests and other treatments for the kidneys. Prior authorization is required for voluntary admissions. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. You don't necessarily need a professional to help your baby get the hang of breastfeeding. It may help with brain development and learning. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. Maximum 60 days per calendar year. Services to keep you from feeling pain during surgery or other medical procedures. Services used to help people who are struggling with drug addiction. This is available to members who are in a SNF or PDN setting and parent is obtaining guardianship to protect those who are unable to care for their own well-being. Sunshine Health is a managed care plan with a Florida Medicaid contract. You do not need prior approval for these services. You have to hire, train and supervise the people who work for you (your direct service workers). Other plans will only cover this benefit when a baby shows medical need. Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases. They also offer comfort through physical and emotional support. We cover 365/366 days of services per calendar year, as medically necessary. Services can include housekeeping; help with bathing, dressing and eating; medication assistance; and social programs. One initial evaluation per calendar year. Massage of soft body tissues to help injuries and reduce pain. Lets go over some of the basics of breastfeeding. Up to 24 hours per day, as medically necessary. Services must be medically necessary (PDF)in order for us to pay for them. Well Child Visits are provided based on age and developmental needs. As part of your Kansas Medicaid benefits and coverage, Sunflower Health Plan can help you find a provider, find local resources, plan an appointment and find transportation. Physical therapy includes exercises, stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition. Call us after you deliver to see if breast pumps are offered. Up to seven therapy treatment units per week. Transportation to and from all of your medical appointments. Treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. We cover the following as prescribed by your treating doctor, when medically necessary: A social club offering peer support and a flexible schedule of activities. One-on-one individual mental health therapy. Please copy the WIC State agency Or find a chapter of La Leche League, a group led by moms who offer support and encouragement to women looking to breastfeed. Medical care and other treatments for the feet. Just call 1-855-232-3596 (TTY: 711) to get your pump. Up to 45 days for all other members (extra days are covered for emergencies). Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for Prior authorization is required for voluntary admissions. Storkpump is AdaptHealth's insurance covered breast pump program. Specialized Therapeutic Foster Care Services. We cover the following as prescribed by your treating doctor, when medically necessary: A social club offering peer support and a flexible schedule of activities. manual breast pumps along with supplies are considered medically necessary and are a Patient Protection and Affordable Care Act Women's Preventive Health Services mandate, effective August 1, 2012. These services are free. Doulas are trained non-medical companions that support pregnant people. Digital blood pressure cuff and weight scale, One (1) digital blood pressure cuff every three (3) years; One (1) weight scale every three (3) years. Ordering a breast pump for your baby can be completely free, and Acelleron does all the work involved in making that happen. You can rent one from the hospital, or buy one from an in-network durable medical equipment (DME) vendor. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. For more information contact the Managed Care Plan. Two pairs of eyeglasses for children ages 0-20. Breast milk has all of the calories, protein, fat, carbohydrates, vitamins and minerals a baby needs. Transportation to and from all of your medical appointments. get your motherhood essentials in 3 simple steps Provide your insurance information We verify your coverage and submit all required paperwork on your behalf Intermittent and skilled nursing care services. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. There may be some services that we do not cover, but might still be covered by Medicaid. If you are there during mealtimes, you can eat there. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. The table below lists the medical services that are covered by Sunshine Health. Provided to members with behavioral health conditions and involves activities with horses. Infant Mental Health Pre- and Post- Testing Services*. Even though the American Academy of Pediatrics recommends that all mothers breastfeed for at least six months, that's not always possible. See information on Patient Responsibility for room & board. You do not need prior approval for these services. Get up to $250 per year to help with living costs like utilities and more, Transition Assistance Nursing facility to community setting. Most of the United Healthcare benefit plans include coverage for the purchase of a personal-use, double-electric breast pump at no cost. Hearing tests, treatments and supplies that help diagnose or treat problems with your hearing. Well Child Visits are provided based on age and developmental needs. After 4 to 6 Weeks: Learn where to get a breast pump, what type is covered, how to request a breast pump and more. All other types of breast pumps require a prior authorization from your provider. