Eligible participants will receive items like prenatal vitamins, a convertible toddler car seat, a breast pump (including related replacement parts), breast milk storage bags, a home safety kit, a . AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. 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. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Services for children with severe mental illnesses that need treatment in a secured facility. Services for families to have therapy sessions with a mental health professional. One initial evaluation and re-evaluation per calendar year. Services for a group of people to have therapy sessions with a mental health professional. 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. 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. The following are covered services: 1. Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). Breast pumps are covered under your Sunshine Health Medicaid plan. Treatments for long-lasting pain that does not get better after other services have been provided. Services to diagnose or treat conditions, illnesses or diseases of the bones or joints. One initial evaluation per calendar year. Order Your Pump. Some service limits may apply. We cover 365/366 days of services in nursing facilities as medically necessary. 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. Sunshine Health is a managed care plan with a Florida Medicaid contract. Respiratory therapy in an office setting. Substance abuse treatment of detoxification services provided in an outpatient setting. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. United Health Care Breast Pump Through Insurance - 100% Free. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. 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 Limitations, co-payments and restrictions may apply. Remember, services must be medically necessary in order for us to pay for them. This means they are optional services you can choose over more traditional services based on your individual needs. 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. Transportation to and from all of your medical appointments. Services provided to children (ages 020) who use medical foster care services. Provided to members with behavioral health conditions and involves activities with trained animals. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day). Services to treat conditions such as sneezing or rashes that are not caused by an illness. Breast pump supplies, including the following: 2.1 Breast . 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. They also include portable x- rays. Some plans offer additional breastfeeding support services such as breastfeeding consultations. Up to seven therapy treatment units per week. If you have any questions about any of the covered services, please call your care manager or Member Services. If you are interested in PDO, ask your case manager for more details. This benefit does not apply to members enrolled in limited benefits coverage plans. * Limitations do not apply to SMI Specialty Plan. Services to diagnose or treat conditions, illnesses or diseases of the bones or joints. If you need a ride to any of these services, we can help you. Therapy services, behavior management, and therapeutic support are coordinated through individualized treatment teams to help members with complex needs from requiring placement in a more intensive, restrictive behavioral health setting. Contact your care manager to determine eligibility. 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. One initial evaluation per calendar year. Note: Pacify is only available to download in the App Store or Google Play Store. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Support services are also available for family members or caregivers. Maternal health benefits - Breastfeeding is linked to a lower risk of these health problems in women: type 2 diabetes; breast cancer; ovarian cancer; and. Must be in the custody of the Department of Children and Families. Our Start Smart for Your Baby program provides customized support and care for pregnant women and new moms. Home Delivered Meals - Disaster Preparedness/ Relief. Call 1-866-796-0530 (TTY: 1-800-955-8770) for more information. It may be either a rental unit or a new one you'll keep. Individual therapy sessions for caregivers. 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. One per day and no limit per calendar year. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. 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. Additional minutes for SafeLink phone or Connections Plus plan. Find breastfeeding resources, education, and products from the breast pump brand most recommended by doctors, chosen first by moms, and used in most hospitals. 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. This service delivers healthy meals to your home. Services that treat conditions, illnesses or diseases of the lungs or respiratory system. A double pumping breast pump kit is an apparatus for the expression of breast milk. Family Training and Counseling for Child Development*. Some service limits may apply. It may help with brain development and learning. Well Child Visits are provided based on age and developmental needs. This can be a short-term or long- term rehabilitation stay. If you need a ride to any of these services, we can help you. 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. Emergency substance abuse services that are performed in a facility that is not a regular hospital. Well Child Visits are provided based on age and developmental needs. Complete our quick online form, and we will do the rest of the work from verifying your coverage and determining your breast pump selection to handling all paperwork and shipping your insurance-covered breast pump to your home! A breast pump is covered for the period of time that a newborn is detained in the hospital after the mother is discharged. 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. Order Your Insurance-Covered Breast Pump Today! Maximum 60 days per calendar year. Must be diagnosed with asthma to qualify. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. You can call 1-877-659-8420 to schedule a ride. 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. * Limitations do not apply to SMI Specialty Plan. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. As stated earlier, you may not see major results at first, however, the body will acclimate to the suction of the pump. Producing milk burns calories and helps you return faster to your pre-baby weight. These are medical-grade garments designed by healthcare professionals that provide lots of health benefits for moms. 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. For information on obtaining doula services, read the Sunshine Health. You'll want to buy or rent a breast pump if a partner or loved one is going to help at feeding time. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Limitations, co-payments and restrictions may apply. A health and wellness program for birth, baby and beyond. Family Training and Counseling for Child Development*. A plan may only cover breast pumps during the first 60 days postpartum. Medical care that you get while you are in the hospital. All services limited to one every two calendar years, except for hearing aid monaural in ear, which is one per calendar year. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. Hand-operated pumps are available through your over-the-counter benefit call 1-866-577-9010 for more information. Services used to detect or diagnose mental illnesses and behavioral health disorders. See information on Patient Responsibility for room & board. It may reduce your risk of ovarian and breast cancer. