NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. E0602 Breast pump, manual Women's Health - Contraceptive Management* (with Diagnosis) . Medical supplies are used to treat and manage conditions, illnesses or injury. Here is a partial list of the services included in your . Must be in the custody of the Department of Children and Families. A review of all the prescription and over- the-counter medications you are taking. Services that include all surgery and pre- and post- surgical care. Emergency substance abuse services that are performed in a facility that is not a regular hospital. Services that treat the heart and circulatory (blood vessels) system. Mobile Crisis Assessment and Intervention Services*. 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. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. Talk to a lactation consultant or breastfeeding counselor for practical help and tips to get started. Individualized care planning and care management service to support children with complex needs who are at risk of placement in a mental health treatment facility. Intermittent and skilled nursing care services. The hospital grade breast pump will be covered upon the mother's discharge from the hospital HUSKY Health will not reimburse for a pump while the mother is inpatient. We support new and expectant moms by providing them with high-quality breast pumps covered by their health insurance providers. Telehealth Services Transportation Services Member Resources Accessing Care Advance Directive Care Management Complaints, Grievances and Appeals Disease Management Emergency Situations EPSDT Program Fraud, Waste and Abuse Get the Most from Your Coverage Interoperability and Patient Access Key Contacts Member Handbook Verify insurance HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE Family Training and Counseling for Child Development*. Order Your Pump. Determined through multi- disciplinary assessment. Doulas are trained non-medical companions that support pregnant people. is a health and wellness program available at no additional cost to eligible members who are either expecting or adopting a child. The death of an infant in the US has been linked to a contaminated breast-feeding pump that was washed in a household sink. 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 . Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Up to two office visits per month for adults to treat illnesses or conditions. This contact information is for WIC Staff Use only. And sometimes that's all you need. Substance abuse treatment of detoxification services provided in an outpatient setting. Tap to START SAVING in 2023! If you need a ride to any of these services, we can help you. Up to three follow-up evaluations per calendar year. If the mother's eligibility has expired in Medicaid, the pump can be issued . One initial evaluation per lifetime, completed by a team. The benefit information provided is a brief summary, not a complete description of benefits. * Limitations do not apply to SMI Specialty Plan. Getting a Breast Pump Covered 100% Free with Your Insurance Home / Ambetter Breast Pump Ambetter Breast Pump When it comes to feeding a baby, every family needs to decide what is best for them. 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. Breast pump supplies . 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. Heavy duty, hospital-grade electric breast pumps are covered under procedure code E0604. The Affordable Care Act requires most health insurance plans to cover breastfeeding services and supplies. Limitations, co-payments and restrictions may apply. This means they are optional services you can choose over more traditional services based on your individual needs. 5. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Nursing services provided in the home to members ages 0 to 20 who need constant care. Postpartum doulas may have additional ideas to help you become more comfortable or more confident in the process. Emergency services are covered as medically necessary. Many women find it helpful to use a breast pump. Services for families to have therapy sessions with a mental health professional. We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. 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. It is what nature intended for mothers and babies. These tables listthe services covered by our Plan. Up to two training or support sessions per week. Medical equipment is used to help manage and treat a condition, illness, or injury. Services must be medically necessary (PDF)in order for us to pay for them. Participants may be directed to call Member Services at 1-800-859-9889. Services to help people understand and make the best choices for taking medication. As a Sunshine Health member, you get these doula benefits at no-cost: 3 visits while pregnant Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases. These breast pumps are portable and lightweight, allowing for a comfortable pumping experience both at home and on the go. SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. Nutritional Assessment/ Risk Reduction Services. Meals delivered to your home after discharge from hospital or nursing facility. Babies who are breastfed have reduced risk for numerous health conditions, including asthma, ear and respiratory infections, and allergies. Up to 24 hours per day, as medically necessary. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Services for women who are pregnant or want to become pregnant. These tables list the services covered by our Plan. As medically necessary and recommended by us. Lets go over some of the basics of breastfeeding. After you have all the information you need from your insurance provider, order your pump. Meals delivered to your home after discharge from hospital or nursing facility. These expenses cover a wide range of healthcare needs, including breastfeeding products like breast pumps, nursing accessories, and breast pump spare parts pre-tax. Limited to members who reside in adult family care homes. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. Up to 480 hours per calendar year, as medically necessary. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Services for a group of people to have therapy sessions with a mental health professional. Treatments for long-lasting pain that does not get better after other services have been provided. 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. As medically necessary, some service and age limits apply. