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This can be a short-term or long- term rehabilitation stay. Substance Abuse Short-term Residential Treatment Services/ Residential Outpatient Services*. You have to hire, train and supervise the people who work for you (your direct service workers). See information on Patient Responsibility for room & board. Training and counseling for the people who help take care of you. You do not need prior approval for these services. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Financial assistance to members residing in a nursing home who can transfer to independent living situations. Treatments for long-lasting pain that does not get better after other services have been provided. One-on-one individual mental health therapy. Services to keep you from feeling pain during surgery or other medical procedures. Transfers between hospitals or facilities. These tables listthe services covered by our Plan. Women's Health - Breast Cancer Screening 77067, 77063, G0202, R403 Screening mammography Once a year ages 35 and up electric or 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. Mobile Crisis Assessment and Intervention Services*. You will need Adobe Reader to open PDFs on this site. As medically necessary and recommended by us. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. byHarvard Health Publishing. Transportation for non-medical trips, such as shopping or social events. A plan may cover a hospital-grade breast pump for any mom. 1-800-342-3556 Fax 850-922-3936 Mailing Address Bureau of WIC Program Services 4052 Bald Cypress Way, Bin A16 Tallahassee FL 32399 Breastfeeding is a normal part of mothers and babies being together. To learn about breast pump coverage under your Independence plan, contact Customer Service at 1-800-ASK-BLUE (1-800-275-2583) (TTY:711). Call Member Services to ask about getting expanded benefits. 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. Available for members aged 17 through 18.5. Services for a group of people to have therapy sessions with a mental health professional. 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. 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. Standard assessment of mental health needs and progress. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Doulas are trained non-medical companions that support pregnant people. In addition, Sunshine Health may from time to time delegate utilization management of specific services; in such circumstances, the delegated vendor's guidelines may also be used to support medical necessity and other coverage determinations. Insertion of thin needles through skin to treat pain, stress and other conditions. They can answer questions about pregnancy, labor and caring for your baby after birth. According to Healthcare.gov, health insurance providers are required to cover the costs of a breast pump. You'll also need breast milk storage bags, bottles and nipples, in addition to cleaning supplies. Low-cost interventions including early initiation when not feeding at the breast, listening to relaxation music, massage and warming of the breasts, hand expression and lower cost pumps may be as effective, or more effective, than large electric pumps for some outcomes. One communication evaluation per five calendar years. Follow-up wheelchair evaluations, one at delivery and one six months later. Up to a 34-day supply of drugs, per prescription. 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. Order now. Asthma Supplies. Supervision, social programs and activities provided at an adult day care center during the day. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. Breast milk has certain proteins that help protect babies from common infections, food allergies, vomiting and diarrhea. of Children and Families (DCF) will evaluate the members income to determine if additional payment is required by member. Meals delivered to your home after discharge from hospital or nursing facility. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. Two pairs of eyeglasses for children ages 0-20. Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for Medical care that you get while you are in the hospital. The system must be able to be used by attachment to an electric breast pump or manually. The, Talk to a postpartum doula. Up to 45 days for all other members (extra days are covered for emergencies). Non-emergency transportation non-medical purposes. Call us after you deliver to see if breast pumps are offered. Sunshine Health is a managed care plan with a Florida Medicaid contract. It can include changes like installing grab bars in your bathroom or a special toilet seat. 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. 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. 5. Children under age 21 can receive swimming lessons. Durable Medical Equipment/ Heavy duty, hospital-grade electric breast pumps are covered under procedure code E0604. Your child must be receiving medical foster care services. Just call 1-855-232-3596 (TTY: 711) to get your pump. Except for emergency care, Sunshine Health must prior authorize any services provided by an out-of-network provider and any elective inpatient admissions. Up to 24 hours per day, as medically necessary. Extra nursing help if you do not need nursing supervision all the time or need it at a regular time. Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over. UMR Breast Pump Supplies Coverage. 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. We cover 365/366 days of services per calendar year, as medically necessary. Your child must be enrolled in the DOH Early Steps program. Excessive bleeding, like bleeding through one pad/hour or passing blood clots the size of a golf ball or bigger An incision that is not healing A red or swollen leg that is painful or warm when you touch it A fever 100.4F or higher A headache that does not get better after taking medicine or causes vision changes As stated earlier, you may not see major results at first, however, the body will acclimate to the suction of the pump. