Where to Get a Breast Pump Through Insurance
A signed RX from your OBGYN
Insurance information & card
Your OBGYN's contact information
Fill out the insurance form. The insurance form captures your basic health insurance information. Using this information, our partner* will contact your insurance company to obtain specific information regarding your coverage and any out of pocket costs that may be applicable. A representative may need to contact you for additional information.
Please note that you are eligible to seek insurance coverage for your pump at any point during your pregnancy and up to one year postpartum. Insurance coverage for breast pumps varies from plan to plan, and is limited to a maximum of 1 pump per birth. If you have recently received another pump through insurance, you will not be eligible for coverage.
Select Breast Pump and Accessories
- The specific insurance coverage you qualify for is determined by your individual health plan. Pump and accessory costs are estimated and contingent upon insurance verification and approval.
- The amount you will pay is the retail price minus the amount your insurance plan will reimburse, which may be less than 100% of the price of the pump. Unfortunately, promotional codes do not apply to purchases made through the Insurance Verification Program.
- Accessories may be covered under your health plan, but you will initially be charged full price. If insurance coverage is available for accessories, you will receive a reimbursement check.
Our partner will investigate your health insurance coverage and submit all necessary paperwork on your behalf.
- Verifying your coverage often takes three to five business days. It's recommended to check your voicemail and email for an update from our partner.
- If your insurance coverage is anticipated to be less than the amount quoted, our partner will reach out to you to approve the pricing change before shipping your order.
- If your insurance claim is denied after shipping, you will be responsible for the remaining balance not paid by your insurer.
Your insurance-covered items will ship free, straight to your door!
- Your pump order will ship according to the timing requirements set forth by your insurance provider. Some insurance providers require that a breast pump be shipped no sooner than 30-days before your due date. That typically means you must be at least 32-36 weeks in your pregnancy for us to ship your breast pump.
- If you order multiple items, there may be different shipment guidelines for each.
- Don't worry! Our partner will clearly indicate the earliest possible ship date for each item in your order and send tracking information as soon as an item is on its way to your door.
Fill out the insurance form. The insurance form captures your basic health insurance information. Using this information, our partner* will contact your insurance company to obtain specific information regarding your coverage and any out of pocket costs that may be applicable. A representative may need to contact you for additional information.
Please note that you are eligible to seek insurance coverage for your pump at any point during your pregnancy and up to one year postpartum. Insurance coverage for breast pumps varies from plan to plan, and is limited to a maximum of 1 pump per birth. If you have recently received another pump through insurance, you will not be eligible for coverage.
Select Breast Pump and Accessories
- The specific insurance coverage you qualify for is determined by your individual health plan. Pump and accessory costs are estimated and contingent upon insurance verification and approval.
- The amount you will pay is the retail price minus the amount your insurance plan will reimburse, which may be less than 100% of the price of the pump. Unfortunately, promotional codes do not apply to purchases made through the Insurance Verification Program.
- Accessories may be covered under your health plan, but you will initially be charged full price. If insurance coverage is available for accessories, you will receive a reimbursement check.
Our partner will investigate your health insurance coverage and submit all necessary paperwork on your behalf.
- Verifying your coverage often takes three to five business days. It's recommended to check your voicemail and email for an update from our partner.
- If your insurance coverage is anticipated to be less than the amount quoted, our partner will reach out to you to approve the pricing change before shipping your order.
- If your insurance claim is denied after shipping, you will be responsible for the remaining balance not paid by your insurer.
Your insurance-covered items will ship free, straight to your door!
- Your pump order will ship according to the timing requirements set forth by your insurance provider. Some insurance providers require that a breast pump be shipped no sooner than 30-days before your due date. That typically means you must be at least 32-36 weeks in your pregnancy for us to ship your breast pump.
- If you order multiple items, there may be different shipment guidelines for each.
- Don't worry! Our partner will clearly indicate the earliest possible ship date for each item in your order and send tracking information as soon as an item is on its way to your door.
Affordable care act
you have benefits
As a result of the Affordable Care Act (ACA) implementation in 2010, your health insurance plan must cover the cost of a breast pump. Your plan may have guidelines on whether the covered pump is manual or electric, rental or personal, the length of the rental, and when you'll receive it (before or after birth).
