Dear Jen,
Kathy D is right, hand expression can probably be just as efficient as a
good quality pump, even lacking the ability to express both sides at
once.  What convinced me was seeing a film from UNICEF, I believe it's
called 'Breastfeeding Low Birth Weight Babies', it is included on a
tape(Breastfeeding 4x4)  UNICEF requires for facilities that are
preparing to become Baby Friendly, and it was filmed in Nairobi, Kenya.
The moms in the film use hand expression to obtain milk for their
premature babies, and they are FAST!!!  given the fact that there's no
equipment to set up or clean afterwards, I think skilled hand expression
could be just as efficient as double-pumping.  And UNICEF requires that
any Baby Friendly facility teach every breastfeeding mother this skill.
  If you want to try another tack with your insurance company,  some
mothers in my area have had good luck getting insurance to pay for
purchase (not rental) of a breast pump as 'Durable Medical Goods".  Call
your company and see what they say to this.
Martha Johnson RN IBCLC
Eugene, Oregon

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