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. Federal health officials are warning parents of newborns, Thursday, March 2, 2023, to sterilize equipment used for both bottle- and breast-feeding after a baby died last year from a rare. You'll also need breast milk storage bags, bottles and nipples, in addition to Respiratory therapy in an office setting. Apple Health covers one manual breast pump per lifetime. Support services are also available for family members or caregivers. Services for families to have therapy sessions with a mental health professional. Provided to members with behavioral health conditions in an outpatient setting. This includes having a case manager and making a plan of care that lists all the services you need and receive. Expanded benefits are extra services we provide to you at no cost. FREE SHIPPING on orders over $75! One initial evaluation per calendar year. A. Medical supplies are items meant for one-time use and then thrown away. Hospital-grade breast pumps are used by mothers of NICU babies or when medical issues may hinder mom & baby's ability to successfully breastfeed. One frame every two years and two lenses every 365 days for adults ages 21 and older. Large LCD screen designed to increase control by displaying suction level, mode, timing, an more. Contact your care manager to determine eligibility. Order Your Insurance-Covered Breast Pump Today! Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items. Services used to help people who are struggling with drug addiction. Covered as medically necessary. A doula is a professional assistant, but not a medical professional. Start your membership today its easy! Services can include housekeeping; help with bathing, dressing and eating; medication assistance; and social programs. Breast milk is easier for babies to digest than formula. Massage of soft body tissues to help injuries and reduce pain. Asthma Supplies. Short-term substance abuse treatment in a residential program. These regular checkups allow doctors to find and treat health problems early, if needed. Published on: August 6, 2019, 08:49 AM ET. We're here to help! All services, including behavioral health. Priority Health has also partnered with Ovia for participants to have access to a free pregnancy tracker and Byram for covered breast pumps. Designed to be discreet, the Elvie Pump is a breastfeeding mom's best friend. 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. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Prenatal care is an important way to keep you and your baby healthy during your pregnancy. Diagnosis and manipulative treatment of misalignments of the joints, especially the spinal column, which may cause other disorders by affecting the nerves, muscles and organs. 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. 2. For children up to 21 there are no limits if medically necessary. sunshine health breast pump coverage sunshine health breast pump coverage on Jun 11, 2022 on Jun 11, 2022 These are services that are usually provided in an assisted living facility (ALF). We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Call Customer Service at 1-877-644-4623 . It can lower your risk for osteoporosis, a disease that weakens your bones. Coverage for cold, cough, allergy, vitamins, supplements, ophthalmic/otic preparations, pain relievers, gastrointestinal products, first aid care, hygiene products, insect repellant, oral hygiene products and skin care. 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. Services for a group of people to have therapy sessions with a mental health professional. It is what nature intended for mothers and babies. Our team of experts is ready to walk you through the process step by step until your insurance breast pump arrives at your door. Covered as medically necessary. Short term residential treatment program for pregnant women with substance use disorder. Limited to members who reside in adult family care homes. Emergency mental health services provided in the home, community or school by a team of health care professionals. 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. Speech therapy includes tests and treatments that help you talk or swallow. We cover 365/366 days of services per calendar year, as medically necessary. Up to 26 hours per calendar year for adults ages 21 and over. Up to two office visits per month for adults to treat illnesses or conditions. Up to 45 days for all other members (extra days are covered for emergencies). If you are a new or expecting mother, be sure to take advantage of the breast pump coverage your insurance provider offers you. Tap to START SAVING in 2023! Expanded benefits are extra goods or services we provide to you, free of charge. If you need help finding an OB-GYN, we can help. Download the free version of Adobe Reader. 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. You will need Adobe Reader to open PDFs on this site. Eligible for the first 1,000 members who have received their flu vaccine. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. Provided to members with behavioral health conditions and involves activities with horses. Please copy the WIC State agency The benefit information provided is a brief summary, not a complete description of benefits. