MEDICAID BREAST PUMP ALERT
August 2016
Did you know that as of June 20, 2016 Medicaid’s Durable Medical Equipment Fee schedule covers breast pumps?
Questions & Answers:
Q: What Medicaid plan cover pumps?
A: A: Currently it is dependent on each Medicaid Managed Care Plan’s own criteria,
but by Florida law each Medicaid Managed Care Plan is to cover breast pumps.
(NO out of pocket expense for the mother)
Q: How long does it take to receive a pump?
A: Varies per policy.
Q: Can moms leave the hospital with a pump?
A: After pre-authorization most E0603 pumps are mailed to
your home by a (DME) Durable Medical Equipment who have contracts with the
Medicaid Managed Care Plan's to fulfill this product.
TAKE ACTION...
1.Request a pump from your Medicaid Managed Care Plan
Provide mom a prescription*
Direct moms to their insurance provider for DME information
Preauthorization required
*BREASTPUMP CPT CODES....
E0604 - Hospital Grade Rental Breast Pump, electric (AC and/or DC)
E0603 - Breast pump electric (AC and/or DC) any type
ICD-10 (DIAGNOSIS) CODES....
If prescription is for the MOTHER, use O92.5 Suppressed lactation
If prescription is for the BABY, use P92.5 (difficulties feeding at breast for 28 days or younger) & R63.3 (difficulties feeding over 28 days of age)
2. File a complaint, if you have any problems getting a breastpump from your Medicaid Managed Care Plan
If access to a pump is denied, click here to inform ACHA- they only track via this link
EVERYONE - doctors, nurse practitioners, lactation consultant, WIC employees and patients should complete a complaint form! The more who send complaints the faster Medicaid will get this system working smoothly!
3. Help with the policy
ACHA will be hosting a full day workshop this fall and needs our help with development
Add your ideas & comment on this BLOG
Medicaid Provider's can call 904-448-9727 and request them to send you their breast pump prescription forms for your office.
PLEASE HELP spread the word about download informational promotional flyer at http://flbreastfeeding.org/pdf/final_medicaidbreastpumpalert.pdf
Please add your comments as to your experience with getting breast pumps. These comments can be from anyone such as mothers, healthcare providers, WIC employees or even dads. To comment below, you will have to pick an option from the drop-down menu. Most the options require you sign-in with your gmail account or other type of account on the list, if you have no account just pick Anonymous! Your comments are important to help Florida Breastfeeding Coalition advocate for Medicaid breastfeeding mothers and babies.
Medicaid Provider's can call 904-448-9727 and request them to send you their breast pump prescription forms for your office.
PLEASE HELP spread the word about download informational promotional flyer at http://flbreastfeeding.org/pdf/final_medicaidbreastpumpalert.pdf
Please add your comments as to your experience with getting breast pumps. These comments can be from anyone such as mothers, healthcare providers, WIC employees or even dads. To comment below, you will have to pick an option from the drop-down menu. Most the options require you sign-in with your gmail account or other type of account on the list, if you have no account just pick Anonymous! Your comments are important to help Florida Breastfeeding Coalition advocate for Medicaid breastfeeding mothers and babies.
At Pediatrics of Tampa Bay we have had success with reimbursement for a breast pump with Staywell Medicaid plans through JC medical equipment provider. Call 904-448-9727 for them to send you their breast pump prescription forms to your office. They will handle Preauthorization and Mail the pump to the mother. Process did take 5-7 days.
ReplyDeleteIs there another number to call this one doesn't work
DeleteWOW! Jessie, it's great that you are already seeing moms receive pumps through their Staywell Medicaid plan. Thanks also for posting the phone for physician offices to call for prescription pads.
ReplyDeleteThis comment has been removed by a blog administrator.
ReplyDeleteThis was a test to test the comment for general public as anonymous
DeleteTesting the comment as anonymous
ReplyDeleteI contacted my medicaid insurance company directly and was told it was not covered and to go to my local WIC office. It was a huge disappointment since I am going back to work and wanted to continue providing breast milk.
ReplyDeleteHi Emily, when did you contact your Medicaid insurance? This is a new addition to Medicaid Durable Equipment items. Some of the Medicare Managed Care are not up to speed with it yet and we want to see that they do realize they must furnish mothers when they have a prescriptions for a breast pump. PLEASE make complaint to Medicaid at https://apps.ahca.myflorida.com/smmc_cirts/ if you made your request for one after June 20, 2016. As well if you are still in need of one try again!
DeleteGrr...I'm about to submit the complaint for this one. First, the Medicaid United Healthcare rep gave me preauth number that now cannot be found in system, while at the same time telling me that this should not require preauth because the cost is under $500. JC Home Medical rep tried to help but insists that pumps cannot be under baby's name, only mother's. Mother no longer has Medicaid so the baby is their only chance. Any thoughts?
ReplyDeleteI sympathized Mary! We actually included that in the Florida Breastfeeding Coalition policy recommendations as an alternative if the mother does not have Medicaid. Hopefully, they will be open to our suggestions. Please be sure to file a complaint. It is the only way our voices will be heard. Thank you.
ReplyDeleteGreat Blog and very useful links provided by you.
ReplyDeleteI appreciate the topic chosen by you.
Thanks a lot.
I had Amerigroup for Medicaid and I received my breast pump after barreling for it for a month to get it and once I received it I was so happy to use it and once I did I was so DISAPPOINTED because even on the lowest setting the pump I received was so painful to use so unfortunately I am unable to pump.
ReplyDeleteBattling*
DeleteThis is a HUGE disappointment being the my WIC office told me I was going to receive a medela pump
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Do you have to be on MMA plan. I have straight medicaid and I need a pump.
ReplyDeleteI'm pretty sure they assign you an MMA plan now if you don't pick one yourself after a certain amount of days.
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ReplyDeleteGet your doctor to write a prescription for a breastpump. Then 1. you don't have to pay taxes on it and 2. you can see if you can get reimbursed at least part of the cost as "medical equipment" by your insurance.
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