Breastfeeding isn't just about the milk though. The following are covered services: 1. One initial assessment per calendar year. All at the touch of a button! 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. Emergency substance abuse services that are performed in a facility that is not a regular hospital. Its important to see a doctor if you are planning on becoming pregnant, or as soon as you know you are pregnant. Breastfeeding offers a huge array of benefits for both . This can be a short-term or long- term rehabilitation stay. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. Services that treat the heart and circulatory (blood vessels) system. They also offer comfort through physical and emotional support. Durable Medical Equipment and Medical Supplies Services. You have to hire, train and supervise the people who work for you (your direct service workers). Follow-up wheelchair evaluations, one at delivery and one six months later. One new hearing aid per ear, once every three years. Up to seven therapy treatment units per week. As medically necessary, some service and age limits apply. Breast Pump Death. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. One initial evaluation and re-evaluation 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. Up to 45 days for all other members (extra days are covered for emergencies). Meals delivered to your home after discharge from hospital or nursing facility. Expanded benefits are extra services we provide to you at no cost. Education and support for you and your family or caregiver about your diet and the foods you need to eat to stay healthy. 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. We're here to help! Hearing tests, treatments and supplies that help diagnose or treat problems with your hearing. These are services that are usually provided in an assisted living facility (ALF). 1 Flu/Pandemic Prevention kit; 3 ply face masks 10 piece; oral digital thermometer; hand sanitizer. What you may not know is that thanks to the Affordable Care Act, breast pumps are covered under most health insurance policies for free. Up to 26 hours per calendar year for adults ages 21 and over. Federal health officials urged parents to sterilize equipment. Services such as personal care, housekeeping, medication oversight and social programs to assist the member in an assisted living facility. So, you may be weighing the pros and cons of direct breastfeeding vs. pumping and formula feeding. Services to treat conditions such as sneezing or rashes that are not caused by an illness. Services to keep you from feeling pain during surgery or other medical procedures. For information on obtaining doula services, read the Sunshine Health. Oh Baby! Prior authorization is required for voluntary admissions. 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. Services for doctors visits to stay healthy and prevent or treat illness. Postpartum doulas may have additional ideas to help you become more comfortable or more confident in the process. AAC fitting, adjustment and training; up to four 30-minute sessions 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. These tables listthe services covered by our Plan. Up to three follow-up evaluations per calendar year. 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 Sessions as needed Pump more and save more when you purchase your Willow pump with insurance. One per day and no limit per calendar year. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Medical supplies include things that are used and then thrown away, like bandages, gloves and other items. 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. Up to 480 hours per calendar year, as medically necessary. Covered as medically necessary. Breast pump, hospital grade rental; Sunshine Health is a managed care plan with a Florida Medicaid contract. This service also includes dialysis supplies and other supplies that help treat the kidneys. Here are some resources that can help. Speech and language therapy services in the office setting. Looking for . Services to treat conditions, illnesses, or diseases of the genitals or urinary system. Must be delivered by a behavioral health clinician with art therapy certification. Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. Supervision, social programs and activities provided at an adult day care center during the day. Detoxification or Addictions Receiving Facility Services*. Respiratory therapy includes treatments that help you breathe better. Services that treat the heart and circulatory (blood vessels) system. Meals delivered to your home after discharge from hospital or nursing facility. Standard assessment of mental health needs and progress. Note: Pacify is only available to download in the App Store or Google Play Store. But if you hear insurance and think red tape, you are not alone. Services can include housekeeping; help with bathing, dressing and eating; medication assistance; and social programs. 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). You do not need prior approval for these services. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items. This means you get to choose your service provider and how and when you get your service. Large LCD screen designed to increase control by displaying suction level, mode, timing, an more. Services for mental health or substance abuse needs. A. This means they are optional services you can choose over more traditional services based on your individual needs. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. To help you successfully breastfeed, EmblemHealth has made breast pumps available to you through participating vendors. They can answer questions about pregnancy, labor and caring for your baby after birth. Maximum 60 days per calendar year. Call Member Services to ask about getting expanded benefits. If you need a ride to any of these services, we can help you. Services to assist people re-enter everyday life. Services for children with severe mental illnesses that need treatment in a secured facility. 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. Assisted living facility or adult family care home. Up to two training or support sessions per week. Testing services by a mental health professional with special training in infants and young children. One adult health screening (check-up) per calendar year. Use our Find a Provider tool or call Member Services at 1-866-796-0530. Here's why: Breastfeeding is good for you, too and not just because it's a great way to bond with your baby. Non-emergency transportation non-medical purposes. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. You will work with a case manager who can help you with PDO. Services that include imaging such as x-rays, MRIs or CAT scans. Services used to help people who are struggling with drug addiction. You'll also need breast milk storage bags, bottles and nipples, in addition to cleaning supplies. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. Mobile Crisis Assessment and Intervention Services*. A plan may cover a hospital-grade breast pump for any mom. As medically necessary and recommended by us. 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. Member is responsible for paying ALF room and board. Call 1-866-796-0530 (TTY: 1-800-955-8770) for more information. Available for members aged 17 through 18.5. They also help make sure your baby is growing and developing properly. Emergency mental health services provided in the home, community or school by a team of health care professionals. One initial evaluation per calendar year. Well Child Visits are provided based on age and developmental needs. This can be a short-term or long- term rehabilitation stay. Visits to primary care provider. Services for women who are pregnant or want to become pregnant. Short-term substance abuse treatment in a residential program. 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 cover the following as prescribed by your treating doctor, when medically necessary: A social club offering peer support and a flexible schedule of activities. 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. 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. 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. Download the free version of Adobe Reader. Children under age 21 can receive swimming lessons. Lightweight, portable pump with single and double pumping capability, quiet pump motor, and 100% anti-backflow design helps eliminate wasted milk. Specialized Therapeutic Foster Care Services. Sessions as needed These services are free. 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 . Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. These expenses cover a wide range of healthcare needs, including breastfeeding products like breast pumps, nursing accessories, and breast pump spare parts pre-tax. Coverage: Medicaid requires that breast pumps meet minimum specifications to be reimbursable through the NYS Medicaid program. They include help with basic activities such as cooking, managing money and performing household chores. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. Services that include imaging such as x-rays, MRIs or CAT scans. Learn about health insurance coverage for breast pumps. You do not need prior approval for these services. This service delivers healthy meals to your home. Up to 480 hours per calendar year, as medically necessary. This can be a short-term rehabilitation stay or long-term. Up to 26 hours per calendar year for adults ages 21 and over. Provided to members with behavioral health conditions and involves activities with horses. . Limitations, co-payments and restrictions may apply. 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. Youll also want a breast pump if you're planning to go back to work soon. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family. United Health Care Breast Pump Through Insurance - 100% Free. Benefits of a breast pump If you're breastfeeding, you'll want to empty your breasts regularly by feeding or using a breast pump. One evaluation/re- evaluation per calendar year. We cover 365/366 days of services in nursing facilities as medically necessary. Two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles. One initial evaluation per calendar year. If you need a ride to any of these services, we can help you. If the mother's eligibility has expired in Medicaid, the pump can be issued . All services limited to one every two calendar years, except for hearing aid monaural in ear, which is one per calendar year. Here's why: Breastfeeding can take time and patience. One communication evaluation per five calendar years. Medical care or skilled nursing care that you get while you are in a nursing facility. 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. This means that most insurers will cover one breast pump per pregnancy (up to one year postpartum) as a preventive benefit. Some service limits may apply. Eligible for the first 1,000 members who have received their flu vaccine. One breast pump is covered per pregnancy. The Minimum Breast Pump Specifications for Medicaid . For more information contact the Managed Care Plan. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. Talk to your care manager about getting expanded benefits. If you need help finding an OB-GYN, we can help. Services to keep you from feeling pain during surgery or other medical procedures. It can lower your risk for osteoporosis, a disease that weakens your bones. Participants may be directed to call Member Services at 1-800-859-9889. Please contact your health care provider to connect with additional resources. Asthma Supplies. Respiratory therapy in an office setting. Durable Medical Equipment/ Doulas are trained non-medical companions that support pregnant people. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. Have your insurance card ready! We cover 365/366 days of services in nursing facilities as medically necessary. 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. We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Must be diagnosed with asthma to qualify. 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. Services that treat conditions, illnesses or diseases of the lungs or respiratory system. One initial evaluation per lifetime, completed by a team. You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. Talk to friends or family members. Breast milk has certain proteins that help protect babies from common infections, food allergies, vomiting and diarrhea. These are in-home services to help you with: Personal Emergency Response Systems (PERS). One therapy re- evaluation per six months. Breast pump supplies . Up to 365/366 days for members ages 0-20. Treatments for long-lasting pain that does not get better after other services have been provided. This service is for drugs that are prescribed to you by a doctor or other health care provider. of Children and Families (DCF) will evaluate the members income to determine if additional payment is required by member. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. We cover 365/366 days of medically necessary services per calendar year. 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 that help children with health problems who live in foster care homes. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Limited to members who live alone or who are alone for significant parts of the day who would otherwise require extensive supervision. These are 24-hour services if you live in an adult family care home. Home delivered meals post inpatient discharge. 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. You will need Adobe Reader to open PDFs on this site. The system must be able to be used by attachment to an electric breast pump or manually. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Family Training and Counseling for Child Development*. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. Medical equipment is used to manage and treat a condition, illness, or injury. Breast Pumps Date of Origin: 09/2019 Last Review Date: 07/27/2022 Effective Date: 08/01/2022 . Lactation services: If you need help with breastfeeding positions, milk supply and soreness, lactation support may . Because of the Affordable Care Act (ACA), health insurance providers are required to provide coverage for breastfeeding support, counseling, and equipment. Prior authorization is required for voluntary admissions. Pumping Bras Pumping Essentials Pump Accessories You've got coverage. Apple Health covers one manual breast pump per lifetime. Services to treat conditions such as sneezing or rashes that are not caused by an illness. byHarvard Health Publishing. To find out about these benefits, call the state Medicaid Help Line at 1-877-254-1055. One-on-one individual mental health therapy. Elvie Pump. One initial evaluation per lifetime, completed by a team. The American Academy of Pediatrics recommends that babies be given exclusively breast milk for their first six months of life or even longer. Here are some activities to do with your doula: Contact The Doula Network team at 1-877-436-8527 and select extension 0 to learn more. Medical care that you get while you are in the hospital. Intermittent and skilled nursing care services. The benefit information provided is a brief summary, not a complete description of benefits. Substance Abuse Intensive Outpatient Program*. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. If you are a new or expecting mother, be sure to take advantage of the breast pump coverage your insurance provider offers you. As stated earlier, you may not see major results at first, however, the body will acclimate to the suction of the pump. 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. 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. Purchase it from a brick-and-mortar medical supply store. Most moms save between $95 and $159 major! Services that treat conditions, illnesses or diseases of the lungs or respiratory system. Training and counseling for the people who help take care of you. 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. Benefits and Services | Long-Term Care | Sunshine Health Benefits Overview Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. It can include changes like installing grab bars in your bathroom or a special toilet seat. Your child must be enrolled in the DOH Early Steps program. Additional minutes for SafeLink phone or Connections Plus plan. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). Prior authorization may be required for some equipment or services. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Medical supplies are items meant for one-time use and then thrown away. A doula is a professional assistant, but not a medical professional. Nutritional Assessment/ Risk Reduction Services. X-rays and other imaging for the foot, ankle and lower leg. Limited to members who reside in adult family care homes. You will need Adobe Reader to open PDFs on this site. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. This service also includes dialysis supplies and other supplies that help treat the kidneys. Lets go over some of the basics of breastfeeding. All services, including behavioral health. is a health and wellness program available at no additional cost to eligible members who are either expecting or adopting a child. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. These are medical-grade garments designed by healthcare professionals that provide lots of health benefits for moms. Just call 1-855-232-3596 (TTY: 711) to get your pump. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Standard assessment of mental health needs and progress. Service provided in a hospital setting on an outpatient basis. 9 suction modes (4 simulation and 5 expression) help simulate babies' natural nursing rhythm. (Note: these items cannot be returned.) 1 Flu/Pandemic Prevention kit; 3 ply face masks 10 piece; oral digital thermometer; hand sanitizer. Detoxification or Addictions Receiving Facility Services*. Can be provided in a hospital, office or outpatient setting. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. Unlimited hypoallergenic bedding and one (1) HEPA filter vacuum cleaner for members diagnosed with asthma. Massage of soft body tissues to help injuries and reduce pain. Order Your Insurance-Covered Breast Pump Today! per provider recommendation. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. Up to four visits per day for pregnant members and members ages 0-20. These services are voluntary and confidential, even if you are under 18 years old. Transportation to and from all of your LTC program services. One per day with no limits per calendar year. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. 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. 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! We cover medically necessary family planning services. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). Services for people to have one-on-one therapy sessions with a mental health professional. Doulas are trained non-medical companions that support pregnant people. APPLY TODAY. Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. The benefit information provided is a brief summary, not a complete description of benefits. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you.