sunshine health breast pump coverage

This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Up to two office visits per month for adults to treat illnesses or conditions. 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. 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. A. One frame every two years and two lenses every 365 days for adults ages 21 and older. Children under age 21 can receive swimming lessons. One initial evaluation per lifetime, completed by a team. Lightweight, portable pump with single and double pumping capability, quiet pump motor, and 100% anti-backflow design helps eliminate wasted milk. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. 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. Eligible for the first 1,000 members who have received their flu vaccine. Call 1-866-796-0530 (TTY: 1-800-955-8770) for more information. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Treatments for long-lasting pain that does not get better after other services have been provided. The benefit information provided is a brief summary, not a complete description of benefits. Its important to see a doctor if you are planning on becoming pregnant, or as soon as you know you are pregnant. Check Your Eligibility In 3 easy steps! Medical care, tests and other treatments for the kidneys. Youll also want a breast pump if you're planning to go back to work soon. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. It may reduce your risk of ovarian and breast cancer. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. Limitations, co-payments and restrictions may apply. 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 a group of people to have therapy sessions with a mental health professional. The most affordable way to obtain a breast pump is through your health insurance. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. Durable Medical Equipment/ One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. Emergency substance abuse services that are performed in a facility that is not a regular hospital. The death of an infant in the US has been linked to a contaminated breast-feeding pump that was washed in a household sink. There may be some services that we do not cover, but might still be covered by Medicaid. These services are free. They can answer questions about pregnancy, labor and caring for your baby after birth. You'll also need breast milk storage bags, bottles and nipples, in addition to cleaning supplies. Breastfeeding offers a huge array of benefits for both . Medical supplies include things that are used and then thrown away, like bandages, gloves and other items. Storkpump is AdaptHealth's insurance covered breast pump program. Babies who are breastfed also have lower lifetime risk for health conditions such as obesity and cardiovascular disease. If you need help finding an OB-GYN, we can help. For more information contact the Managed Care Plan. Remember, many first-time moms have the same questions and concerns that you do. Provided to members with behavioral health conditions and involves activities with horses. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Note: Pacify is only available to download in the App Store or Google Play Store. Oh Baby! Home delivered meals post inpatient discharge. Standard assessment of mental health needs and progress. Even though the American Academy of Pediatrics recommends that all mothers breastfeed for at least six months, that's not always possible. Here are some resources that can help. As stated earlier, you may not see major results at first, however, the body will acclimate to the suction of the pump. You will need Adobe Reader to open PDFs on this site. For children up to 21 there are no limits if medically necessary. Talk to your care manager about getting expanded benefits. Download the free version of Adobe Reader. Eligible for the first 1,000 members who have received their flu vaccine. Can be provided in a hospital, office or outpatient setting. Up to 45 days for all other members (extra days are covered for emergencies). Emergency mental health services provided in the home, community or school by a team of health care professionals. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. In some cases, you can rent or buy an electric breast pump. 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. 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. The Affordable Care Act requires most health insurance plans to cover breastfeeding services and supplies. Support services are also available for family members or caregivers. FILE - A mother holds a bottle of baby formula as she feeds her infant son, Friday, May 13, 2022, in San Antonio. 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. If you need a ride to any of these services, we can help you. Services that include all surgery and pre- and post- surgical care. Available for long distance medical appointment day-trips. *Some Medicaid members may not have all the benefits listed. Sunshine Health is a managed care plan with a Florida Medicaid contract. Massage of soft body tissues to help injuries and reduce pain. One initial evaluation per calendar year. 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. Prior authorization may be required for some equipment or services. 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. Our Start Smart for Your Baby program provides customized support and care for pregnant women and new moms. Medical care that you get while you are in the hospital but are not staying overnight. Speech and language therapy services in the office setting. 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. This service lets your caregivers take a short break. One initial evaluation per calendar year. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. One per day and no limit per calendar year. Order Your Insurance-Covered Breast Pump Today! Specialized Therapeutic Foster Care Services. Must be delivered by a behavioral health clinician with art therapy certification. 24 patient visits per calendar year, per member. Download the free version of Adobe Reader. One per day and no limit per calendar year. See information on Patient Responsibility for room & board. Services to help get medical and behavioral health care for people with mental illnesses. One initial wheelchair evaluation per five years. Most of the United Healthcare benefit plans include coverage for the purchase of a personal-use, double-electric breast pump at no cost. 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. Expanded benefits are extra goods or services we provide to you, free of charge. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). Up to 365/366 days for members ages 0-20. These services are voluntary and confidential, even if you are under 18 years old. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. We cover preventive services and tests, even when you are healthy. Up to two training or support sessions per week. Two pairs of eyeglasses for children ages 0-20. Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. This service is for drugs that are prescribed to you by a doctor or other health care provider. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Participants may be directed to call Member Services at 1-800-859-9889. An electronic device that you can wear or keep near you that lets you call for emergency help anytime. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. The following are covered services: 1. APPLY TODAY. Family Training and Counseling for Child Development*. A plan may cover 100% of the cost of a breast pump or may cover only a fraction of the cost. For more information contact the Managed Care Plan. This means they are optional services you can choose over more traditional services based on your individual needs. 