Getting a Breast Pump Through Insurance: What You Need to Know

By Cindy Puppos | April 07, 2025

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We get it-navigating insurance coverage for a breast pump can feel like a maze. With different plans, varying costs, and fine print that's hard to decipher, it's no wonder so many moms have questions. That's why we're here to break it all down for you.

At 1 Natural Way, we do our best to make this process as easy and stress-free as possible. While our FAQ section gives you quick answers, this guide is meant to dive deeper into the details. Think of it as your go-to resource for understanding what's covered, what's not, and how to avoid unexpected costs.

We tapped Cindy Puppos, our in-house insurance expert, to get the inside scoop on common concerns, misconceptions, and how you can make sure your experience goes as smoothly as possible. Let's get into it!

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Will I Have to Pay Anything Out-of-Pocket for My Breast Pump or Accessories?

Most insurance plans cover a standard double-electric breast pump at no cost under the Affordable Care Act (ACA). However, there are exceptions. Some plans are "grandfathered" and do not follow ACA guidelines, meaning they may not cover breast pumps or may require cost-sharing. Additionally, while a standard pump may be fully covered, upgrades-such as hands-free models, rechargeable options, or extra accessories-may involve an additional cost.

If your plan is "grandfathered," it may exclude breast pump coverage altogether. Another factor is whether your insurance provider considers us in-network or out-of-network. In-network providers typically result in lower costs for you, while out-of-network coverage may involve additional expenses. At 1 Natural Way, we are expanding our in-network coverage all the time to provide more seamless access to our products.

Upgrade fees are another important consideration. If you choose a premium pump beyond what your insurance covers, you will be responsible for the difference in cost. Every insurance plan sets its own reimbursement limits, so while some may fully cover an upgraded pump, others may only contribute a portion of the price.

Lastly, insurance policies can change. If you're unsure about your specific coverage, it's always best to check directly with your insurance provider. While we strive to provide accurate verification, sudden policy changes or limitations may impact what's covered.

Action Steps to Avoid Unexpected Costs:

• Keep an eye on your email-if we need additional details from you, responding quickly can prevent delays.
• Contact your insurance provider directly for clarification on coverage, especially if you have a unique or employer-sponsored plan.
• If you select an upgraded pump, review the costs before finalizing your order.

How Do I Verify If My Insurance Covers a Breast Pump?

1 Natural Way simplifies the verification process by working directly with your insurance provider. Our automated system checks policy details and active coverage. However, some plans require additional steps, such as providing a prescription or verifying whether you've used your benefit before.

If your name is listed differently with your insurer-such as using a maiden name instead of a married name-it can cause verification delays. Similarly, if we only have your secondary insurance on file, or if your primary policy has recently changed, we may need updated information. Another common issue is that some customers unknowingly order from multiple providers, and since insurance will only cover one pump per eligibility period, this can lead to claim denials.

If we require more details to complete verification, we'll notify you promptly. To avoid delays, check your insurance coverage in advance and ensure that the information you provide matches your records.

Action Steps to Ensure Seamless Verification:

• Double-check that the name on your insurance policy matches the name you provide.
• Ensure your insurance policy is active and hasn't changed recently.
• If you've previously received a breast pump, confirm that you're still eligible for another one.

What Does "In-Network" vs. "Out-of-Network" Mean for My Order?

When ordering a breast pump through insurance, understanding whether your provider is in-network or out-of-network is crucial, as it can significantly impact the cost you may need to pay out of pocket.

If 1 Natural Way is in-network with your insurance provider, it means we have a contract with them that allows us to bill your insurance directly at negotiated rates. This typically results in a lower cost-or no cost at all-to you. Being in-network can also mean faster processing times, as there are fewer administrative hurdles to navigate.

If 1 Natural Way is out-of-network, it means we do not have a direct agreement with your insurance provider. While some insurance plans still provide partial reimbursement for out-of-network purchases, they may require additional paperwork, approvals, or higher out-of-pocket costs. Depending on your plan, you may be responsible for covering the cost upfront before submitting a claim to your insurer for potential reimbursement.

During the verification process, we check to see if we are able to work with your insurance provider. While we can determine whether your provider is in-network, please note that details within your specific policy-such as coverage limitations or timing restrictions-may still affect your eligibility. These nuances are not fully disclosed by your insurer until we submit the claim to them.

When you select your breast pump, we display the devices that have an upgrade fee as well as those that do not. This helps you make an informed decision before completing your order.

