Insurance Guidelines

The Affordable Care Act requires specific criteria when providing a patient a breast pump. Please provide a qualifying diagnosis that shows the need for the breast pump based on one of the following criteria. The documentation must be dated within the past year.

1. The lactating parent is unable to be present at feeding time
2. The infant is unable to breastfeed due to congenital anomalies, poor or weak sucking response
3. Other medical conditions of the infant or lactating parent that interferes with direct breast feeding, such as mother/baby separation due to return to work/school status

Providers That Cover Breast Pump Purchases:

1. UPMC For You / UPMC Community Health Choices
   1. 1 Unit Per Birth (Annually)
2. UPMC Health Plan
   1. 1 Per Birth
3. Highmark Commercial / Highmark PPO Blue
   1. 1 Per Birth
4. Highmark Wholecare (Gateway Medicaid)
   1. 1 Every 2 Years
5. Aetna Commercial
   1. 1 Every 3 Years
6. United Healthcare Community
   1. 1 Per Birth

Providers That Do Not Cover Breast Pump Purchases:

1. Highmark Federal (Supplied by CVS)
2. PA and NY Medicaid
3. PA Health & Wellness
4. Medicare or Medicare Replacement Program
5. Cigna
6. Humana
7. Tricare
8. United Healthcare Commercial
9. Amerihealth Caritas (Supplied by Brightstar)

If you are unsure if your insurance provider covers breast pump purchases, you can either call your provider or contact our customer service team for more information (800) 503-5554.