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BTricareb Breast Pump Order Form Contract - Tidewater Lactation Group

BTricareb Breast Pump Order Form Contract - Tidewater Lactation Group 2025

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The document is a Tricare Breast Pump Order Form from Tidewater Lactation Group, Inc., located in Virginia Beach, VA. It collects essential patient information for mothers ordering breast pumps, including personal details and pump selection options. The form outlines various breast pump models available, their features, and warranties. By signing the form, the mother authorizes Tidewater Lactation Group to submit a claim to Tricare on her behalf.

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Click ‘Get Form’ to open the BTricareb Breast Pump Order Form Contract in the editor.
Begin by filling out the 'Patient Information' section. Enter the mother's name, date of birth, address (street, city/state/zip), phone number, and the baby's date of birth or due date.
Next, provide the sponsor's name and full Social Security Number (SSN), along with their relationship to the sponsor and an email address.
Select your preferred breast pump from the options provided. Ensure you review each pump's included items for informed selection.
Read and acknowledge the authorization statement regarding claim submission to Tricare. Sign and date where indicated.
Once completed, save your form. You can then fax it to 757-455-8055, email it to twlg@verizon.net, or mail it to Tidewater Lactation Group at the provided address.

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Does TRICARE pay for a lactation consultant?

The easiest way to get the pump through insurance is to use a company like Aeroflow or similar. They take care of getting the prescription from the doctor, contacting insurance, knowing which pumps and supplies are covered, and shipping it to you. Its a completely free service.

How to get reimbursed for a pump?

One benefit of using a network provider like or is they will automatically send you monthly reminders to order resupply items that we are eligible for. This includes milk storage bags and replacement parts of the pump.

How to order a TRICARE pump?

TRICARE covers some services from labor doulas as well as lactation consultants and counselors.

How do I order a pump from TRICARE?

You must get your prescription from a TRICARE-authorized doctor, physician assistant, nurse practitioner, or nurse midwife. Your prescription must show the type of pump you bought (manual or standard electric pump). Your prescription doesnt have to specify a brand.

How much does TRICARE Overseas cover for pumps?

One manual or one commercial off-the-shelf electric pump is covered per birth event. A prescription from a TRICARE-authorized physician, physician assistant, nurse practitioner, or nurse midwife is required.

How to get a free pump with TRICARE?

You can either have your wifes OB write a prescription and obtain the pump from any retailer that will accept the prescription, or you can purchase a pump and submit the receipt to Tricare to submit a claim and they will reimburse you.

How often can you get a pump with TRICARE?

TRICARE covers one manual or standard electric pump per birth event, including portable pumps. (To get a hospital-grade pump, you need to work with your provider and your regional contractor to get a referral and authorization.)

BTricareb Breast Pump Order Form Contract - Tidewater Lactation Group 2025

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