As of August 2012, many insurance plans began covering the purchase of breastpumps for expectant or lactating mothers under the Affordable Healthcare Act (ACA).
Coverage can vary by insurance company and policy type. The only way to verify your specific plan coverage with Pumping Essentials is to complete the Verify Eligibility form. Then, Pumping Essentials will contact your insurance provider for you and inform you of your coverage via phone or email. Now you can relax and focus on the most important thing in your life: your growing family.
If you are covered under more than one insurance plan, then we need to know about it when you complete the Verify Eligibility form. There are fields on this form for you to fill in this information. If we are not notified of other insurance at the time of your order, you could be responsible for full payment of your pump.
Pumping Essentials will help you through the entire process of getting a breastpump through insurance. You only have to complete the form on our Verify Eligibility page, and Pumping Essentials will do the rest! We will contact your insurance to verify coverage, and your health care provider’s office to collect a prescription if necessary. A Pumping Essentials representative will call or email you to inform you of your coverage, and if you qualify the pump will be mailed direct to your home.
Depending on your insurance company, you may be eligible to receive a breastpump before your baby is born under your Preventative Care clause and up to a year after delivery. Typically, Pumping Essentials is able to dispense your breastpump between 60-90 days before your due date, however, the one-year warranty period on your breastpump starts as of the date we ship the pump to you. Once you complete the Verify Eligibility form, we will contact your insurance company for you to find out the exact details of your coverage.
The process begins when you complete the Verify Eligibility form. Once Pumping Essentials receives that information, we will verify your insurance and collect a prescription from your doctor (if necessary). Our policy is to gather this information and contact you about your coverage within two business days.
We can only ship a breastpump to you once all information has been verified, and any upgrade costs, if applicable, have been paid. Breastpumps ship via Ontrac or Fedex and if you have provided a valid email address you will receive a tracking number via email to follow the shipping status of your order. We work very hard to verify your information and get your breastpump shipped out as soon as possible; you will be notified if there are any known delays to your order.
Some insurances and/or HMO medical groups require that we obtain an authorization from them prior to shipping your breastpump, or the claim will not be paid. We make every attempt to initiate and collect these when they are needed, but occasionally we will need your assistance to complete this task. In most cases we can obtain an authorization within 1-2 business days, but at times it can take longer. Please understand this is a requirement of your insurance/medical group and not our requirement.
Pumping Essentials currently offers upgrade options from Medelas’ “Basic” insurance grade pumps to “Deluxe” retail grade pumps. We have also created our own custom upgrade pump packages that combine your favorite Medela Pump in Style Advanced breastpump with popular Skip Hop diaper bags, discreet and fashionable Juno Blu and Simple Wishes breastpump bags, cooler bags and extra accessories to enhance your breastfeeding experience.
Breast pump coverage depends on your particular insurance and plan. There is no cookie cutter approach regarding insurance-grade breastpumps or upgrade pumps. If you are interested in an upgrade option pump, you will need to complete the Verify Eligibility form before we are able to determine any costs.
Don’t worry, Pumping Essentials takes care of all the phone calls with your insurance and will notify you of your specific coverage details via email or phone. Pumping Essentials does accept HSA and FSA spending accounts as payment for upgrade pump charges.
Yes! Your HSA and FSA funds can be used anytime to purchase qualified medical expenses, such as breastpump upgrades and spare-parts.
Medicaid plans are not included in the ACA law, vary from state to state, and may require medical necessity to be established for coverage of a personal use or rental pump. If you have Medicaid or are on WIC benefits, your local WIC agency can help determine your coverage benefits.
Some insurance plans are “grandfathered,” and are not required to provide breastfeeding supplies or support. If your policy is “grandfathered” you may still qualify under Durable Medical Equipment. However, a Copay or Deductible may need to be met. If you have no coverage, or have an unmet deductible, we can still help by passing on the significant discounts we receive on breastpumps to you as an out of pocket expense. Remember, if you have an FSA or HSA account you can use this to pay for breastpumps.
