• Medicaid

We are In-Network with Medicaid!

You are eligible for a Breast Pump through Medicaid. Follow the steps below to order and we will file the claim for you. You will need the Medicaid Form 352 and your Insurance Card. 

*Please let us know if you have an MCO or another Insurance. If you are unsure of what insurance you have, please have your card available and call our office for assistance.

*We are NOT in network with and cannot submit claims to Managed Care Organizations such as, but not limited to; Virginia Premier, Anthem HealthKeepers Plus, Aetna Better Health, and Molina. Please ask us for a SuperBill to seek reimbursement from your insurance carrier.

Step One

Print the Medicaid Form 352 for your Provider to fill out.

Step Two

Make your pump selection

Visit our Pumps page for more helpful information.

Step Three

Download our Medicaid Breast Pump Order Form, fill out your information, and submit it with your PROVIDER-FILLED Form 352 to our secure email address pumps@twlgmail.com

Step Four

You will be notified when your pump is ready for pick-up. Please make sure your contact information is accurate.

Online Fillable Form

We’ve made it simple for you to fill out our Medicaid Breast Pump Order Form. Click on the form to the right to get started.

PDF Reader required, download here