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Contact your care manager to determine eligibility. Pumping Bras Pumping Essentials Pump Accessories You've got coverage. Limited to members who live alone or who are alone for significant parts of the day who would otherwise require extensive supervision. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Supervision, social programs and activities provided at an adult day care center during the day. If the mother's eligibility has expired in Medicaid, the pump can be issued . Available for members aged 17 through 18.5. Up to three visits per day for all other members. Respiratory therapy includes treatments that help you breathe better. Federal health officials are warning parents of newborns . Services to keep you from feeling pain during surgery or other medical procedures. Types of pumps covered for rental, pending prior authorization: Hospital-grade heavy duty electric breast pump (CPT code E0604): A piston electric pump with pulsatile vacuum suction and release cycles. is a health and wellness program available at no additional cost to eligible members who are either expecting or adopting a child. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. Services for mental health or substance abuse needs. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. Limited to members who reside in adult family care homes. Keep in mind, however, that your exact plan will specify the type of pump they will cover (electric or manual), the length of a rental, and whether the pump . Testing services by a mental health professional with special training in infants and young children. Outpatient visits with a dietician for members. And remember, while there are plenty of benefits to breastfeeding, if you need to supplement or switch to formula, your baby will still grow and thrive. Babies who are breastfed also have lower lifetime risk for health conditions such as obesity and cardiovascular disease. Talk to friends or family members. Additional minutes for SafeLink phone or Connections Plus plan. This hands-free, wearable breast pump fits inside nursing bras so you can pump on the gowithout the hassle of external cords or tubes to get in your way. Medical supplies are items meant for one-time use and then thrown away. We cover the following as prescribed by your doctor, when medically necessary: Services to children ages 0-3 who have developmental delays and other conditions. Services to treat conditions, illnesses, or diseases of the stomach or digestion system. Covered as medically necessary. Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. For more information contact the Managed Care Plan. Nursing services provided in the home to members ages 0 to 20 who need constant care. We cover 365/366 days of medically necessary services per calendar year. Educational services for family members of children with severe emotional problems focused on child development and other family support. We cover the following inpatient hospital services based on age and situation, when medically necessary: Services to diagnose or treat skin conditions, illnesses or diseases. Member is responsible for paying ALF room and board. That's pretty amazing! Breast pumps will only be covered once per 3 years, and if the item is used for multiple pregnancies during the reasonable useful lifetime, only the kits will be covered. One initial evaluation per calendar year. But it's up to you and your doctor to decide what's right . It may be either a rental unit or a new one you'll keep. One initial evaluation per lifetime, completed by a team. One frame every two years and two lenses every 365 days for adults ages 21 and older. Limitations, co-payments and restrictions may apply. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. Unlimited units for verbal interaction, medication management and drug screening, Behavioral Health Psychosocial Rehabilitation, Services to help people re-enter everyday life (cooking, managing money and performing household chores), Computerized Cognitive Behavioral Analysis. Must be diagnosed with asthma to qualify. Extra nursing help if you do not need nursing supervision all the time or need it at a regular time. A plan may only cover breast pumps during the first 60 days postpartum. 5. Services for children with severe mental illnesses that need treatment in a secured facility. Nutritional Assessment/ Risk Reduction Services. We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap, as medically necessary: We cover for people of all ages, as medically necessary: Services that provide teeth extractions (removals) and to treat other conditions, illnesses or diseases of the mouth and oral cavity. Services that help you get the services and support you need to live safely and independently. The benefit information provided is a brief summary, not a complete description of benefits. It is what nature intended for mothers and babies. Because of the Affordable Care Act (ACA), health insurance providers are required to provide coverage for breastfeeding support, counseling, and equipment. Download the free version of Adobe Reader. Service provided in a hospital setting on an outpatient basis. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Expanded benefits are extra goods or services we provide to you, free of charge. Beds can be held for 14 days if the member has resided in facility for a minimum of 30 days between episodes. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Talk to a lactation consultant or breastfeeding counselor for practical help and tips to get started. Available for long distance medical appointment day-trips. Breast milk has certain proteins that help protect babies from common infections, food allergies, vomiting and diarrhea. Services for women who are pregnant or want to become pregnant. Services for children with severe mental illnesses that need treatment in a secured facility. Services provided to children (ages 020) who use medical foster care services. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. Limitations, co-payments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. They can answer questions about pregnancy, labor and caring for your baby after birth. Emergency substance abuse services that are performed in a facility that is not a regular hospital. It also lets you build a stash of milk that someone else can feed your baby, giving you the chance to grab a yoga class or get a much-needed haircut. Medical care that you get while you are in the hospital but are not staying overnight. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. As a Sunshine Health member, you get these doula benefits at no-cost: Doula visits can be at your home, doctors office or in a public place. See information on Patient Responsibility for room & board. Must be delivered by a behavioral health clinician with art therapy certification. Services for families to have therapy sessions with a mental health professional. Purchase it from a brick-and-mortar medical supply store. Services to diagnose or treat conditions, illnesses or diseases of the bones or joints. Up to 365/366 days for members ages 0-20. For information on obtaining doula services, read the Sunshine Health. per provider recommendation. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. This program focuses on your health during your pregnancy and your babys first year. Start your membership today its easy! Remember, services must be medically necessary in order for us to pay for them. Eligible for the first 1,000 members who have received their flu vaccine. Benefits and Services | Long-Term Care | Sunshine Health Benefits Overview Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. Emergency mental health services provided in the home, community or school by a team of health care professionals. Up to 365/366 days for members ages 0-20. The American Academy of Pediatrics recommends that babies be given exclusively breast milk for their first six months of life or even longer. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. Hearing services include: assessment, hearing evaluation, hearing aid fitting, hearing aid monaural in ear, behind ear hearing aid, hearing aid dispensing fee, in ear binaural hearing aid, behind ear binaural hearing aid, behind ear cors hearing aid and behind ear bicros hearing aid. Regional Perinatal Intensive Care Center Services. Want to breastfeed your baby? Call 1-866-796-0530 (TTY: 1-800-955-8770) for more information. Standard electric or manual breast pumps. We cover 365/366 days of medically necessary services per calendar year. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. If there are changes in covered services or other changes that will affect you, we will notify you in writing at least 30 days before the effective date of the change. Mobile Crisis Assessment and Intervention Services*. Services that include all surgery and pre- and post- surgical care. Please refer to Guidance for WIC Staff regarding HUSKY Health Coverage of Breast Pumps to determine who to contact. One breast pump is covered per pregnancy. Assisted living facility or adult family care home. Breastfeeding isn't just about the milk though. Up to three visits per day for all other members. Help taking medications if you cant take medication by yourself. It can include changes like installing grab bars in your bathroom or a special toilet seat. It's a good idea to try it if you can, because breast milk has all the nutrition a baby needs during the first six months. Priority Health has also partnered with Ovia for participants to have access to a free pregnancy tracker and Byram for covered breast pumps. One evaluation/re- evaluation per calendar year. Infant Mental Health Pre- and Post- Testing Services*. Treatments for long-lasting pain that does not get better after other services have been provided. These tables list the services covered by our Plan. Download the free version of Adobe Reader. Follow-up wheelchair evaluations, one at delivery and one six months later. These are 24-hour services if you live in an adult family care home. Treatment Breastfeeding guide Sunshine Health Health (9 days ago) WebFor more information on obtaining a breast pump, call Member Services at 1-866-796-0530, or TTY at 1-800-955-8770, Monday through Friday, 8 a.m. to 8 p.m. other than holidays. The Affordable Care Act requires most health insurance plans to cover the cost of a breast pump as part of women's preventive health services. It's been shown that these breast pumps mimic the process of breastfeeding more than other pumps, which can help you build a strong milk supply and reserve. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. Durable Medical Equipment/ Breast milk can be stored at room temperature for 10 hours, in the refrigerator for up to eight days, and in a freezer for three months. Family supplementation is allowed to pay the difference in cost between a shared and private room directly to the facility. These are medical-grade garments designed by healthcare professionals that provide lots of health benefits for moms. These are services that are usually provided in an assisted living facility (ALF). Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. Women's Health - Breast Cancer Screening 77067, 77063, G0202, R403 Screening mammography Once a year ages 35 and up Covered as medically necessary for children ages 0-20. Home delivered meals post inpatient discharge. You'll also need breast milk storage bags, bottles and nipples, in addition to cleaning supplies. Emergency substance abuse services that are performed in a facility that is not a regular hospital. We cover 365/366 days of services per calendar year, as medically necessary. Must be delivered by a behavioral health clinician with art therapy certification. 9 suction modes (4 simulation and 5 expression) help simulate babies' natural nursing rhythm. We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. The following are included in the rental payment for a hospital-grade breast pump: Set-up and education on the proper use and care of the pump; Here is a partial list of the services included in your . Services to assist people re-enter everyday life. Personal toiletries and household items such as detergent, bleach and paper towels are covered as medically necessary. One initial evaluation and re-evaluation per calendar year. One therapy re- evaluation per six months. Short-term substance abuse treatment in a residential program. Can be provided in a hospital, office or outpatient setting. APPLY TODAY. Substance abuse treatment of detoxification services provided in an outpatient setting. They also include portable x- rays. Breast Pumps Date of Origin: 09/2019 Last Review Date: 07/27/2022 Effective Date: 08/01/2022 . Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over. A double pumping breast pump kit is an apparatus for the expression of breast milk. X-rays and other imaging for the foot, ankle and lower leg. Additionally, with all of the health benefits, you can save money on trips to the doctor's as well. Services used to help people who are struggling with drug addiction. Less work missed - Breastfeeding mothers miss fewer days from work, because their infants are sick less often. Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, How to Create Positive New Habits in our New World, Services must be medically necessary (PDF). Follow the steps to receive your membership code. Services that treat conditions, illnesses or diseases of the lungs or respiratory system. Lightweight, portable pump with single and double pumping capability, quiet pump motor, and 100% anti-backflow design helps eliminate wasted milk. E0602 Breast pump, manual Women's Health - Contraceptive Management* (with Diagnosis) . Covered as medically necessary for children ages 0-20. Up to 24 office visits per calendar year. per provider recommendation. Apple Health covers one manual breast pump per lifetime. Federal health officials urged parents to sterilize equipment. Provided to members with behavioral health conditions and involves activities with trained animals. Nursing facility services include medical supervision, 24-hour nursing care, help with day-to-day activities, physical therapy, occupational therapy and speech- language pathology. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. To find out about these benefits, call the state Medicaid Help Line at 1-877-254-1055. This service delivers healthy meals to your home. They include help with basic activities such as cooking, managing money and performing household chores. Remember, you may need a referral from your Primary Care Provider (PCP) or approval from us before you go to an appointment or use a service. One per day with no limits per calendar year. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. Emergency mental health services provided in the home, community or school by a team of health care professionals. As medically necessary and recommended by us. Covered as medically necessary. You will need Adobe Reader to open PDFs on this site. Services that help children with health problems who live in foster care homes. We cover hearing tests and the following as prescribed by your doctor, when medically necessary: Nursing services and medical assistance provided in your home to help you manage or recover from a medical condition, illness or injury. One frame every two years and two lenses every 365 days for adults ages 21 and older. Excludes those adaptations or improvements to the home that are of general use and are not of direct medical or remedial benefit to the member. As medically necessary, some service and age limits apply. Prior authorization may be required for some equipment or services. FREE SHIPPING on orders over $75! Regional Perinatal Intensive Care Center Services. Asthma Supplies. Eligible for the first 1,000 members who have received their flu vaccine. We support new and expectant moms by providing them with high-quality breast pumps covered by their health insurance providers. An electronic device that you can wear or keep near you that lets you call for emergency help anytime. Medical care that you get while you are in the hospital. They can answer questions about pregnancy, labor and caring for your baby after birth. Call Customer Service at 1-877-644-4623 . You can also ask for a copy of the PDO Guidelines to read and help you decide if this option is the right choice for you. All services, including behavioral health. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. Breast pumps, depending on the type, are covered in full as a preventive service. Services include evaluation of the need for medication; clinical effectiveness and side effects of medication; medication education; and prescribing, dispensing, and administering of psychiatric medications.