Services that include imaging such as x-rays, MRIs or CAT scans. Breast pump, hospital grade rental; Sunshine Health is a managed care plan with a Florida Medicaid contract. Can be provided in a hospital, office or outpatient setting. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. Medical care that you get while you are in the hospital. For information on obtaining doula services, read the Sunshine Health. All services, including behavioral health. All services limited to one every two calendar years, except for hearing aid monaural in ear, which is one per calendar year. We cover medically necessary family planning services. It may reduce your risk of ovarian and breast cancer. Additionally, with all of the health benefits, you can save money on trips to the doctor's as well. One evaluation of oral pharyngeal swallowing per calendar year. 24 patient visits per calendar year, per member. Doctor visits after delivery of your baby. Substance Abuse Intensive Outpatient Program*. Services to keep you from feeling pain during surgery or other medical procedures. Unlimited hypoallergenic bedding and one (1) HEPA filter vacuum cleaner for members diagnosed with asthma. One-on-one individual mental health therapy. Must be delivered by a behavioral health clinician with art therapy certification. This service also includes dialysis supplies and other supplies that help treat the kidneys. Can be provided in a hospital, office or outpatient setting. If you have additional questions about the Medicaid insurance guidelines for breast pumps, give us a call today at 844-867-9890. 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. Up to three visits per day for all other members. Lactation services: If you need help with breastfeeding positions, milk supply and soreness, lactation support may . If you have any questions about any of the covered services, please call your care manager or Member Services. Purchase it from a brick-and-mortar medical supply store. Services provided to children (ages 020) who use medical foster care services. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. After 4 to 6 Weeks: Assisted living facility or adult family care home. Mobile Crisis Assessment and Intervention Services*. Hospital-grade breast pumps are used by mothers of NICU babies or when medical issues may hinder mom & baby's ability to successfully breastfeed. There may be some services that we do not cover, but might still be covered by Medicaid. These breast pumps are portable and lightweight, allowing for a comfortable pumping experience both at home and on the go. The death of an infant in the US has been linked to a contaminated breast-feeding pump that was washed in a household sink. Services to help get medical and behavioral health care for people with mental illnesses. You can also view more information about Sunshine Health in our Member Handbook. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. 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. Our Start Smart for Your Baby program provides customized support and care for pregnant women and new moms. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. What you may not know is that thanks to the Affordable Care Act, breast pumps are covered under most health insurance policies for free. Federal health officials are warning parents of newborns . Talk to your care manager about getting expanded benefits. "As both an insurance provider and part of a healthcare system, we have the ability to collaboratively look at our current maternity management programs, and identify opportunities within both education . Home delivered meals post inpatient discharge. Durable Medical Equipment and Medical Supplies Services. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or 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. . Specialized Therapeutic Foster Care Services. Start your membership today its easy! One initial wheelchair evaluation per five years. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. A plan may only cover breast pumps during the first 60 days postpartum. Services that help children with health problems who live in foster care homes. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. Limitations, co-payments and restrictions may apply. A doula is a professional assistant, but not a medical professional. Home delivered meals post inpatient discharge. One standard electric or manual breast pump per pregnancy; 2. Available for members aged 17 through 18.5. Services that include all surgery and pre- and post- surgical care. Services to help people understand and make the best choices for taking medication. Up to 480 hours per calendar year, as medically necessary. Prior authorization may be required for some equipment or services. 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. As medically necessary and recommended by us. For 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. Emergency services are covered as medically necessary. Your Primary Care Provider will work with you to make sure you get the services you need. We cover preventive services and tests, even when you are healthy. 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. Services for children with severe mental illnesses that need treatment in a secured facility. Up to two training or support sessions per week. 5. Breast pumps are covered through all health plans including Medicaid, CHIP, and Tricare. Emergency substance abuse services that are performed in a facility that is not a regular hospital. See information on Patient Responsibility for room & board. One new hearing aid per ear, once every three years. Breastfeeding isn't just about the milk though. These services are free. Emergency mental health services that are performed in a facility that is not a regular hospital. 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. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. 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 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. It helps protect babies from chronic problems like diabetes, asthma and obesity. This can be a short-term or long- term rehabilitation stay. Prior authorization is required for voluntary admissions. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Covered as medically necessary. Must be in the custody of the Department of Children and Families. It does not include major changes like new carpeting, roof repairs, plumbing systems, etc. You do not need prior approval for these services. All services must be medically necessary. Standard assessment of mental health needs and progress. To learn about breast pump coverage under your Independence plan, contact Customer Service at 1-800-ASK-BLUE (1-800-275-2583) (TTY:711). Family Training and Counseling for Child Development*. 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. There may be some services that we do not cover, but might still be covered by Medicaid. Up to 24 hours per day, 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. The system must be able to be used by attachment to an electric breast pump or manually. Hand-operated pumps are available through your over-the-counter benefit call 1-866-577-9010 for more information. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. Speech therapy includes tests and treatments that help you talk or swallow. Storkpump is AdaptHealth's insurance covered breast pump program. NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. Up to three visits per day for all other members. Supervision, social programs and activities provided at an adult day care center during the day. Services that treat conditions, illnesses or diseases of the lungs or respiratory system. 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. It may help protect against sudden infant death syndrome (SIDS). Doulas are trained non-medical companions that support pregnant people. Please contact your health care provider to connect with additional resources. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. Standard electric or manual breast pumps. It is what nature intended for mothers and babies. 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. Health care providers and DME vendors must review the specifications and determine if the pumps they prescribe/issue to postpartum women qualify to be reimbursed. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. A health and wellness program for birth, baby and beyond. 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. Getting a Breast Pump Covered 100% Free with Your Insurance Home / Ambetter Breast Pump Ambetter Breast Pump When it comes to feeding a baby, every family needs to decide what is best for them. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). Infant Mental Health Pre- and Post- Testing Services*. Prenatal care is an important way to keep you and your baby healthy during your pregnancy. Buy it yourself and submit the receipt for reimbursement to your insurance company. Nutritional Assessment/ Risk Reduction Services. Elvie Pump.