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Breast Pump Request Form

Thank you for choosing to obtain your breast pump at MilkWorks- your community breastfeeding center! We are in-network with all major private insurance plans and all NE Medicaid plans for high quality, double electric breast pumps.* We offer Medela, Spectra, and BabyBuddha breast pumps and our Pump Service Plan is provided with all of our Personal Use Pumps (PUPs). Please fill out the form below to start your breast pump order.

Note: an actual person processes this request and it may take up to 2 business days. 

*We ALWAYS encourage that you call your insurance provider to verify that a breast pump is a covered benefit under your plan as we cannot guarantee coverage. Please bring your insurance card and a prescription from your healthcare provider (breast pumps filing through NE Medicaid must be signed by a MD/DO). 

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(i.e. Blue Cross Blue Shield, NE Medicaid, UnitedHealthcare, Aetna, TriCare, etc.)
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Location Preference for Breast Pump Curbside Pick Up
Once this request has been submitted and insurance forms are complete, you can pick up your breast pump at either location Monday - Saturday 10am-4pm. If you choose to pick up at a different location than selected on this form, please inform our staff at arrival.

Curbside Pickup of Breast Pumps & Supplies:

Please check the box of the location where you would like to pick up your pump. When forms are completed, a staff member will be in touch to send you the appropriate insurance forms and establish the most convenient pickup time. 

Need your pump faster? Give us a call at 402.423.6402 {Lincoln} or 402.502.0617 {Omaha} to have insurance forms emailed to you directly. 

 

Personal Use Pump & Parts Shipping Option:  

If curbside pick up is not convenient for you at this time, please fill out the form above and select the shipping option. MilkWorks currently offers free shipping on all personal use breast pumps and pump parts.