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Talk to friends or family members. Medical supplies are items meant for one-time use and then thrown away. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. Substance Abuse Intensive Outpatient Program*. They include help with basic activities such as cooking, managing money and performing household chores. This can be a short-term rehabilitation stay or long-term. After the first three days, prior authorization required. Services for children with severe mental illnesses that need treatment in a secured facility. They include help with basic activities such as cooking, managing money and performing household chores. You can either: Order it online from a medical supply company. As medically necessary, some service and age limits apply. Services for women who are pregnant or want to become pregnant. Other plans will only cover this benefit when a baby shows medical need. Maximum 60 days per calendar year. Insertion of thin needles through skin to treat pain, stress and other conditions. 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. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other 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). Services for a group of people to have therapy sessions with a mental health professional. X-rays and other imaging for the foot, ankle and lower leg. Services can include housekeeping; help with bathing, dressing and eating; medication assistance; and social programs. You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. Yes, for dental procedures not done in an office. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day). Standard assessment of mental health needs and progress. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. 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. Follow the steps to receive your membership code. Support services are also available for family members or caregivers. Support services are also available for family members or caregivers. Up to two training or support sessions per week. 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. Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over. 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. Up to 26 hours per calendar year for adults ages 21 and over. A doula is a professional assistant, but not a medical professional. Transportation for non-medical trips, such as shopping or social events. One new hearing aid per ear, once every three years. For children up to 21 there are no limits if medically necessary. Breast Pumps Covered By Insurance I apologize in advance if this has already been asked, but is there anyone here that has Sunshine Health (in FL) that has had their breast pump supplied by Univita? We have IBCLC's and CLC's on staff to provide expert support. Durable Medical Equipment and Medical Supplies Services. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. One per day and no limit per calendar year. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. 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. The following are covered services: 1. "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 . All at the touch of a button! We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Federal health officials are warning parents of newborns . All services limited to one every two calendar years, except for hearing aid monaural in ear, which is one per calendar year. A plan may only cover in-network-network benefits. The most affordable way to obtain a breast pump is through your health insurance. This can be a short-term or long- term rehabilitation stay. 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 . One evaluation of oral pharyngeal swallowing per calendar year. Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). Up to seven therapy treatment units per week. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. 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 to treat conditions, illnesses, or diseases of the stomach or digestion system. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day). Substance Abuse Short-term Residential Treatment Services/ Residential Outpatient Services*. Up to four visits per day for pregnant members and members ages 0-20. Medical care that you get while you are in the hospital. You will need Adobe Reader to open PDFs on this site. A. Moda Health will consider coverage for rental of hospital grade breast pump medically necessary when ALL of the following criteria are met; a. Expert health content provided 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 genitals or urinary system. You will need Adobe Reader to open PDFs on this site. Medical care and other treatments for the feet. As a Sunshine Health member, you get these doula benefits at no-cost: 3 visits while pregnant Available for long distance medical appointment day-trips. Family Training and Counseling for Child Development*. This prevents your breasts from becoming full and painful. If you need a ride to any of these services, we can help you. So, you may be weighing the pros and cons of direct breastfeeding vs. pumping and formula feeding. Services that include all surgery and pre- and post- surgical care. Priority Health has also partnered with Ovia for participants to have access to a free pregnancy tracker and Byram for covered breast pumps. One new hearing aid per ear, once every three years. Therapeutic counseling for primary caregivers who reside with LTC members in a private home. Purchase it from a brick-and-mortar medical supply store. Family Training and Counseling for Child Development*. A Specialist will verify your coverage and be in contact with you about your insurance-covered breast pump options. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Some service limits may apply. Mental health therapy in a group setting. Services for people to have one-on-one therapy sessions with a mental health professional. 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. 