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. After the first three days, prior authorization required. Services to keep you from feeling pain during surgery or other medical procedures. If you have additional questions about the Medicaid insurance guidelines for breast pumps, give us a call today at 844-867-9890. One frame every two years and two lenses every 365 days for adults ages 21 and older. Home Delivered Meals - Disaster Preparedness/ Relief. One evaluation of oral pharyngeal swallowing per calendar year. Two of the most popular breast pumps that may be covered by your Medicaid plan are the Smartpump 2.0 Starter Set and the Signature Pro Double Electric Breast Pump. You will need Adobe Reader to open PDFs on this site. You'll also need breast milk storage bags, bottles and nipples, in addition to cleaning supplies. Breast pump supplies, including the following: 2.1 Breast . A. If your insurance company does not cover a breast pump, MedSource will work with you to find an affordable option. You can call 1-877-659-8420 to schedule a ride. Available for long distance medical appointment day-trips. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Prior authorization may be required for some equipment or services. Provided to members with behavioral health conditions in an outpatient setting. It may help protect against sudden infant death syndrome (SIDS). 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. Breast Pump Death. Members can order covered breast pumps directly from Edgepark without prior authorization for consumer grade pumps. Even though the American Academy of Pediatrics recommends that all mothers breastfeed for at least six months, that's not always possible. Up to three visits per day for all other members. This service also includes dialysis supplies and other supplies that help treat the kidneys. One breast pump is covered per pregnancy. Follow-up wheelchair evaluations, one at delivery and one six months later. Services for mental health or substance abuse needs. Producing milk burns calories and helps you return faster to your pre-baby weight. Asthma Supplies. Services to help people understand and make the best choices for taking medication. 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. Insertion of thin needles through skin to treat pain, stress and other conditions. Talk to your care manager about getting expanded benefits. Or find a chapter of La Leche League, a group led by moms who offer support and encouragement to women looking to breastfeed. It can lower your risk for osteoporosis, a disease that weakens your bones. 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. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day). Elvie Pump. Services to treat conditions such as sneezing or rashes that are not caused by an illness. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. Medical care that you get while you are in the hospital. One therapy re- evaluation per six months. Standard assessment of mental health needs and progress. These regular checkups allow doctors to find and treat health problems early, if needed. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). They offer high-quality choices that can help you have a successful breastfeeding experience. This means that most insurers will cover one breast pump per pregnancy (up to one year postpartum) as a preventive benefit. Medical care that you get while you are in the hospital. Available for members aged 17 through 18.5. Up to 45 days for all other members (extra days are covered for emergencies). But it's up to you and your doctor to decide what's right . Services for people to have one-on-one therapy sessions with a mental health professional. Women's Health - Breast Cancer Screening 77067, 77063, G0202, R403 Screening mammography Once a year ages 35 and up Medical supplies are items meant for one-time use and then thrown away. Two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles. This benefit does not apply to members enrolled in limited benefits coverage plans. It may reduce your risk of ovarian and breast cancer. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. Prior authorization is required for voluntary admissions. One adult health screening (check-up) per calendar year. 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. Or, let's be honest, just get a few more minutes of sleep. 24 patient visits per calendar year, per member. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. Medical care and other treatments for the feet. This service is for drugs that are prescribed to you by a doctor or other health care provider. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. One per day with no limits per calendar year. As stated earlier, you may not see major results at first, however, the body will acclimate to the suction of the pump. We cover medically necessary family planning services. Substance Abuse Short-term Residential Treatment Services/ Residential Outpatient Services*. Some service limits may apply. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. According to Healthcare.gov, health insurance providers are required to cover the costs of a breast pump. Detoxification or Addictions Receiving Facility Services*. Up to 45 days for all other members (extra days are covered for emergencies). Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Other moms may have additional ideas or offer the support you need. Talk to friends or family members. After 4 to 6 Weeks: Up to 365/366 days for members ages 0-20. They also offer comfort through physical and emotional support. Most moms save between $95 and $159 major! If patients request more information, please direct them to Member Services at 1-800-682-9090 (TTY 711). One per day with no limits per calendar year. Standard electric or manual breast pumps. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. All services, including behavioral health. Home delivered meals post inpatient discharge. get your motherhood essentials in 3 simple steps Provide your insurance information We verify your coverage and submit all required paperwork on your behalf Get Your Free Breast Pump Through UMR With A Medical Supply. A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. All services limited to one every two calendar years, except for hearing aid monaural in ear, which is one per calendar year. 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. A. Moda Health will consider coverage for rental of hospital grade breast pump medically necessary when ALL of the following criteria are met; a. We cover the following medically necessary services for children ages 0-20: We cover the following medically necessary services for adults: Statewide Inpatient Psychiatric Program Services. Massage of soft body tissues to help injuries and reduce pain. A doula is a professional assistant, but not a medical professional. It may be either a rental unit or a new one you'll keep. After the first three days, prior authorization required. Coverage is provided when they are essential to the health and welfare of the member. Standard assessment of mental health needs and progress. A health and wellness program for birth, baby and beyond. 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. 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. Up to a 34-day supply of drugs, per prescription. