Steps to getting your breast pump through insurance
1. Fill out form
Complete the insurance form HERE to provide your basic health insurance details.
Our partner will use this information to contact your insurance company and confirm your specific coverage, as well as any out-of-pocket costs. A representative may reach out if further information is needed.
You can apply for insurance coverage for your pump anytime during pregnancy and up to one year postpartum. Coverage varies by plan and is typically limited to one pump per birth. If you’ve recently received a pump through insurance, you may not be eligible for additional coverage.
2. Choose your flange size and accessories
Your insurance coverage depends on your specific health plan, so pump and accessory costs are estimated based on insurance verification and approval.
You’ll pay the retail price minus the amount your insurance reimburses, which may be less than 100% of the pump’s cost. Please note that promotional codes aren’t applicable for purchases made through the Insurance Verification Program.
Accessories may also be eligible for coverage under your health plan, but they will initially be charged at full price. If covered, you’ll receive a reimbursement check for accessory costs.
3. Submit necessary documentation
Our partner will review your health insurance coverage and submit all required paperwork on your behalf.
Coverage verification typically takes three to five business days. Please check your voicemail and email for updates from our partner.
If your insurance is expected to cover less than the quoted amount, our partner will contact you to confirm the revised pricing before shipping your order.
In the event that your insurance claim is denied after shipping, you will be responsible for any remaining balance.
4. Your pump is shipped
Yay! You’re insurance-covered items will now ship for free, right to your door.
Your breast pump will be shipped according to your insurance provider’s timing guidelines. Some providers require that pumps be shipped no earlier than 30 days before your due date, meaning you may need to be at least 32–36 weeks into your pregnancy before we can send your pump.
Our partner will inform you of the earliest possible ship date for the item(s) you’ve purchased and provide tracking details once your item(s) are on the way!
Breast Pump Coverage Under the Affordable Care Act
Thanks to the Affordable Care Act (ACA), health insurance plans are required to cover the cost of a breast pump.
Since every plan differs, the best next step is to check with your insurance provider directly.
✨ Coverage may include manual or electric pumps.
🤰 Some plans allow you to get your pump before your baby arrives.
Our Partner
🤩 When you purchase a breast pump through our insurance verification program, it will be provided by Enos Healthy Baby Essentials.
🤝 We’re proud to work alongside a trusted provider who have been helping make insurance coverage for your breast pump a reality for over 20 years.
Fill Out The FormFrequently Asked Questions
Will my insurance cover Perifit Pump?
Each insurance plan varies in the type of breast pump it covers. While there may be out-of-pocket expenses for your Perifit Pump, you may be able to use FSA or HSA funds to cover these costs.
Alternatively, you can also contact your insurance provider directly for more information on your coverage options.
If your insurance provider is not among those listed, we encourage you to contact them directly for more information on your coverage options.
What does my prescription need to say?
Your prescription should be dated within 90 days of your breast pump order and signed by an MD, CNM, or NP. While it doesn’t need to specify the Perifit Pump, it does need to include the following codes:
Item: E0603 (electric breast pump)
Diagnosis: Z39.1 (post-partum lactation)
If your prescription is missing these details or was issued too early in your pregnancy, we’ll need to contact your doctor for an updated version.
My insurance was not in the drop-down so I chose “Other”. How long will it take to know if I am covered?
If you select a non-contracted insurance plan, we ask that you pay for the pump upfront, as our partner does not have a set rate with your insurer and cannot predict the amount they may cover. However, you’ll be refunded for any portion your insurance pays once billing is complete. Please note that the out-of-network billing process can take several weeks to several months, depending on your insurance company, and we appreciate your patience as we know you will be waiting anxiously for updates.
Which questions should I ask my insurance company?
- Does my plan cover an electric breast pump?
- When am I eligible to receive a breast pump through insurance?
Eligibility varies, but you may qualify for a pump before your baby is born or up to 12 months postpartum, depending on your plan.
- Do I need to buy an In-Network recommended pump, or can I choose an Out-of-Network pump and get reimbursed?
- What is the coverage limit? Do I need to meet a deductible first?
If Out-of-Network purchases are allowed, you may need to meet your deductible before insurance coverage kicks in.
- Do I need a prescription, and who can provide it?
If required, your OB-GYN, pediatrician, or nurse practitioner can assist with the prescription. Perifit is not a healthcare provider, so we can’t provide an NPI number or diagnosis code, but we can offer an itemized invoice for insurance purposes. Reach out to our customer care team if needed.
- Are supplies like flanges and pump replacement accessories covered?
Some insurance plans may cover part or all of the cost of accessories, depending on the specifics of your policy.
- Are specific reimbursement codes needed?
Your insurance provider will confirm the appropriate codes.
- Can I buy a Perifit Pump now and submit a receipt for reimbursement?
Check with your insurer. Some companies will allow you to submit a receipt from Perifit or another retailer for reimbursement. You can submit a claim yourself or use our insurance form to have it processed on your behalf. Please avoid submitting both, as it may lead to claim denial.
When will Perifit be In-Network with my insurance?
We’re committed to expanding options for parents to purchase the Perifit Pump through insurance.
If your In-Network options aren’t meeting your needs, consider asking your insurance provider to establish an In-Network contract with Perifit. This may help speed up the process and improve access.
I already purchased a Perifit Pump and would like a reimbursement
If you’ve already purchased a Perifit Pump and wish to seek reimbursement, contact your insurance provider to confirm the specific documentation required.
Please note that Perifit is not a healthcare provider and should not be listed as the “Provider” on any reimbursement request. For the HCPCS code, enter E0603, which corresponds to an electric breast pump.
Questions to Ask Your Insurer for Reimbursement:
- Where can I find the reimbursement request form for my breast pump purchase?
- Is the Date of Service based on the date I ordered, received the pump, or my baby’s delivery date?
- What additional documentation is required to complete my reimbursement request?
- Should my OB be listed as the provider since they issued the prescription? If not, what provider information is necessary?
- Should I exclude the sales tax amount from the total to be reimbursed?
- Does my coverage include accessories and resupplies?
Can I use my FSA/HSA to pay for Perifit?
You can use funds from your FSA or HSA to pay for your Perifit device. Simply use your FSA/HSA debit card at checkout.
Alternatively, you can choose to pay with another card and then submit your receipt to your plan's administrator for reimbursement. Since plan requirements may vary, we strongly recommend consulting with your FSA or HSA provider before purchasing the device to ensure you understand the reimbursement requirements.