More details on how these nuances may affect out-of-pocket costs can be found in the "Will I Have to Pay Anything Out-of-Pocket for My Breast Pump or Accessories?" section above.

Action Steps to Understand Your Coverage:

• Check with your insurance provider to confirm if 1 Natural Way is in-network.
• Be aware that out-of-network coverage may result in additional costs.
• Look out for updates as we expand our in-network partnerships.
• Review the device selection page carefully to understand what's covered and what may require an upgrade fee.

Do I Need a Prescription to Get a Breast Pump Through Insurance?

In most cases, insurance providers require a prescription before they will approve coverage for a breast pump. Even when not explicitly required, we obtain a prescription for every order as part of our documentation process to ensure compliance with insurance regulations. This prescription acts as confirmation that the pump is a necessary medical device for you and helps prevent any unexpected claim denials.

Your OB-GYN, primary care provider, or midwife can write a prescription for a breast pump and other maternity items. Some insurance companies have specific requirements for what must be on the prescription. Because of these requirements, we always verify the details to ensure a smooth approval process.

To make this process as simple as possible, our team automatically reaches out to your physician or medical provider to obtain the prescription on your behalf. While many providers respond quickly, some offices take longer to process these requests. If your medical provider has not responded in a timely manner, we will notify you so you can follow up with their office directly. In many cases, a quick call or email from you can help nudge them to process the request faster and keep your order moving forward.

To avoid delays, we recommend for you to be proactive and speak with your doctor about the prescription as early as possible, ideally before you begin the ordering process. If we request additional information, responding promptly will help keep your order on track.

Action Steps to Prevent Delays:

• Be proactive and speak with your healthcare provider about obtaining a prescription for the items you are requesting.
• Ask your doctor to include any necessary details required by your insurance.
• Check your email regularly for any updates or requests for additional documentation.
• If your physician's office has not provided the prescription in a timely manner, follow up with them directly to help expedite the process.

Why Might I Receive a Bill Even If My Insurance Shows Coverage?

Receiving an unexpected bill for your breast pump can be frustrating, especially if you were under the impression that your insurance covered the cost. There are several reasons why this might happen:

Sometimes, insurance plans cover a breast pump, but only under specific conditions. For example, some policies require a copay, deductible, or cost-sharing, meaning you may still be responsible for part of the cost. Additionally, some plans have limitations on how often they will cover a pump-such as only once every three years or only within a specific timeframe before or after birth.

Another common issue is claim denials due to policy restrictions. Insurance companies may initially indicate coverage but later deny the claim based on factors such as a plan's exclusions, changes in policy terms, or discrepancies in eligibility. Unfortunately, these details are often not available until after we submit the claim.

Billing statements and Explanation of Benefits (EOB) documents can also cause confusion. A billing statement is issued by your healthcare provider and outlines the charges related to your breast pump. This statement may list the total cost of the pump, what insurance has covered, and what you may be responsible for paying. An Explanation of Benefits (EOB) is a separate document sent directly by your insurance company after they process your claim. It details how much of the cost was covered, how much remains your responsibility, and whether any part of the claim was denied. Many customers see the total amount billed to insurance and assume that is the amount they owe, but insurance companies often negotiate reduced rates, and the final out-of-pocket cost is typically lower than what appears on the Explanation of Benefits.

At 1 Natural Way, we automatically submit claim appeals if a customer is entitled to a breast pump and the insurance company denied the claim due to a documentation technicality. This ensures that if the issue is purely administrative, we do everything we can to help get your claim approved. However, if your coverage is denied for other reasons outside of our control, our customer service team is available to discuss payment plan options to help make your breast pump more affordable.

What to Do If You Receive an Unexpected Bill?

• Contact Your Insurance Provider: If you believe your claim was denied in error, you can file an appeal. Customer appeals often have a higher success rate than provider appeals.
• Reach Out to Us: We can provide additional documentation or clarification to assist you in resolving billing concerns.
• Return Policy: While our return policy is strict due to hygiene concerns, please do not hesitate to reach out to us as we will do our best to assist you.

Additional Support & Resources

1 Natural Way is committed to making this process as smooth and stress-free as possible. If you have any questions or concerns, our team is here to assist you every step of the way. Please contact our customer service team at support@1naturalway.com or (888) 977-2229.

By staying informed, verifying coverage, and responding to requests for additional information, you can ensure a seamless experience in obtaining your breast pump and accessories through insurance.

Wishing you a smooth and stress-free pumping journey!

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