Learn More about the Affordable Care Act
Each insurance plan is different in what pump they will cover. We can support your efforts by investigating your insurance benefits through our insurance verification program. There may be out-of-pocket expenses for you in obtaining your Willow Pump, but you may be able to use FSA or HSA dollars to cover these costs. Alternatively, you can contact your insurance company directly to learn more about your options.
Your prescription should be written within 90 days of when you order your breast pump, and it should be signed by an MD, CNM or NP. It does not have to say that you are getting a Willow breast pump, but it does need to have the following codes:
- Item: E0603 (electric breast pump)
- Diagnosis: Z39.1 (post-partum lactation)
If your prescription was not written this way, or was signed too early in your pregnancy, we will need to reach out to your OB for an updated copy.
Our partner quotes according to their contract with your insurance. Some insurances offer direct reimbursement where members can submit their own claims and be paid back directly. They may also be quoting you rates from a different year than our partner's contract was created so there may haven been changes which do not apply to our partner's contracted rate.
When you choose a non-contracted insurance plan, we ask that you pay for the pump up front since our partner does not have a contracted rate with your insurer and therefore do not know what they may pay for the pump. However, you will be refunded whatever portion your insurance pays after the billing. We understand you will be waiting anxiously for updates. Out of network billing process can take several weeks to several months depending on your insurance company.
• Does my plan cover an electric breast pump?
• When am I eligible to receive a breast pump through insurance?
- Depending on your plan, you may be eligible before the baby is born and/or up to 12 months after delivery.
• Do I have to purchase your In-Network "recommended" breast pump(s) or can I purchase an Out-of-Network pump and get reimbursed?
• What is the dollar limit to coverage? Do I need to hit a deductible first?
- If your insurance allows for Out-of-Network, you might need to meet your deductible before they will cover the cost.
• Do I need a prescription and from whom (e.g., pediatrician, OBGYN, nurse practitioner)? What information does it need to include?
- If a prescription is required, your physician or midwife can assist you. Willow is not a health care provider and cannot provide a NPI number or diagnosis code. We can provide an itemized invoice which includes our tax ID number, legal company name and address. If you need this information, reach out to our customer care team.
• Do you cover breast pump supplies like flanges, storage bags, etc?
- Depending on your plan, some insurance companies will cover part or all of the cost of pumping accessories.
• Are specific reimbursement codes required?
- For the Willow Pump and accessories, you may need the following codes*: Pump E0603, Flange A4284, Pump Tube A4281, Milk Bags K1005 and Container A4285. Your insurance company ultimately decides which codes are appropriate.
• Can I purchase a Willow Pump now and provide a receipt for reimbursement?
- Check with your insurance. Some companies will allow you to submit a receipt from Willow or another retailer for reimbursement. You can either submit a receipt to your insurance company directly or use our insurance form above and have a claim sent in on your behalf. Do not do both as it may result in the denial of one or both claims.
- We're working hard to give moms more options to purchase Willow through insurance.
- If you are unhappy with your In-Network options, ask your insurance provider to establish an In-Network contract with Willow–this may help expedite the process
If you have already purchased a Willow pump and would like to seek reimbursement from your insurance company, contact them directly to determine what specific documentation you need in order to be reimbursed.
Please note, Willow is not a healthcare provider and should not be listed as "Provider" on any reimbursement request.
In the area requesting a HCPCS code for your pump, you should enter E0603 (this is the specific code for an electric breast pump).
Questions to ask your insurer if you have already purchased a pump:
- Where can I find the reimbursement request form for my breast pump purchase?
- Is the Date of Service the date I received the pump, the date I ordered the pump or my baby's delivery date?
- What specific additional documentation do I need in order to submit this request?
- Will my OB be noted as the provider since he/she provided the prescription? If not, what provider information is necessary (note: Willow is not the provider).
- Do I need to exclude the sales tax amount I paid from the total to be reimbursed?
- Do I have coverage for accessories and resupplies?
Each insurance plan is different in what pump they will cover. We can support your efforts by investigating your insurance benefits through our insurance verification program. There may be out-of-pocket expenses for you in obtaining your Willow Pump, but you may be able to use FSA or HSA dollars to cover these costs. Alternatively, you can contact your insurance company directly to learn more about your options.
Your prescription should be written within 90 days of when you order your breast pump, and it should be signed by an MD, CNM or NP. It does not have to say that you are getting a Willow breast pump, but it does need to have the following codes:
- Item: E0603 (electric breast pump)
- Diagnosis: Z39.1 (post-partum lactation)
If your prescription was not written this way, or was signed too early in your pregnancy, we will need to reach out to your OB for an updated copy.
Our partner quotes according to their contract with your insurance. Some insurances offer direct reimbursement where members can submit their own claims and be paid back directly. They may also be quoting you rates from a different year than our partner's contract was created so there may haven been changes which do not apply to our partner's contracted rate.
When you choose a non-contracted insurance plan, we ask that you pay for the pump up front since our partner does not have a contracted rate with your insurer and therefore do not know what they may pay for the pump. However, you will be refunded whatever portion your insurance pays after the billing. We understand you will be waiting anxiously for updates. Out of network billing process can take several weeks to several months depending on your insurance company.
• Does my plan cover an electric breast pump?
• When am I eligible to receive a breast pump through insurance?
- Depending on your plan, you may be eligible before the baby is born and/or up to 12 months after delivery.
• Do I have to purchase your In-Network "recommended" breast pump(s) or can I purchase an Out-of-Network pump and get reimbursed?
• What is the dollar limit to coverage? Do I need to hit a deductible first?
- If your insurance allows for Out-of-Network, you might need to meet your deductible before they will cover the cost.
• Do I need a prescription and from whom (e.g., pediatrician, OBGYN, nurse practitioner)? What information does it need to include?
- If a prescription is required, your physician or midwife can assist you. Willow is not a health care provider and cannot provide a NPI number or diagnosis code. We can provide an itemized invoice which includes our tax ID number, legal company name and address. If you need this information, reach out to our customer care team.
• Do you cover breast pump supplies like flanges, storage bags, etc?
- Depending on your plan, some insurance companies will cover part or all of the cost of pumping accessories.
• Are specific reimbursement codes required?
- For the Willow Pump and accessories, you may need the following codes*: Pump E0603, Flange A4284, Pump Tube A4281, Milk Bags K1005 and Container A4285. Your insurance company ultimately decides which codes are appropriate.
• Can I purchase a Willow Pump now and provide a receipt for reimbursement?
- Check with your insurance. Some companies will allow you to submit a receipt from Willow or another retailer for reimbursement. You can either submit a receipt to your insurance company directly or use our insurance form above and have a claim sent in on your behalf. Do not do both as it may result in the denial of one or both claims.
- We're working hard to give moms more options to purchase Willow through insurance.
- If you are unhappy with your In-Network options, ask your insurance provider to establish an In-Network contract with Willow–this may help expedite the process
If you have already purchased a Willow pump and would like to seek reimbursement from your insurance company, contact them directly to determine what specific documentation you need in order to be reimbursed.
Please note, Willow is not a healthcare provider and should not be listed as "Provider" on any reimbursement request.
In the area requesting a HCPCS code for your pump, you should enter E0603 (this is the specific code for an electric breast pump).
Questions to ask your insurer if you have already purchased a pump:
- Where can I find the reimbursement request form for my breast pump purchase?
- Is the Date of Service the date I received the pump, the date I ordered the pump or my baby's delivery date?
- What specific additional documentation do I need in order to submit this request?
- Will my OB be noted as the provider since he/she provided the prescription? If not, what provider information is necessary (note: Willow is not the provider).
- Do I need to exclude the sales tax amount I paid from the total to be reimbursed?
- Do I have coverage for accessories and resupplies?
* Breast pumps purchased through the insurance verification program will be provided by Enos Healthy Baby Essentials. In some instances depending on your insurance coverage, the breast pump may be provided in collaboration with SunMed Medical LLC or ACA Ventures LLC, a division of Enos Healthy Baby Essentials. All providers are accredited durable medical equipment providers. They are national suppliers of specialized medical equipment for over two decades and have been providing the most clinically superior brands and sought-after models of each product they carry.
† This is informational only, general in nature and does not cover all payers' rules and policies. Moms, health plans and their healthcare providers should utilize the codes that most accurately describe the mother's medical condition and the products used. This information represents no promise or guarantee by Willow regarding coverage or payment by insurance payers and Willow makes no representation or warranty regarding its accuracy or completeness or any undertaking to update or correct it at any time. This information does not replace seeking billing and coding advice from the insurance company and/or your own healthcare provider and is not intended as, and shall not be construed as, legal or medical advice. The ultimate responsibility for correct billing and coding lies with the provider of services.
Where to Get a Breast Pump Through Insurance
Source: https://onewillow.com/insurance/
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