Insurance Pump Coverage Request

If you would like to find out if your health insurance covers an electric breast pump, please fill in the form below.

Required Information:
1. Fill out form completely.
2. Ask your doctor for a prescription that says "Double Electric Breast Pump".
***If you already have the RX and have Blue Cross Blue Shield, you can fax it to: 847-272-4008.
***If you have Aetna, please fax the RX to: 847-715-9856.
3. If able, please fax a copy of your insurance card (front and back, please use the numbers above).
4. Once the insurance information has been verified you will be contacted to discuss your pump options.

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