Breast Pump Benefit
| Date: | May 29, 2024 |
| From: | Health Plan |
| To: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) Practitioners, OBGYNs, and OB Departments at all Hospitals and Facilities |
| Type: | Informational/Educational |
| Subject: | Breast Pump Benefit |
| Business: | Medi-Cal Managed Care |
Health Plan would like to inform you that members are eligible for a breast pump through our durable medical equipment (DME) provider, Western Drug. Providers can submit the Breast Pump Order Form at the member’s request. Please see below for more information.
Qualifying for a breast pump as a Health Plan member
- Member discusses with their provider
- The provider fills out a breast pump request form
- Providers can find the form on Health Plan’s website under “Breast Pump Order Form” at https://www.hpsj.com/forms-documents/
- The provider sends the form to Western Drug
- Prior authorizationis required for breast pumps. Please follow Health Plan’s prior authorization process, as outlined in our Provider Manual. This can be accessed online at https://www.hpsj.com/wp-content/uploads/2023/11/Section-8-Utilization-Management.pdf.
What type of pump is offered?
- Ameda Mya Single User Double Electric Pump
- Hospital Grade can be provided based on diagnosis
Additional breastfeeding resources can be found on Health Plan’s website: https://www.hpsj.com/breastfeeding/
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