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. Sessions as needed Elvie's silent motor helps you pump from anywhere (like work, the store and more) with confidence. Prior authorization is required for voluntary admissions. You may be offered the Participant Direction Option (PDO). And sometimes that's all you need. All services, including behavioral health. Services for doctors visits to stay healthy and prevent or treat illness. Other moms may have additional ideas or offer the support you need. Supervision, social programs and activities provided at an adult day care center during the day. As medically necessary and recommended by us. Eligible for the first 1,000 members who have received their flu vaccine. Substance Abuse Intensive Outpatient Program*. Breastfeeding isn't just about the milk though. 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. For children up to 21 there are no limits if medically necessary. Expanded benefits are extra goods or services we provide to you, free of charge. You'll also need breast milk storage bags, bottles and nipples, in addition to cleaning supplies. This program focuses on your health during your pregnancy and your babys first year. If you are there during mealtimes, you can eat there. Two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles. Get up to $250 per year to help with living costs like utilities and more, Transition Assistance Nursing facility to community setting. Published on: August 6, 2019, 08:49 AM ET. Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for 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. Talk to a lactation consultant or breastfeeding counselor for practical help and tips to get started. Breastfeeding may benefit society - The OWH . Available for members aged 17 through 18.5. Service provided in a hospital setting on an outpatient basis. The benefit information provided is a brief summary, not a complete description of benefits. Services to help people who are in recovery from an addiction or mental illness. The Minimum Breast Pump Specifications for Medicaid . Services for a group of people to have therapy sessions with a mental health professional. Provided to members with behavioral health conditions in an outpatient setting. Yes, for dental procedures not done in an office. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. These services are voluntary and confidential, even if you are under 18 years old. per provider recommendation. Two pairs of eyeglasses for children ages 0-20. FILE - A mother holds a bottle of baby formula as she feeds her infant son, Friday, May 13, 2022, in San Antonio. 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. Medical equipment is used to help 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. One adult health screening (check-up) per calendar year. Breast pump, hospital grade rental; Sunshine Health is a managed care plan with a Florida Medicaid contract. We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. For more information contact the Managed Care Plan. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. 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 Breast Pumps Date of Origin: 09/2019 Last Review Date: 07/27/2022 Effective Date: 08/01/2022 . get your motherhood essentials in 3 simple steps Provide your insurance information We verify your coverage and submit all required paperwork on your behalf Medical care and other treatments for the feet. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. This contact information is for WIC Staff Use only. I was given an RX by my doctor for an electric pump, but I am curious as to which brands are available. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). Covered as medically necessary. 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. All at the touch of a button! The, Talk to a postpartum doula. 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. 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. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Transportation to and from all of your LTC program services. This service also includes dialysis supplies and other supplies that help treat the kidneys. But it's up to you and your doctor to decide what's right . 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. This could be on the bus, a van that can transport disabled people, a taxi, or other kinds of vehicles. As a Sunshine Health member, you get these doula benefits at no-cost: 3 visits while pregnant Testing services by a mental health professional with special training in infants and young children. 2. Breast pump supplies . Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when you'll receive it (before or after birth). This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Call us. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. 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. Must be in the custody of the Department of Children and Families. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). That means you could receive a high-quality, name brand pump at no cost to you. 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. That's pretty amazing! These are in-home services to help you with: Personal Emergency Response Systems (PERS). After the first three days, prior authorization required. Transfers between hospitals or facilities. Eligible for the first 1,000 members who have received their flu vaccine. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day). Up to two training or support sessions per week. Short-term substance abuse treatment in a residential program. Services to help people understand and make the best choices for taking medication. Up to three screenings per calendar year. Learn about health insurance coverage for breast pumps. Durable Medical Equipment/ If your insurance company does not cover a breast pump, MedSource will work with you to find an affordable option. We cover medically necessary family planning services. They include help with basic activities such as cooking, managing money and performing household chores. Short term residential treatment program for pregnant women with substance use disorder. Financial assistance to members residing in a nursing home who can transfer to independent living situations. Its important to see a doctor if you are planning on becoming pregnant, or as soon as you know you are pregnant. Meals delivered to your home after discharge from hospital or nursing facility. 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). Buy it yourself and submit the receipt for reimbursement to your insurance company. One evaluation/re- evaluation per calendar year. A quick look at Healthline's picks for the best breast pumps Best all-around breast pump: Spectra S1 Plus Electric Breast Pump Best natural suction breast pump: Haakaa Silicone. Services to assist people re-enter everyday life. Transportation to and from all of your medical appointments. Services for families to have therapy sessions with a mental health professional. If you need a ride to any of these services, we can help you. One therapy re- evaluation per six months. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. Services to assist people re-enter everyday life. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Outpatient visits with a dietician for members. 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. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. Breastfeeding offers a huge array of benefits for both . Services that help you get the services and support you need to live safely and independently. Download the free version of Adobe Reader. Up to $5,000 per lifetime to assist member in moving out of a nursing facility. Services used to detect or diagnose mental illnesses and behavioral health disorders. 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. (Note: these items cannot be returned.) From breast pumps to maternity support and postpartum recovery, discover the motherhood essentials covered by your insurance.