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. The Affordable Care Act requires most health insurance plans to cover breastfeeding services and supplies. 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. Emergency mental health services that are performed in a facility that is not a regular hospital. This means you get to choose your service provider and how and when you get your service. Comprehensive Behavioral Health Assessments. Breastfeeding isn't just about the milk though. 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. Individual therapy sessions for caregivers. Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases. Testing services by a mental health professional with special training in infants and young children. Or, let's be honest, just get a few more minutes of sleep. Breast pump, hospital grade rental; Sunshine Health is a managed care plan with a Florida Medicaid contract. Up to 365/366 days for members ages 0-20. Babylist Health was created to help cut through the paperwork and make it easier for you to get your breast pump. This service delivers healthy meals to your home. Home delivered meals post inpatient discharge. One visit per month for people living in nursing facilities. Up to three visits per day for all other members. Benefits and Services | Long-Term Care | Sunshine Health Benefits Overview Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. Must be in the custody of the Department of Children and Families. 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. If you have questions about any of the covered medical services, please call Member Services. You can call 1-877-659-8420 to schedule a ride. Covered as medically necessary. Use our Find a Provider tool or call Member Services at 1-866-796-0530. Doctor visits after delivery of your baby. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. Breast pumps, depending on the type, are covered in full as a preventive service. Standard assessment of mental health needs and progress. Home delivered meals post inpatient discharge. Expanded benefits are extra goods or services we provide to you, free of charge. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. The system must be able to be used by attachment to an electric breast pump or manually. Services for families to have therapy sessions with a mental health professional. It may be either a rental unit or a new one you'll keep. Your child must be enrolled in the DOH Early Steps program. Must be delivered by a behavioral health clinician with art therapy certification. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family. 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. Because of the Affordable Care Act (ACA), health insurance providers are required to provide coverage for breastfeeding support, counseling, and equipment. 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. Breast milk is easier for babies to digest than formula. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. If you are there during mealtimes, you can eat there. Respiratory therapy in an office setting. NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. If you need a ride to any of these services, we can help you. They also help make sure your baby is growing and developing properly. Detoxification or Addictions Receiving Facility Services*. Unlimited units for group therapy and unlimited units for brief group medical therapy. Follow-up wheelchair evaluations, one at delivery and one six months later. Breast pump supplies . Up to three follow-up evaluations per calendar year. Verify insurance HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE HANDS-FREE WEARABLE CORD-FREE This benefit does not apply to members enrolled in limited benefits coverage plans. Services such as personal care, housekeeping, medication oversight and social programs to assist the member in an assisted living facility. Talk to your doctor if you're having a lot of pain or feel like your baby isn't getting enough to eat. 1 Flu/Pandemic Prevention kit; 3 ply face masks 10 piece; oral digital thermometer; hand sanitizer. Breast pumps that are hospital-grade are specifically designed for multiple users, with a special closed system that makes the pump safe for moms to share. Sunshine Health is a managed care plan with a Florida Medicaid contract. Looking for . For more information contact the Managed Care Plan. Breast pump supplies, including the following: 2.1 Breast . Up to 26 hours per calendar year for adults ages 21 and over. Services to treat conditions such as sneezing or rashes that are not caused by an illness. Emergency substance abuse services that are performed in a facility that is not a regular hospital. Breast pumps can be issued to both mothers and babies enrolled in Medicaid or CHIP. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. Up to 24 hours per day, as medically necessary. Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items. You'll also need breast milk storage bags, bottles and nipples, in addition to Short-term substance abuse treatment in a residential program. Sessions as needed Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. That's pretty amazing! Doulas are trained non-medical companions that support pregnant people. There may be some services that we do not cover, but might still be covered by Medicaid. Coverage is provided when they are essential to the health and welfare of the member. Transportation to and from all of your medical appointments. One communication evaluation per five calendar years. 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. Specialized Therapeutic Foster Care Services. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. If you are a new or expecting mother, be sure to take advantage of the breast pump coverage your insurance provider offers you. Services to help people who are in recovery from an addiction or mental illness. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. Lets go over some of the basics of breastfeeding. 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.