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. Services to treat conditions, illnesses, or diseases of the stomach or digestion system. Services that include all surgery and pre- and post- surgical care. These are medical-grade garments designed by healthcare professionals that provide lots of health benefits for moms. A health and wellness program for birth, baby and beyond. Once the newborn is discharged, the breast pump will no longer be covered; or A breast pump will be covered for babies who have congenital anomalies that interfere with feeding. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. Doctor visits after delivery of your baby. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. One evaluation of oral pharyngeal swallowing per calendar year. One per day and no limit per calendar year. Home Delivered Meals - Disaster Preparedness/ Relief. Up to 24 hours per day, as medically necessary. Must be in the custody of the Department of Children and Families. Home Delivered Meals - Disaster Preparedness/ Relief. Breast milk has all of the calories, protein, fat, carbohydrates, vitamins and minerals a baby needs. You can either: Order it online from a medical supply company. See information on Patient Responsibility for room & board. Substance Abuse Intensive Outpatient Program*. Emergency services are covered as medically necessary. A plan may only cover in-network-network benefits. For 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. You will need Adobe Reader to open PDFs on this site. Member is responsible for paying ALF room and board. Mental health therapy in a group setting. Looking for . Provided to members with behavioral health conditions and involves activities with trained animals. Well Child Visits are provided based on age and developmental needs. Coverage: Medicaid requires that breast pumps meet minimum specifications to be reimbursable through the NYS Medicaid program. Medical equipment is used to manage and treat a condition, illness, or injury. There may be some services that we do not cover, but might still be covered by Medicaid. Rent A Hospital-Grade Breast Pump Month-by-Month! Covered as medically necessary for children ages 0-20. Learn where to get a breast pump, what type is covered, how to request a breast pump and more. We have IBCLC's and CLC's on staff to provide expert support. These expenses cover a wide range of healthcare needs, including breastfeeding products like breast pumps, nursing accessories, and breast pump spare parts pre-tax. As a reminder, we also provide the following: A 24-hour nurse advice line Breastfeeding support and resources Help obtaining a breast pump overwhelmed, "down" or thinking about harming yourself or others) Methods to help you quit smoking, alcohol or drugs Ask your doctor or call us for more information. Maximum 60 days per calendar year. Regional Perinatal Intensive Care Center Services. A plan may only cover breast pumps during the first 60 days postpartum. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. Can be provided in a hospital, office or outpatient setting. Speech and language therapy services in the office setting. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. 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. Download the free version of Adobe Reader. Provided to members with behavioral health conditions and involves activities with trained animals. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. This service makes changes to your home to help you live and move in your home safely and more easily. Up to 24 office visits per calendar year. Most moms save between $95 and $159 major! All services must be medically necessary. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. Respiratory therapy includes treatments that help you breathe better. Outpatient visits with a dietician for members. And sometimes that's all you need. Your health insurance plan must cover the cost of a breast pump. 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 initial evaluation and re-evaluation per calendar year. Services to help people who are in recovery from an addiction or mental illness. You can use this service in your home, an Assisted Living Facility or a Nursing Facility. Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). Services provided to children ages 0- 20 with mental illnesses or substance use disorders. It can be a great resource for minimizing any out-of-pocket expenses you may run into on your breast milk feeding journey by instead using money that has already been set aside. 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. The table below lists the medical services that are covered by Sunshine Health. Hand-operated pumps are available through your over-the-counter benefit call 1-866-577-9010 for more information. Prior authorization is required for voluntary admissions. It does not include major changes like new carpeting, roof repairs, plumbing systems, etc. One communication evaluation per five calendar years. Up to four visits per day for pregnant members and members ages 0-20. This can be a short-term or long- term rehabilitation stay. Emergency services are covered as medically necessary. Support services are also available for family members or caregivers. Services that help you get the services and support you need to live safely and independently. Follow the steps to receive your membership code. Comprehensive Behavioral Health Assessments. EdgePark www . It helps protect babies from chronic problems like diabetes, asthma and obesity. They also offer comfort through physical and emotional support. Services to treat conditions, illnesses, or diseases of the genitals or urinary system. Short-term substance abuse treatment in a residential program. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. 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. Because of the Affordable Care Act (ACA), health insurance providers are required to provide coverage for breastfeeding support, counseling, and equipment.