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IMPORTANT: Our primary method of contact is email. Please provide an email address you check regularly.

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.

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.

Fully Covered Breast Pumps
At no cost to you

Premium Upgrade Breast Pumps
Upgrade your pump for the ultimate breastfeeding experience

For the best possible pumping experience, please select one of our premium breast pump options.

Accessories and Add-Ons

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Pumps for Mom offers the most popular accessories and add-ons. Would you like to see them now?

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Expectant / New Mother's Information

Your phone number is kept confidential and we never share it with any third party sources.

Do You Have a Prescription?*

I have a prescription for a breast pump:

   

Please provide the following:

Mother's Primary Insurance Information*

Mother's Secondary Insurance Information

   

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 Ship My Breast Pump To*

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.

I certify that I have reviewed, understand and accept the terms and conditions disclosed here.

CUSTOMER AGREEMENT

  • I hereby authorize Pumps for Mom by Neb Doctors (herein referred to as “Provider”) to provide the equipment prescribed above and understand that Provider is an independent company and not part of any other medical practice, hospital or any other company.
  • I certify that the information provided by me above in applying for payment under title XVII (Medicare) of the Social Security Act or any other insurance benefits is true and correct.
  • I understand that I am personally responsible to Pumps for Mom by Neb Doctors (Pumps for Mom) for charges not paid in full by insurance coverage, deductible or co-pay responsibilities or, in the absence of insurance coverage, the full balance. The portions of any bill for which I am responsible are due upon invoice receipt from Pumps for Mom. I must pay charges outstanding within 30 days of the first invoice received. Should Pumps for Mom refer my account to a collection agency or attorney for collection, I agree to pay all collection costs, including but not limited to court costs and attorney fees of 30% of my bill. I understand that all delinquent accounts shall bear interest at the charge of 12% per annum. The usual and customary prices for the above listed product(s) are not to exceed ($399.00 Electric Pump, $59.00 Manual Pump, $65.00 Canister Supplies). I certify that I have read the terms and conditions of this agreement with the attachments listed above, and agree to its content. I have also been instructed on the proper and Patient received privacy policy.

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).