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. Covered as medically necessary. To help you successfully breastfeed, EmblemHealth has made breast pumps available to you through participating vendors. As medically necessary and recommended by us. (Note: these items cannot be returned.) Additional minutes for SafeLink phone or Connections Plus plan. Maximum 60 days per calendar year. Breast Pumps Date of Origin: 09/2019 Last Review Date: 07/27/2022 Effective Date: 08/01/2022 . One initial assessment per calendar year. One-on-one individual mental health therapy. One standard electric or manual breast pump per pregnancy; 2. One initial evaluation and re-evaluation per calendar year. Services used to detect or diagnose mental illnesses and behavioral health disorders. This can be a short-term or long- term rehabilitation stay. So, you may be weighing the pros and cons of direct breastfeeding vs. pumping and formula feeding. You can either: Order it online from a medical supply company. Note: Pacify is only available to download in the App Store or Google Play Store. To find out about these benefits, call the Agency Medicaid Help Line at 1-877-254-1055. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. Elvie's silent motor helps you pump from anywhere (like work, the store and more) with confidence. We cover 365/366 days of medically necessary services per calendar year. Call Customer Service at 1-877-644-4623 . per provider recommendation. Must be delivered by a behavioral health clinician with art therapy certification. Unlimited units for group therapy and unlimited units for brief group medical therapy. Up to 365/366 days for members ages 0-20. But if you hear insurance and think red tape, you are not alone. Pumping Bras Pumping Essentials Pump Accessories You've got coverage. Hand-operated pumps are available through your over-the-counter benefit call 1-866-577-9010 for more information. Please contact customer service at 888-510-5100 or Click Here to verify insurance. Call 1-866-796-0530 (TTY: 1-800-955-8770) for more information. Medical equipment is used to manage and treat a condition, illness, or injury. Durable Medical Equipment and Medical Supplies Services. The American Academy of Pediatrics recommends that babies be given exclusively breast milk for their first six months of life or even longer. One new hearing aid per ear, once every three years. Transportation to and from all of your medical appointments. Services for children with severe mental illnesses that need treatment in a secured facility. Learn about health insurance coverage for breast pumps. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. If you need help finding an OB-GYN, we can help. Please let us know when you are pregnant by logging in to our secure member portal and filling out a Notice of Pregnancy form. We cover 365/366 days of services per calendar year, as medically necessary. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). Durable Medical Equipment/ 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. 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. Except for emergency care, Sunshine Health must prior authorize any services provided by an out-of-network provider and any elective inpatient admissions. sunshine health breast pump coverage sunshine health breast pump coverage on Jun 11, 2022 on Jun 11, 2022 A plan may cover a hospital-grade breast pump for any mom. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Other plans will only cover this benefit when a baby shows medical need. One evaluation/re- evaluation per calendar year. Services to help people who are in recovery from an addiction or mental illness. Short term residential treatment program for pregnant women with substance use disorder. It can include changes like installing grab bars in your bathroom or a special toilet seat. Assisted living facility or adult family care home. Substance Abuse Short-term Residential Treatment Services/ Residential Outpatient Services*. Up to 26 hours per calendar year for adults ages 21 and over. Up to seven therapy treatment units per week. 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. You can rent one from the hospital, or buy one from an in-network durable medical equipment (DME) vendor. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. You can hire family members, neighbors or friends. Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. There may be some services that we do not cover, but might still be covered by Medicaid. Just call 1-855-232-3596 (TTY: 711) to get your pump. Most UMR insurance plans provide coverage for maternity support bands (also known as belly bands) and postpartum recovery garments through insurance but are subject to deductible and coinsurance. Two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles. This service delivers healthy meals to your home. These services are voluntary and confidential, even if you are under 18 years old. It does not include major changes like new carpeting, roof repairs, plumbing systems, etc. Adapt to your breast shape for personalized comfort and 11.8% more milk faster compared to a traditional breast shield Safe & simple parts All parts that touch breast milk are made without BPA, and most parts are dishwasher safe for easy cleaning Get the #1 breast pump brand in America through insurance Email Baby's Birth / Due Date 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. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. It helps protect babies from chronic problems like diabetes, asthma and obesity. Emergency mental health services that are performed in a facility that is not a regular hospital. Emergency mental health services provided in the home, community or school by a team of health care professionals. Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items. Testing services by a mental health professional with special training in infants and young children. Call us. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. Treatments for long-lasting pain that does not get better after other services have been provided. This service also includes dialysis supplies and other supplies that help treat the kidneys. Must be in the custody of the Department of Children and Families. Services to treat conditions such as sneezing or rashes that are not caused by an illness. Services for children with severe mental illnesses that need treatment in a secured facility. Electric Breast Pump (E0603)/ Standard/Manual Breast Pump (E0602)Hospital Grade Pumps (E0604) Hospital Grade Pumps (E0604) Effective for dates of service on or after April 12, 2019: One electric or manual breast pump is covered per birth event (birth or adoption) beginning at the 27th week of pregnancy (third trimester) or birth of a child should the birth occur earlier than 27 weeks.

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