Up to two office visits per month for adults to treat illnesses or conditions. Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. To help you successfully breastfeed, EmblemHealth has made breast pumps available to you through participating vendors. (Note: these items cannot be returned.) Your child must be enrolled in the DOH Early Steps program. Federal health officials urged parents to sterilize equipment. 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. Testing services by a mental health professional with special training in infants and young children. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. Up to three visits per day for all other members. Additionally, with all of the health benefits, you can save money on trips to the doctor's as well. Unlimited hypoallergenic bedding and one (1) HEPA filter vacuum cleaner for members diagnosed with asthma. 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. get your motherhood essentials in 3 simple steps Provide your insurance information We verify your coverage and submit all required paperwork on your behalf Talk to a lactation consultant or breastfeeding counselor for practical help and tips to get started. Testing services by a mental health professional with special training in infants and young children. 9 suction modes (4 simulation and 5 expression) help simulate babies' natural nursing rhythm. Two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles. 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. Up to three screenings 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. Call us. Coverage: Medicaid requires that breast pumps meet minimum specifications to be reimbursable through the NYS Medicaid program. Durable Medical Equipment/ 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. A plan may cover 100% of the cost of a breast pump or may cover only a fraction of the cost. Covered as medically necessary for children ages 0-20. 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. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Less work missed - Breastfeeding mothers miss fewer days from work, because their infants are sick less often. Services for families to have therapy sessions with a mental health professional. Up to 480 hours per calendar year, as medically necessary. Limited to members who live alone or who are alone for significant parts of the day who would otherwise require extensive supervision. Transfers between hospitals or facilities. Short-term substance abuse treatment in a residential program. Breast pumps are covered under your Sunshine Health Medicaid plan. 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. This service is for drugs that are prescribed to you by a doctor or other health care provider. This service helps you with general household activities, like meal preparation and routine home chores. Medical care, treatment and emotional support services for people with terminal illnesses or who are at the end of their lives to help keep them comfortable and pain free. Maximum 60 days per calendar year. 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. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. UMR Breast Pump Supplies Coverage. Rent A Hospital-Grade Breast Pump Month-by-Month! 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. Your child must be enrolled in the DOH Early Steps program. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Service provided in a hospital setting on an outpatient basis. 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. You'll want to buy or rent a breast pump if a partner or loved one is going to help at feeding time. Yes, for dental procedures not done in an office. NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. Medical care, tests and other treatments for the kidneys. Medical care that you get while you are in the hospital. Nursing services provided in the home to members ages 0 to 20 who need constant care. 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. From breast pumps to maternity support and postpartum recovery, discover the motherhood essentials covered by your insurance. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. Massage of soft body tissues to help injuries and reduce pain. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. You do not need prior approval for these 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. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). 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 One-on-one individual mental health therapy. Eligible for the first 1,000 members who have received their flu vaccine. Determined through multi- disciplinary assessment. You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. All other types of breast pumps require a prior authorization from your provider. If you decide to place an order, call us to confirm if a breast pump is covered by your plan. Home Delivered Meals - Disaster Preparedness/ Relief. We support new and expectant moms by providing them with high-quality breast pumps covered by their health insurance providers. Large LCD screen designed to increase control by displaying suction level, mode, timing, an more. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). Services that include all surgery and pre- and post- surgical care. Up to three visits per day for all other members. One initial evaluation per lifetime, completed by a team. Talk to your doctor if you're having a lot of pain or feel like your baby isn't getting enough to eat. Talk to your care manager about getting expanded benefits. Services that treat the heart and circulatory (blood vessels) system. Babies who are breastfed also have lower lifetime risk for health conditions such as obesity and cardiovascular disease. Members can order covered breast pumps directly from Edgepark without prior authorization for consumer grade pumps. Provided to members with behavioral health conditions and involves activities with trained animals. Services used to help people who are struggling with drug addiction. Individual therapy sessions for caregivers. 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. Breast milk is easier for babies to digest than formula. X-rays and other imaging for the foot, ankle and lower leg. Services that include imaging such as x-rays, MRIs or CAT scans. Provided to members with behavioral health conditions in an outpatient setting. Treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. We have IBCLC's and CLC's on staff to provide expert support. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Postpartum doulas may have additional ideas to help you become more comfortable or more confident in the process. Up to seven therapy treatment units per week. A plan may only cover in-network-network benefits. Services for women who are pregnant or want to become pregnant. 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. Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. Asthma Supplies. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. Regional Perinatal Intensive Care Center Services. 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. One adult health screening (check-up) per calendar year. Emergency services are covered as medically necessary. 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. We will work with your insurance company to determine benefits for your insurance covered breast pump and file an insurance claim on your behalf. 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. 