Hospital-Grade Breast Pump Rental for Blue Cross Blue Shield of Rhode Island Mothers

Effective 8/1/22, Blue Cross Blue Shield of Rhode Island will cover a hospital-grade breast pump rental and an individual pumping kit at the member’s durable medical equipment benefit for those that have a medical need. Please check your durable medical equipment benefit, as there is sometimes a copay or coinsurance for these items. It might also hit your deductible.

Healthy Babies, Happy Moms Inc. is proud to provide the Medela Symphony Double Electric Hospital-Grade Breast Pump and a Symphony Double Pumping Kit for eligible mothers.

In order to obtain this pump and have it covered, you will need to:

Fill out the form below so we can verify your insurance coverage with BCBSRI.
Get a prescription from your OB or the baby's pediatrician and have it faxed to 401-884-5541. The prescription needs to indicate the medical reason for use of a hospital-grade pump. Some examples of this include: low supply, a baby that won't latch, a baby that is not gaining, or mother and infant separation due to hospitalization, for example, an admission to a NICU or Hasbro admission.

Rhode Island residents with out of state BCBS plans, should call their insurance plan and confirm that this is a covered benefit for them as well. These plans generally follow the Rhode Island policies. Please obtain an authorization number for these items so that we can use that when we file your claim.

If you have a medical need that allows you to take advantage of this benefit, please fill out the form below. Our office staff will verify your insurance and get in touch with you to make arrangements for you to sign our rental agreement and pick up your pump at our office in East Greenwich, Rhode Island.

Mother's Name

First Name

Last Name

Mother's Date of Birth

MM

DD

YYYY

Email

Phone

(###)

###

####

BCBS Member ID #

Authorization #

For out-of-state BCBS plans only

Is this your primary coverage?

Yes

No

BCBS Subscriber's Name

First Name

Last Name

BCBS Subscriber's Date of Birth

MM

DD

YYYY

I acknowledge that HBHM is a provider for Blue Cross Blue Shield of Rhode Island and that HBHM will bill the insurance provider directly for the hospital grade breast pump rental. I understand that if, for some reason, my insurance does not pay for this item, the cost will be my responsibility.

I give permission for my information to be released to Blue Cross Blue Shield of Rhode Island to assist in the evaluation of a claim.