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 Beds can be held for 14 days if the member has resided in facility for a minimum of 30 days between episodes. Doctor visits after delivery of your baby. Don't give up if your baby doesn't easily latch on the first day or even the first week. Additional minutes for SafeLink phone or Connections Plus plan. You will work with a case manager who can help you with PDO. You can rent one from the hospital, or buy one from an in-network durable medical equipment (DME) vendor. Hearing tests, treatments and supplies that help diagnose or treat problems with your hearing. Up to 480 hours per calendar year, as medically necessary. Mental health therapy in a group setting. Limitations, co-payments and restrictions may apply. For the rental of a breast pump, a higher per day reimbursement rate is allowed during the initial 30-day rental period for the costs associated with providing a new starter/accessory kit. If the mother's eligibility has expired in Medicaid, the pump can be issued . Education and support for you and your family or caregiver about your diet and the foods you need to eat to stay healthy. You will need Adobe Reader to open PDFs on this site. Hand-operated pumps are available through your over-the-counter benefit call 1-866-577-9010 for more information. Start your membership today its easy! They also help make sure your baby is growing and developing properly. Medical supplies are items meant for one-time use and then thrown away. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Services used to help people who are struggling with drug addiction. 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. 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. Your Primary Care Provider will work with you to make sure you get the services you need. Some service limits may apply. Medical supplies are items meant for one-time use and then thrown away. 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. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Lactation services: If you need help with breastfeeding positions, milk supply and soreness, lactation support may . Or, let's be honest, just get a few more minutes of sleep. Help taking medications if you cant take medication by yourself. Transfers between hospitals or facilities. 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 only cover in-network-network benefits. Services for women who are pregnant or want to become pregnant. Short term residential treatment program for pregnant women with substance use disorder. You have to hire, train and supervise the people who work for you (your direct service workers). According to Healthcare.gov, health insurance providers are required to cover the costs of a breast pump. One initial wheelchair evaluation per five years. 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. * Limitations do not apply to SMI Specialty Plan. Talk to a lactation consultant or breastfeeding counselor for practical help and tips to get started. Nursing facility services include medical supervision, 24-hour nursing care, help with day-to-day activities, physical therapy, occupational therapy and speech- language pathology. One new hearing aid per ear, once every three years. Services can include housekeeping; help with bathing, dressing and eating; medication assistance; and social programs. Our team of experts is ready to walk you through the process step by step until your insurance breast pump arrives at your door. Are You Pregnant? And remember, while there are plenty of benefits to breastfeeding, if you need to supplement or switch to formula, your baby will still grow and thrive. Outpatient visits with a dietician for members. Contact your care manager to determine eligibility. Transfers between hospitals or facilities. Have your insurance card ready! 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 makes changes to your home to help you live and move in your home safely and more easily. It may help with brain development and learning. A review of all the prescription and over- the-counter medications you are taking. Transportation for non-medical trips, such as shopping or social events. Up to three visits per day for all other members. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. Published on: August 6, 2019, 08:49 AM ET. Services to help people understand and make the best choices for taking medication. But if you hear insurance and think red tape, you are not alone. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. Other plans will only cover this benefit when a baby shows medical need. What you may not know is that thanks to the Affordable Care Act, breast pumps are covered under most health insurance policies for free. Please copy the WIC State agency Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). Call Member Services to ask about getting expanded benefits. Non-emergency transportation non-medical purposes. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. These expenses cover a wide range of healthcare needs, including breastfeeding products like breast pumps, nursing accessories, and breast pump spare parts pre-tax. 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. 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. of Children and Families (DCF) will evaluate the members income to determine if additional payment is required by member. One evaluation/re- evaluation per calendar year. Member is responsible for paying ALF room and board. Home So, you may be weighing the pros and cons of direct breastfeeding vs. pumping and formula feeding. Many women find it helpful to use a breast pump. 1 Flu/Pandemic Prevention kit; 3 ply face masks 10 piece; oral digital thermometer; hand sanitizer. Services that include all surgery and pre- and post- surgical care. Some service limits may apply. A health and wellness program for birth, baby and beyond. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Call us. Medical care that you get while you are in the hospital but are not staying overnight. Services for people to have one-on-one therapy sessions with a mental health professional. It does not include major changes like new carpeting, roof repairs, plumbing systems, etc. 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). Up to three follow-up evaluations per calendar year. Covered as medically necessary. SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. Services that treat conditions, illnesses or diseases of the lungs or respiratory system. This prevents your breasts from becoming full and painful. This benefit does not apply to members enrolled in limited benefits coverage plans. Elvie's silent motor helps you pump from anywhere (like work, the store and more) with confidence. Some plans offer additional breastfeeding support services such as breastfeeding consultations. We will work with your insurance company to determine benefits for your insurance covered breast pump and file an insurance claim on your behalf. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. 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 Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. Home delivered meals post inpatient discharge. Unlimited units for group therapy and unlimited units for brief group medical therapy. Assisted living facility or adult family care home. Please contact your health care provider to connect with additional resources. As medically necessary, some service and age limits apply. One evaluation/re- evaluation per calendar year. After 4 to 6 Weeks: Digital blood pressure cuff and weight scale, One (1) digital blood pressure cuff every three (3) years; One (1) weight scale every three (3) years. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Up to 480 hours per calendar year, as medically necessary. 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. * Limitations do not apply to SMI Specialty Plan. Yes, for dental procedures not done in an office. Rent A Hospital-Grade Breast Pump Month-by-Month! Services to diagnose or treat conditions, illnesses or diseases of the bones or joints.

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