I acknowledge I have not received a personal use breast pump through this insurance policy or any other insurance policy for this pregnancy. I understand if I have received a breast pump through another provider or insurance coverage this claim may be denied and I will be responsible for paying the full retail value of the breast pump to Pumping Essentials. Additionally, I understand I am ultimately responsible for any unpaid charges for the breast pump if my insurer denies the claim for any reason.
As an accredited medical supplier, Pumping Essentials is required to document disclosure of several policies to each of our customers. "I acknowledge that I have reviewed, understand and accept the policies disclosed here."