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. Durable Medical Equipment/ These are services that are usually provided in an assisted living facility (ALF). Services for doctors visits to stay healthy and prevent or treat illness. The First Four Weeks: Aim for 8 to 10 pumping sessions every 24 hours following birth, expressing (expelling milk) for at least 15 minutes each session. All services must be medically necessary. Educational services for family members of children with severe emotional problems focused on child development and other family support. If you have questions about any of the covered medical services, please call Member Services. Breast pump supplies, including the following: 2.1 Breast . Apple Health covers one manual breast pump per lifetime. Yes, for dental procedures not done in an office. If you have any questions about any of the covered services, please call your care manager or Member Services. Meals delivered to your home after discharge from hospital or nursing facility. Your child must be receiving medical foster care services. You will need Adobe Reader to open PDFs on this site. Services to help people who are in recovery from an addiction or mental illness. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). Use our Find a Provider tool or call Member Services at 1-866-796-0530. Hearing tests, treatments and supplies that help diagnose or treat problems with your hearing. Help taking medications if you cant take medication by yourself. Services for a group of people to have therapy sessions with a mental health professional. They offer high-quality choices that can help you have a successful breastfeeding experience. Sunshine Health is a managed care plan with a Florida Medicaid contract. Producing milk burns calories and helps you return faster to your pre-baby weight. Short term residential treatment program for pregnant women with substance use disorder. Its important to see a doctor if you are planning on becoming pregnant, or as soon as you know you are pregnant. To learn about breast pump coverage under your Independence plan, contact Customer Service at 1-800-ASK-BLUE (1-800-275-2583) (TTY:711). 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. 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. This service helps you fix meals, do laundry and light housekeeping. We cover 365/366 days of medically necessary services per calendar year. Some service limits may apply. Breastfeeding can help your uterus return to its normal size more quickly after delivery. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. With a range of breast pump brands and insurance-covered maternity compression garments, Pumps for Mom can help make new and expectant moms' lives easier. 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. This can be a short-term rehabilitation stay or long-term. One new hearing aid per ear, once every three years. Doctor visits after delivery of your baby. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day). The table below lists the medical services that are covered by Sunshine Health. Services can include housekeeping; help with bathing, dressing and eating; medication assistance; and social programs. 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. Designed to be discreet, the Elvie Pump is a breastfeeding mom's best friend. Treatments for long-lasting pain that does not get better after other services have been provided. Breast milk has all of the calories, protein, fat, carbohydrates, vitamins and minerals a baby needs. Services that treat the heart and circulatory (blood vessels) system. All services limited to one every two calendar years, except for hearing aid monaural in ear, which is one per calendar year. Two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles. Eligible for the first 1,000 members who have received their flu vaccine. Services to treat conditions, illnesses, or diseases of the genitals or urinary system. It does not include major changes like new carpeting, roof repairs, plumbing systems, etc. Services used to detect or diagnose mental illnesses and behavioral health disorders. Available for long distance medical appointment day-trips. One evaluation of oral pharyngeal swallowing per calendar year. Please refer to Guidance for WIC Staff regarding HUSKY Health Coverage of Breast Pumps to determine who to contact. We cover 365/366 days of services per calendar year, as medically necessary. Tell Us Right Away! But if you hear insurance and think red tape, you are not alone. Training and counseling for the people who help take care of you. Medical equipment is used to manage and treat a condition, illness, or injury. One communication evaluation per five calendar years. 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. per provider recommendation. These services are voluntary and confidential, even if you are under 18 years old. For children up to 21 there are no limits if medically necessary. 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 SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. Detoxification or Addictions Receiving Facility Services*. For children up to 21 there are no limits if medically necessary. 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. You will need Adobe Reader to open PDFs on this site. You just pump breast milk when it works for you. Maternal health benefits - Breastfeeding is linked to a lower risk of these health problems in women: type 2 diabetes; breast cancer; ovarian cancer; and. 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. Doulas are trained non-medical companions that support pregnant people. You will work with a case manager who can help you with PDO. Follow the steps to receive your membership code. If you need a ride to any of these services, we can help you. Limitations, co-payments and restrictions may apply. If the mother's eligibility has expired in Medicaid, the pump can be issued . 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. Provided to members with behavioral health conditions and involves activities with horses. This could be on the bus, a van that can transport disabled people, a taxi, or other kinds of vehicles. Unlimited units for group therapy and unlimited units for brief group medical therapy. Emergency mental health services provided in the home, community or school by a team of health care professionals. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). A plan may cover a hospital-grade breast pump for any mom. Medical care or skilled nursing care that you get while you are in a nursing facility. This means they are optional services you can choose over more traditional services based on your individual needs. The benefit information provided is a brief summary, not a complete description of benefits. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. 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. 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. The most affordable way to obtain a breast pump is through your health insurance. Women's Health - Breast Cancer Screening 77067, 77063, G0202, R403 Screening mammography Once a year ages 35 and up Home AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. . These breast pumps are portable and lightweight, allowing for a comfortable pumping experience both at home and on the go. Call Member Services to ask about getting expanded benefits. Federal health officials are warning parents of newborns . Pumping Bras Pumping Essentials Pump Accessories You've got coverage. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. A plan may only cover breast pumps during the first 60 days postpartum. Short-term substance abuse treatment in a residential program. Prior authorization is required for voluntary admissions. It helps protect babies from chronic problems like diabetes, asthma and obesity. Breast pump, hospital grade rental; Sunshine Health is a managed care plan with a Florida Medicaid contract. See information on Patient Responsibility for room & board. Personal toiletries and household items such as detergent, bleach and paper towels are covered as medically necessary. Up to 24 hours per day, as medically necessary. 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. After the first three days, prior authorization required. Expert health content provided Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Talk to friends or family members. One initial evaluation per calendar year. 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.
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