ORDER YOUR BREAST PUMP THROUGH INSURANCE – Breast Pumps Through Insurance

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Breast Pump Through Insurance

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Email*

IMPORTANT: Our primary method of contact is email. Please provide an email address you check regularly.
State where insurance is issued*
REMINDER: This may not be the state where you live. Ex. Maryland BCBS, but you live in Virginia, then Select Maryland for State where your insurance was issued.
Primary Insurance*
I acknowledge*
- I acknowledge I have not received a personal use breast pump through this insurance policy or any other insurance policy for this pregnancy. I understand if I have received a breast pump through another provider or insurance coverage this claim may be denied and I will be responsible for paying the full retail value of the breast pump to Neb Doctors. I authorize Pumps for Mom to contact me by phone, email, or text message. Pumps for Mom will not share this information.
Insurance breast pumps and accessories

Here’s what you can expect from Pumps for Mom:

Choice.

We carry one of the largest varieties of insurance and upgrade pumps available in one location.

Simplicity.

Our process is fast and easy; choose a quick online form or fill out a one-page application and we’ll do the rest!

Expertise.

Breast pumps are all we do. When you contact Pumps for Mom, be assured that a knowledgeable, caring staff member will answer any questions you may have and guide you through every step of the process.

Quality.

Our brands are among the best known in the business and include Ameda, Ardo, Freemie, Medela, Lansinoh, and Spectra.

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Pump
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Pump Type
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Cost to You
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Item Number
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Allowable Amount
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List Price
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Payer ID
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Unique ID
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Milkbags Checkbox

Mother's Information
First Name*
Last Name*
Middle Initial
Street Address*
Street Address Line 2
City*
State*
Zipcode*
Best Phone # to Reach You*
Your phone # is kept confidential and we never share it with any third party sources.
Mother's Date of Birth*
Month
Day
Year
Baby Due Date or Birth Date*
Month
Day
Year
Emergency Contact Name
Emergency Contact Phone #
Do You Have a Prescription?
I have a prescription for a breast pump*
- Yes
- No
Please upload a copy of your prescription*
Accepted file types: jpg, jpeg, gif, png, pdf, heic, Max. file size: 50 MB.
Office Name*
Provider Name*
If you see more than one provider, please list only one.
Office Phone #*
Mother's Primary Insurance Information
Primary Insurance Company (Ex: United Healthcare)
Primary Insurance ID*
Primary Insurance Group #
Primary Insurance Company Phone #*
Please upload the FRONT of your Primary Insurance card*
Accepted file types: jpg, jpeg, gif, png, pdf, heic, Max. file size: 50 MB.
Please upload the BACK of your Primary Insurance card*
Accepted file types: jpg, jpeg, gif, png, pdf, heic, Max. file size: 50 MB.
Have you ever had a breast pump using your primary or secondary insurance?
- Yes
- No
If YES, please provide approximate date you received it (Mo/Year)
Mother's Secondary Insurance Information
If you have secondary insurance, please upload the FRONT here
Accepted file types: jpg, jpeg, gif, png, pdf, heic, Max. file size: 50 MB.
If you have secondary insurance, please upload the BACK here
Accepted file types: jpg, jpeg, gif, png, pdf, heic, Max. file size: 50 MB.
Insurance Acknowledgement*
- I acknowledge that if I have coverage under more than one insurance policy that I have listed both insurances in the proper Primary and Secondary insurance sections. If I do not, I may be responsible for payment in full if my claim is denied by the Primary listed insurer.
My Preferred Method of Contact
Please contact me by:
- Text
- Email
- Phone
Please Ship My Breast Pump To
Address*
- The Address I Have Provided Above
- An Alternate Address
First Name*
Last Name*
Middle Initial
Street Address*
Street Address Line 2
City*
State*
Zip*
Policies and Acknowledgement
As an accredited medical supplier, Pumps for Mom by Neb Doctors is required to document disclosure of several policies to each of our customers.
Customer Acknowledgement*
- I certify that I have reviewed, understand and accept the terms and conditions disclosed here.
Preferred Breastfeeding Experience
- I'm Upgrading for the Preferred Breastfeeding Experience I've indicated by this checkbox selection, I approve the Upgrade Waiver; I have been offered the standard double electric breast pump that is fully covered by my insurance; however, I am opting to upgrade to a deluxe model. I am aware that the breast pump I am purchasing is a deluxe model and will be responsible for the difference between the reimbursement rate for the standard model and the deluxe model. (Sales tax will be charged in applicable states).
NOTE: It may take a moment for your order to go through; PLEASE BE PATIENT!

If it does not submit after 30 seconds, please click HERE to submit another way.
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Coupon Code

76665

Toll Free: 1-888-411-7231
Fax: 800-791-0667
info@pumpsformom.com

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