A Starter Set breastpump will come with all accessories needed in order to begin pumping right away. However, many moms quickly realize they need additional accessories: a spare pump kit, breastpump tote bags, cooler bags, extra bottles, cleaning supplies, nipple pads, nipple cream, etc. Pumping Essentials offers these supplies and more through our private shopping site, which is accessible via the “My Account” link once you are logged into your secure account on our website. Items sold in our store are guaranteed authentic pump manufacturer parts and guaranteed to work with your pump of the same brand. We also offer other baby supplies such as nursing covers, diaper bags, and nursing tanks, all at an average 20% discount off of suggested retail. You can even pay with an HSA/FSA spending account card. Log into your secure account on our website and click the “My Account” link to shop now.
Pumping Essentials works with you, your physician, and your insurance company to file your claim, making the most of your benefits. Additionally, most insurance plans will not reimburse you for a breastpump purchased through a traditional retailer such as Target, Babies R Us, Amazon, etc as they are not considered to be “In Network” durable medical equipment (DME) providers. As an “In Network” contracted DME provider, we charge only the allowable amount permitted by your insurance company. If you were to purchase a pump from a traditional retailer and your insurance plan reimbursed you, your reimbursement will most likely only be at this lower “allowable amount” and you will end up paying more out of pocket for a pump than you would by using an “In Network” DME.
Coverage and reimbursement depends on health insurance type, plan, and network. Our representatives are able to thoroughly explain your options if we discover your insurance policy does not have coverage. If for any reason you do not qualify for a breastpump through insurance, Pumping Essentials has pumps available for purchase at significantly lower rates than at Target or other “Big Box” retailers.
Most insurances only cover ONE breastpump per pregnancy. By completing the Verify Eligibility form and requesting a pump through Pumping Essentials, you acknowledge that you have not received a personal use breastpump through the same insurance policy or any other insurance policy for this pregnancy. If you have received another breastpump through a different provider or insurance, this claim may be denied and you are responsible for paying the full retail value of the pump to Pumping Essentials. If you believe a statement was issued in error, please call (866) 688-4203 and one of our representatives will address the issue.
Of course—we want to handle this for you! We let you know exactly what is needed from both your insurance and your doctor, and do as much of the filing and phone calls as possible. You can submit signed prescriptions via email; include it as an attachment and send to RX@pumpingessentials.com
Due to the personal nature of these products, all breastpumps are non-returnable to Pumping Essentials if the hygienic seal has been broken.
If you have not broken the hygienic seal on your pump and have decided to return, you will be responsible for the cost of shipping back to us. Returns are accepted within 30 days of your original ship date. Please note, we cannot start the claim reversal process with your insurance company until it is confirmed in our warehouse that all return items have been received. If a pump upgrade fee refund is applicable, this will be issued at that time as well. Claim reversal can be quick for us to send to your insurance, but can vary in the amount of time it takes for your insurance company to process the reversal. It is important to know, that you will be unable to use your breastpump benefit with any other provider until your the claim has been reversed by your insurance company.
If there is an issue with your breastpump, please contact the manufacturer.
Pumping Essentials Customer Care
All our suppliers honor their electric breastpump warranties. Please note, the warranty may differ for pump motor and parts. If you should have any trouble with your pump, the manufacturer will be the one to work with to correct the problem. Please have the pump’s serial number and model number available and then contact the manufacturer directly:
Pumping Essentials Customer Care
Pumping Essentials and our sister company, Simple Wishes, have been serving mothers, building relationships with health insurance companies, health care professionals, breastfeeding support advocates/educators and providing high quality breastfeeding supplies for over six years. In 2014 we helped make the experience of obtaining and using a breastpump easier for over 150,000 mothers. Additionally, Pumping Essentials is fully accredited and has been awarded certification as meeting “Exemplary Provider Standards” by The Compliance Team as a trusted Durable Medical Equipment supplier.
We care about, and understand what you are experiencing as a pregnant or new mother. The founders and key staff at Pumping Essentials are all mothers, collectively having over 20 years experience with breastfeeding and newborn care. Give us a call at (866-688-4203) if you have any other questions. See for yourself how easy the process of obtaining your new breast pump can be by completing our Verify Eligibility form to get started!
Here is a list of resources that can provide more information about the Affordable Care Act and provisions regarding breastpumps: