Breast Pump Upgrade Authorization Waiver

Upgrade for the Ultimate Breastfeeding Experience

By completing this Upgrade Waiver, I have been offered the standard double electric breast pump that is fully covered by my insurance; however, I am opting to upgrade to a deluxe model. I am aware that the breast pump I am purchasing is a deluxe model and will be responsible for the difference between the reimbursement rate for the standard model and the deluxe model.

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