Medical care that you get while you are in the hospital but are not staying overnight. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. Massage of soft body tissues to help injuries and reduce pain. You'll be able to choose from popular brands like Ameda Finesse, Evenflo Advanced, Lansinoh Signature Pro, Spectra S2 Plus and Medela Pump in Style. Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases. Comprehensive Behavioral Health Assessments. Provided to members with behavioral health conditions and involves activities with horses. These are 24-hour services if you live in an adult family care home. Two pairs of eyeglasses for children ages 0-20. EdgePark www . Expanded benefits are extra goods or services we provide to you, free of charge. 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. A. Moda Health will consider coverage for rental of hospital grade breast pump medically necessary when ALL of the following criteria are met; a. One standard electric or manual breast pump per pregnancy; 2. A Specialist will verify your coverage and be in contact with you about your insurance-covered breast pump options. 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. Emergency substance abuse services that are performed in a facility that is not a regular hospital. Get up to $250 per year to help with living costs like utilities and more, Transition Assistance Nursing facility to community setting. Home Delivered Meals - Disaster Preparedness/ Relief. 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. Your Primary Care Provider will work with you to make sure you get the services you need. 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. You will need Adobe Reader to open PDFs on this site. Services to help people understand and make the best choices for taking medication. Breastfeeding can help your uterus return to its normal size more quickly after delivery. Medical care, tests and other treatments for the kidneys. Up to 26 hours per calendar year for adults ages 21 and over. Insertion of thin needles through skin to treat pain, stress and other conditions. Detoxification or Addictions Receiving Facility Services*. 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. Eligible for the first 1,000 members who have received their flu vaccine. It may reduce your risk of ovarian and breast cancer. Services to treat conditions such as sneezing or rashes that are not caused by an illness. Postpartum doulas may have additional ideas to help you become more comfortable or more confident in the process. For more information contact the Managed Care Plan. They also offer comfort through physical and emotional support. 1 Flu/Pandemic Prevention kit; 3 ply face masks 10 piece; oral digital thermometer; hand sanitizer. Up to three visits per day for all other members. Well Child Visits are provided based on age and developmental needs. Limited to members who live alone or who are alone for significant parts of the day who would otherwise require extensive supervision. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. Provided to members with behavioral health conditions in an outpatient setting. After the first three days, prior authorization required. Limited to members who reside in adult family care homes. Additional minutes for SafeLink phone or Connections Plus plan. 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. Elvie's silent motor helps you pump from anywhere (like work, the store and more) with confidence. It is what nature intended for mothers and babies. Treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Your child must be receiving medical foster care services. * Limitations do not apply to SMI Specialty Plan. It may be either a rental unit or a new one you'll keep. Services to treat conditions such as sneezing or rashes that are not caused by an illness. You will need Adobe Reader to open PDFs on this site. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. If you need a ride to any of these services, we can help you. Up to a 34-day supply of drugs, per prescription. Members can order covered breast pumps directly from Edgepark without prior authorization for consumer grade pumps. Sunshine Health is a managed care plan with a Florida Medicaid contract. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. Must be diagnosed with asthma to qualify. 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. One evaluation/re- evaluation per calendar year. Hospital-grade breast pumps are used by mothers of NICU babies or when medical issues may hinder mom & baby's ability to successfully breastfeed. Services for people to have one-on-one therapy sessions with a mental health professional. Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for 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). Substance Abuse Short-term Residential Treatment Services/ Residential Outpatient Services*. This means they are optional services you can choose over more traditional services based on your individual needs. Sessions as needed Durable Medical Equipment and Medical Supplies Services. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. Must be delivered by a behavioral health clinician with art therapy certification. Breast pumps are covered under your Sunshine Health Medicaid plan. Help taking medications if you cant take medication by yourself. After 4 to 6 Weeks: Your health insurance plan must cover the cost of a breast pump. Some service limits may apply. Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases. 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. Maximum 60 days per calendar year. The, Talk to a postpartum doula. Breast pumps can be issued to both mothers and babies enrolled in Medicaid or CHIP. The hospital grade breast pump will be covered upon the mother's discharge from the hospital HUSKY Health will not reimburse for a pump while the mother is inpatient. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family. 24 patient visits per calendar year, per member. Testing services by a mental health professional with special training in infants and young children. Services such as personal care, housekeeping, medication oversight and social programs to assist the member in an assisted living facility. If you decide to place an order, call us to confirm if a breast pump is covered by your plan. Breast Pump Death. Up to two office visits per month for adults to treat illnesses or conditions. Medical care that you get while you are in the hospital. Services for people to have one-on-one therapy sessions with a mental health professional. One initial evaluation per lifetime, completed by a team. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. The following are included in the rental payment for a hospital-grade breast pump: Set-up and education on the proper use and care of the pump; For more information contact the Managed Care Plan. 