Services to keep you from feeling pain during surgery or other medical procedures. NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. If you are there during mealtimes, you can eat there. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. Up to 24 hours per day, as medically necessary. We cover 365/366 days of services per calendar year, as medically necessary. One new hearing aid per ear, once every three years. For more information contact the Managed Care Plan. Pumping Bras Pumping Essentials Pump Accessories You've got coverage. Are You Pregnant? We cover hearing tests and the following as prescribed by your doctor, when medically necessary: Nursing services and medical assistance provided in your home to help you manage or recover from a medical condition, illness or injury. Coverage is provided when they are essential to the health and welfare of the member. 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). Limitations, co-payments and restrictions may apply. This can be a short-term or long- term rehabilitation stay. 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. Medical supplies include things that are used and then thrown away, like bandages, gloves and other items. FILE - A mother holds a bottle of baby formula as she feeds her infant son, Friday, May 13, 2022, in San Antonio. . Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. Prior authorization may be required for some equipment or services. Services must be medically necessary (PDF)in order for us to pay for them. Breast pump supplies . Home delivered meals post inpatient discharge. Prior authorization is required for voluntary admissions. This can be a short-term rehabilitation stay or long-term. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. There may be some services that we do not cover, but might still be covered by Medicaid. You just pump breast milk when it works for you. Download the free version of Adobe Reader. For more information contact the Managed Care Plan. Additional minutes for SafeLink phone or Connections Plus plan. 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. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). 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. You will need Adobe Reader to open PDFs on this site. postpartum depression. Talk to your doctor if you're having a lot of pain or feel like your baby isn't getting enough to eat. Prior authorization may be required for some equipment or services. This can be a short-term rehabilitation stay or long-term. Available for long distance medical appointment day-trips. Services to help people understand and make the best choices for taking medication. 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 Up to 365/366 days for members ages 0-20. Members can order covered breast pumps directly from Edgepark without prior authorization for consumer grade pumps. All services, including behavioral health. After the first three days, prior authorization required. Services to diagnose or treat conditions, illnesses or diseases of the bones or joints. 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. It may help protect against sudden infant death syndrome (SIDS). We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Sessions as needed One new hearing aid per ear, once every three years. Apple Health covers deliveries provided by a licensed midwife, nurse midwife or physician. The table below lists the medical services that are covered by Sunshine Health. Services to help get medical and behavioral health care for people with mental illnesses. Speech and language therapy services in the office setting. Breastfeeding can help your uterus return to its normal size more quickly after delivery. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Doctor visits after delivery of your baby. If your insurance company does not cover a breast pump, MedSource will work with you to find an affordable option. Or, let's be honest, just get a few more minutes of sleep. Covered as medically necessary. Up to a 34-day supply of drugs, per prescription. Emergency substance abuse services that are performed in a facility that is not a regular hospital. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. 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. FREE SHIPPING on orders over $75! Services that help children with health problems who live in foster care homes. Please copy the WIC State agency We cover 365/366 days of services per calendar year, as medically necessary. 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. Up to seven therapy treatment units per week. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. Services for women who are pregnant or want to become pregnant. The benefit information provided is a brief summary, not a complete description of benefits. Services to assist people re-enter everyday life. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. 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 and re-evaluation per calendar year. 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. A. 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. Up to three visits per day for all other members. Services for doctors visits to stay healthy and prevent or treat illness. Up to 480 hours per calendar year, as medically necessary. Medical care that you get while you are in the hospital but are not staying overnight. These tables listthe services covered by our Plan. This contact information is for WIC Staff Use only. If you are a new or expecting mother, be sure to take advantage of the breast pump coverage your insurance provider offers you. Follow-up wheelchair evaluations, one at delivery and one six months later. Priority Health has also partnered with Ovia for participants to have access to a free pregnancy tracker and Byram for covered breast pumps. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. Services to help people who are in recovery from an addiction or mental illness. per provider recommendation. Download the free version of Adobe Reader. Doctor visits after delivery of your baby. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Breast pumps, depending on the type, are covered in full as a preventive service. Hawaiian Tropic Mineral Skin Nourishing Milk SPF 50 is an equally nice-feeling, near-odorless, physical-only sunscreen that comes in a convenient pump bottle. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. You will work with a case manager who can help you with PDO. 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. Services to assist people re-enter everyday life. 1 Flu/Pandemic Prevention kit; 3 ply face masks 10 piece; oral digital thermometer; hand sanitizer. Order now. But if you hear insurance and think red tape, you are not alone. These regular checkups allow doctors to find and treat health problems early, if needed. 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. Emergency services are covered as medically necessary. This means that most insurers will cover one breast pump per pregnancy (up to one year postpartum) as a preventive benefit. United Health Care Breast Pump Through Insurance - 100% Free. Services for mental health or substance abuse needs. One evaluation/re- evaluation per calendar year. Looking for . Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over. If you need help finding an OB-GYN, we can help. We cover hearing tests and the following as prescribed by your doctor, when medically necessary: Nursing services and medical assistance provided in your home to help you manage or recover from a medical condition, illness or injury. Follow-up wheelchair evaluations, one at delivery and one six months later. You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. Eligible for the first 1,000 members who have received their flu vaccine. 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. You will need Adobe Reader to open PDFs on this site. This service helps you fix meals, do laundry and light housekeeping. Services such as personal care, housekeeping, medication oversight and social programs to assist the member in an assisted living facility. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. 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. Treatments for long-lasting pain that does not get better after other services have been provided. Call 1-866-796-0530 (TTY: 1-800-955-8770) for more information. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. If you have additional questions about the Medicaid insurance guidelines for breast pumps, give us a call today at 844-867-9890. A quick look at Healthline's picks for the best breast pumps Best all-around breast pump: Spectra S1 Plus Electric Breast Pump Best natural suction breast pump: Haakaa Silicone. Remember, services must bemedically necessary in order for us to pay for them. Specialized Therapeutic Foster Care Services. Don't give up if your baby doesn't easily latch on the first day or even the first week. Up to three follow-up evaluations per calendar year. 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. Many women find it helpful to use a breast pump. One evaluation/re- evaluation per calendar year. Please contact your health care provider to connect with additional resources. Comprehensive Behavioral Health Assessments. They also include portable x- rays. Limited to members who live alone or who are alone for significant parts of the day who would otherwise require extensive supervision.