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. I was given an RX by my doctor for an electric pump, but I am curious as to which brands are available. Substance abuse treatment of detoxification services provided in an outpatient setting. Follow the steps to receive your membership code. These tables list the services covered by our Plan. Insertion of thin needles through skin to treat pain, stress and other conditions. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. These are services that are usually provided in an assisted living facility (ALF). Transportation to and from all of your medical appointments. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. Find breastfeeding resources, education, and products from the breast pump brand most recommended by doctors, chosen first by moms, and used in most hospitals. Please contact customer service at 888-510-5100 or Click Here to verify insurance. Verify insurance HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE Have your insurance card ready! You have to hire, train and supervise the people who work for you (your direct service workers). Breast pump supplies . 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. Services for children with severe mental illnesses that need treatment in a secured facility. One therapy re- evaluation per six months. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. Note: Pacify is only available to download in the App Store or Google Play Store. 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 . Speech and language therapy services in the office setting. Yes, for dental procedures not done in an office. Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases. The American Academy of Pediatrics recommends that babies be given exclusively breast milk for their first six months of life or even longer. Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. Order now. Must be in the custody of the Department of Children and Families. Supervision, social programs and activities provided at an adult day care center during the day. This means that most insurers will cover one breast pump per pregnancy (up to one year postpartum) as a preventive benefit. Speech and language therapy services in the office setting. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Services to treat conditions, illnesses, or diseases of the stomach or digestion system. Benefits of a breast pump If you're breastfeeding, you'll want to empty your breasts regularly by feeding or using a breast pump. 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. Medical care, tests and other treatments for the kidneys. You will need Adobe Reader to open PDFs on this site. 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. Prior authorization may be required for some equipment or services. The benefit information provided is a brief summary, not a complete description of benefits. Support services are also available for family members or caregivers. Family supplementation is allowed to pay the difference in cost between a shared and private room directly to the facility. We cover 365/366 days of services in nursing facilities as medically necessary. It can include changes like installing grab bars in your bathroom or a special toilet seat. Services to diagnose or treat conditions, illnesses or diseases of the bones or joints. A health and wellness program for birth, baby and beyond. Some plans offer additional breastfeeding support services such as breastfeeding consultations. Substance Abuse Intensive Outpatient Program*. You can also ask for a copy of the PDO Guidelines to read and help you decide if this option is the right choice for you. Services for people to have one-on-one therapy sessions with a mental health professional. One adult health screening (check-up) per calendar year. Emergency mental health services that are performed in a facility that is not a regular hospital. They can answer questions about pregnancy, labor and caring for your baby after birth. Lets go over some of the basics of breastfeeding. You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. Up to 365/366 days for members ages 0-20. 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. Two pairs of eyeglasses for children ages 0-20. Additionally, with all of the health benefits, you can save money on trips to the doctor's as well. Services for families to have therapy sessions with a mental health professional. Outpatient visits with a dietician for members. This service helps you with general household activities, like meal preparation and routine home chores. Available for long distance medical appointment day-trips. Medical care or skilled nursing care that you get while you are in a nursing facility. get your motherhood essentials in 3 simple steps Provide your insurance information We verify your coverage and submit all required paperwork on your behalf To help you successfully breastfeed, EmblemHealth has made breast pumps available to you through participating vendors. Comprehensive Behavioral Health Assessments. Covered as medically necessary. Excludes those adaptations or improvements to the home that are of general use and are not of direct medical or remedial benefit to the member. 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 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'll also need breast milk storage bags, bottles and nipples, in addition to 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; One per day and no limit per calendar year. Services to help people who are in recovery from an addiction or mental illness. If you need a ride to any of these services, we can help you. Order your Insurance Covered Breast Pump Now. Want to breastfeed your baby? Please copy the WIC State agency One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. One frame every two years and two lenses every 365 days for adults ages 21 and older. Talk to your care manager about getting expanded benefits. Beds can be held for 14 days if the member has resided in facility for a minimum of 30 days between episodes. Substance Abuse Short-term Residential Treatment Services/ Residential Outpatient Services*. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Your health insurance plan must cover the cost of a breast pump. 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 These are medical-grade garments designed by healthcare professionals that provide lots of health benefits for moms. Find out what breast pump you qualify for through your insurance. Provided to members with behavioral health conditions in an outpatient setting. A plan may only cover in-network-network benefits. Short term residential treatment program for pregnant women with substance use disorder. 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. Remember, services must bemedically necessary in order for us to pay for them. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. It helps protect babies from chronic problems like diabetes, asthma and obesity. Services for doctors visits to stay healthy and prevent or treat illness. If you need a ride to any of these services, we can help you. Up to four visits per day for pregnant members and members ages 0-20. 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. Unlimited hypoallergenic bedding and one (1) HEPA filter vacuum cleaner for members diagnosed with asthma. See information on Patient Responsibility for room & board. Download the free version of Adobe Reader. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. One communication evaluation per five calendar years. 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). Up to two office visits per month for adults to treat illnesses or conditions. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. Family Training and Counseling for Child Development*. All services, including behavioral health. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Up to two training or support sessions per week. Expert health content provided Maximum 60 days per calendar year. 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. After the first three days, prior authorization required. Services that help children with health problems who live in foster care homes. Coverage is provided when they are essential to the health and welfare of the member. Can be provided in a hospital, office or outpatient setting. Federal health officials are warning parents of newborns . 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. Just call 1-855-232-3596 (TTY: 711) to get your pump. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. Looking for . Well Child Visits are provided based on age and developmental needs. 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. There may be some services that we do not cover, but might still be covered by Medicaid. Here's why: Breastfeeding is good for you, too and not just because it's a great way to bond with your baby. Mental health therapy in a group setting. Less work missed - Breastfeeding mothers miss fewer days from work, because their infants are sick less often. A plan may cover a hospital-grade breast pump for any mom. That's pretty amazing! A Specialist will verify your coverage and be in contact with you about your insurance-covered breast pump options. Covered as medically necessary for children ages 0-20. One-on-one individual mental health therapy. It may help protect against sudden infant death syndrome (SIDS). Breast milk is easier for babies to digest than formula. 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. Substance Abuse Intensive Outpatient Program*. Heavy duty, hospital-grade electric breast pumps are covered under procedure code E0604. If patients request more information, please direct them to Member Services at 1-800-682-9090 (TTY 711). Up to $5,000 per lifetime to assist member in moving out of a nursing facility. Home Delivered Meals - Disaster Preparedness/ Relief. Treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. We cover 365/366 days of services in nursing facilities as medically necessary. Breast pumps will only be covered once per 3 years, and if the item is used for multiple pregnancies during the reasonable useful lifetime, only the kits will be covered. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. Up to 26 hours per calendar year for adults ages 21 and over. 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. You do not need prior approval for these services. You can call 1-877-659-8420 to schedule a ride. Additional minutes for SafeLink phone or Connections Plus plan. Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for Medical equipment is used to help manage and treat a condition, illness, or injury. Please refer to Guidance for WIC Staff regarding HUSKY Health Coverage of Breast Pumps to determine who to contact. Learn about health insurance coverage for breast pumps. Here is a partial list of the services included in your . Services that treat the heart and circulatory (blood vessels) system. Breast pump supplies, including the following: 2.1 Breast . Services to help people understand and make the best choices for taking medication. 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 to treat conditions such as sneezing or rashes that are not caused by an illness. Infant Mental Health Pre- and Post- Testing Services*. 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. Up to 45 days for all other members (extra days are covered for emergencies). Available for members aged 17 through 18.5. Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items.

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