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. Women's Health - Breast Cancer Screening 77067, 77063, G0202, R403 Screening mammography Once a year ages 35 and up To find out about these benefits, call the state Medicaid Help Line at 1-877-254-1055. You may be offered the Participant Direction Option (PDO). sunshine health breast pump coverage sunshine health breast pump coverage on Jun 11, 2022 on Jun 11, 2022 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. After you have all the information you need from your insurance provider, order your pump. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. Please contact customer service at 888-510-5100 or Click Here to verify insurance. Please let us know when you are pregnant by logging in to our secure member portal and filling out a Notice of Pregnancy form. Therapeutic counseling for primary caregivers who reside with LTC members in a private home. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). These services are free. This includes having a case manager and making a plan of care that lists all the services you need and receive. That means you could receive a high-quality, name brand pump at no cost to you. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. Services for a group of people to have therapy sessions with a mental health professional. We cover 365/366 days of medically necessary services per calendar year. Extra nursing help if you do not need nursing supervision all the time or need it at a regular time. 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. 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. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day). They can answer questions about pregnancy, labor and caring for your baby after birth. As a Sunshine Health member, you get these doula benefits at no-cost: 3 visits while pregnant Up to 24 hours per day, as medically necessary. A doula is a professional assistant, but not a medical professional. The Florida Dept. Treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Some service limits may apply. Provided to members with behavioral health conditions and involves activities with horses. Breastfeeding may benefit society - The OWH . Expert health content provided Maximum 60 days per calendar year. Oh Baby! There may be some services that we do not cover, but might still be covered by Medicaid. Your child must be receiving medical foster care services. Services for families to have therapy sessions with a mental health professional. * Limitations do not apply to SMI Specialty Plan. If you are there during mealtimes, you can eat there. We cover medically necessary family planning services. A manual, battery powered, or standard electric breast pump has been trialed and failed, and any . Medical care and other treatments for the feet. Our team of experts is ready to walk you through the process step by step until your insurance breast pump arrives at your door. It's easier to prepare than formula and is always at the correct temperature. You will work with a case manager who can help you with PDO. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. And sometimes that's all you need. You can also view more information about Sunshine Health in our Member Handbook. Even though the American Academy of Pediatrics recommends that all mothers breastfeed for at least six months, that's not always possible. Services to help people understand and make the best choices for taking medication. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. The American Academy of Pediatrics recommends that babies be given exclusively breast milk for their first six months of life or even longer. The Affordable Care Act requires most health insurance plans to cover breastfeeding services and supplies. Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items. Get Your Free Breast Pump Through UMR With A Medical Supply. 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. Breast pumps, depending on the type, are covered in full as a preventive service. One initial evaluation per lifetime, completed by a team. Educational services for family members of children with severe emotional problems focused on child development and other family support. Substance Abuse Short-term Residential Treatment Services/ Residential Outpatient Services*. They also help make sure your baby is growing and developing properly. Standard assessment of mental health needs and progress. If patients request more information, please direct them to Member Services at 1-800-682-9090 (TTY 711). Family supplementation is allowed to pay the difference in cost between a shared and private room directly to the facility. Or, let's be honest, just get a few more minutes of sleep. is a health and wellness program available at no additional cost to eligible members who are either expecting or adopting a child. Insertion of thin needles through skin to treat pain, stress and other conditions. Here's why: Breastfeeding is good for you, too and not just because it's a great way to bond with your baby. Doctor visits after delivery of your baby. For more information contact the Managed Care Plan. For more information contact the Managed Care Plan. One initial wheelchair evaluation per five years. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. 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. Education and support for you and your family or caregiver about your diet and the foods you need to eat to stay healthy. If you have any questions about any of the covered services, please call your care manager or Member Services. Services for children with severe mental illnesses that need treatment in a secured facility. One initial assessment per calendar year. Breast pump supplies . Provided to members with behavioral health conditions in an outpatient setting. Beds can be held for 14 days if the member has resided in facility for a minimum of 30 days between episodes. If you are a new or expecting mother, be sure to take advantage of the breast pump coverage your insurance provider offers you. 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. Personal toiletries and household items such as detergent, bleach and paper towels are covered as medically necessary. There may be some services that we do not cover, but might still be covered by Medicaid. Buy it yourself and submit the receipt for reimbursement to your insurance company. One visit per month for people living in nursing facilities. These tables listthe services covered by our Plan. Contact your care manager to determine eligibility. Services for children with severe mental illnesses that need treatment in a secured facility. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Use our Find a Provider tool or call Member Services at 1-866-796-0530. Must be delivered by a behavioral health clinician with art therapy certification. Additional minutes for SafeLink phone or Connections Plus plan. You can rent one from the hospital, or buy one from an in-network durable medical equipment (DME) vendor. Ordering a breast pump for your baby can be completely free, and Acelleron does all the work involved in making that happen.