Breast Pump FAQ

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Moms Frequently Asked Questions

The U.S. Department of Health and Human Services has adopted legislation requiring commercial health insurances to add breast pumps as a covered benefit. Eligibility and coverage vary by insurance company and policy, but Edwards Health Care Services is here to assist in getting your insurance-covered breast pump efficiently and easily. We will verify your benefits and coverage, complete all the paperwork, and work with your insurance so you don’t have to. Below are a few answers to our most asked questions!

What is the Affordable Care Act, and what does it mean to me?

In January 2013, the U.S. Department of Health & Human Services officially acknowledged that breastfeeding is “one of the most effective preventative measures mothers can take to protect their health and that of their children. One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies.” As such, the government adopted legislation that requires health plans to cover specific women’s health services, including breastfeeding support, supplies, and counseling.

What this means for you is that most commercial insurance companies are required to provide coverage for breast pumps. Coverage varies from plan-to-plan, and we can help you figure out what you’re eligible for and how much – if anything – you will have to pay out-of-pocket.

Are the breast pumps EHCS carries covered by my insurance?

Most insurance policies cover breast pumps in some manner. In many situations, breast pumps are covered 100% by insurance; however, policies do vary on whether they cover a manual pump or an electric pump, whether there’s a copay or deductible, or whether a specific pump brand is specified. EHCS only carries high-quality, name-brand pumps from Medela, Ameda, Ardo, Spectra, and Lansinoh, which are normally covered by insurance. We work with many insurance companies nationwide, and we are adept at interpreting policies to make sure you’re getting what you deserve. If any out-of-pocket expenses are required, we will give you a quote before proceeding with the order. We will never swap out the desired breast pump without your approval, but there may be an upgrade fee if your insurance company does not cover your desired pump.

How do I get my insurance provider to pay for my breast pump?

To get started, just fill out this online form or give us a call at 888-344-3434. Make sure you have your insurance policy, doctor’s information, and baby’s due date on-hand. We’ll verify your coverage, determine what pumps you’re eligible for, and work with your healthcare provider to make sure your doctor submits the paperwork required by your insurance company. Once all the paperwork is received and all requirements are met, we’ll ship your breast pump to your door!

Do I need a prescription from my doctor?

For your insurance company to approve your covered breast pump, you will need to have a prescription, but we can handle that for you! Call 1-888-344-3434 or click here to get started online. We’ll work with your insurance company to verify coverage, determine what you’re eligible for, and make sure we have all the paperwork required by your insurance company.

How quickly will I get my breast pump?

This varies depending on your insurance company’s policies and how quickly your doctor’s office can submit the required paperwork. With most insurance policies, you can receive a pump before your due date. However, there are a few plans that specify when we can ship your pump. Once you apply online or over the phone, we will start processing your order immediately by verifying your insurance and contacting your doctor’s office for the required paperwork. Typically, we have all the required paperwork in a week, and if the breast pump is approved for immediate shipment by your insurance, we will ship the next day!

Can I return my breast pump?

Breast pumps are designated as personal, single-user personal hygiene items by the FDA; they are not returnable if already opened. Please read our complete return policy.

When should I contact the breast pump manufacturer?

If you’ve already purchased your pump and need assistance, you may contact the manufacturer directly.

If you have any further questions, please contact EHCS Customer Service at (888) 344-3434 or breastpumps@myehcs.com.

Not all insurance policies cover all breast pumps, and some policies do not permit upgrades. Your breast pump coordinator will walk you through the process, determine your coverage, explain the pumps you’re qualified for, and inform you of any available upgrades. Please note that your available brand and model will depend on your insurance plan and eligibility.

Exceptions: There are some plans that are grandfathered in, and those plans do not have to provide breast pump coverage. Grandfathered plans are ones that existed prior to March 23, 2010 and “haven’t changed in ways that substantially cut benefits or increase costs for plan holders,” according to HealthCare.gov. Please note that your insurance company must notify you if you have a grandfathered plan. Here at Edwards Health Care Services, we’re seeing fewer and fewer grandfathered plans. If you’re not sure of your eligibility, just fill out the form and someone from our team will be in touch.

 

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