Find your Insurance-Covered Breast Pump

I request that payment of authorized insurance and other benefits be made on my behalf to Breastpumps.com (BP.com) or its affiliates for the products and services that they have provided for me. I authorize BP.com to bill my insurance company for the equipment listed above and I agree to pay any copays or other charges not covered by my insurance. BP.com will notify me prior to shipping of any listed copays. If, for any reason, my insurer denies the claims through no fault of BP.com, I will be billed, and will pay BP.com, for this pump. I further authorize a copy of this agreement to be used in place of the original and authorize any holder of medical information about me to release to BP.com any information needed to determine these benefits or compliance with current healthcare standards including HIPAA. By signing below I acknowledge I have read and understand this notice. BP.com is not the specific manufacturer of the breast pump options herein and therefore is not liable for the unanticipated malfunction of any pump. If, in the unlikely instance a breast pump does not function for its intended use for any reason, you can contact the manufacturer of your chosen pump and request a replacement pursuant to the specific warranty of that pump, as applicable.