THE ESSURANCE PROMISE™ PROGRAM
is a unique reliance warranty program for your patient’s Essure Confirmation Test. Only Essure can make this offer — because only Essure is supported by almost a decade of clinical and real-world data proving it to be the most effective* permanent birth control by far.
The Essurance Promise Program is also an important part of your informed consent process, emphasizing to patients the need for procedure compliance and the importance of returning for their Essure (HSG) Confirmation Test.
For more about the Essurance Promise Program, or suggestions for discussing it with your patients, contact your Conceptus representative.
*Based on four years of clinical data
**Based on three years of clinical data. No direct comparative data exists. References: 1. Essure Instructions for Use. 2. Adiana data from Panel Briefing Information for December 14, 2007 FDA Panel, Clinical Report page 586. 3. Essure Effectiveness Report (data December 16, 2004), page 14. Data on file. 4. Peterson HB, et al. The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol. 1996Apr:174(4):1161-8. 5. Jamieson DJ, et al. For the U.S. Collaborative Review of Sterilization Working Group. The Risk of Pregnancy After Vasectomy. Obstet Gynecol. 2004:103:848-50. 6. Adiana Instructions for Use, Rev 3 |
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Once both Essure inserts are placed and the Essure (HSG) Confirmation Test results are read, if a patient is told she cannot yet rely on Essure for birth control for ANY reason, Conceptus, Inc. will pay her out-of-pocket costs for the test, up to $150 per test, according to the following conditions:
• The Essure patient must register for the Essurance Promise Program online at www.essurancepromise.com or by phone through the Essurance Promise Program Information Center at 855-323-7873 within 30 days of her Essure procedure.
• The Essurance Promise Program can be offered only to patients who have had the procedure on or after May 1, 2011, and is valid for nine months from the date of the Essure procedure.
• To make a claim, the Essure patient must send a copy of her medical bills for the HSG test, along with her HSG report, to the Essurance Promise Program Information Center at Essurance Promise Program, PO Box 2605, Appleton, WI 54912. You can also email them to EssurancePromise@essure.com or fax them to 877-496-0003.
• Within 30 days of receipt of all of the above documentation, Conceptus will issue payment of up to $150 per HSG test.
• If additional inserts are placed due to expulsion or for ANY other reason, the eligibility period resets and the Essurance Promise Program extends for an additional nine months.
• If, according to the HSG report, the Essure inserts are visibly in their proper place yet the Essure patient’s tubes are not occluded, the patient must continue to use alternative birth control methods and return for another HSG test in three months. Note: In clinical trials, all women who had properly placed inserts and returned for an additional HSG test were found to have their tubes blocked and were able to rely on Essure for permanent birth control.
• Federal law prohibits Conceptus from offering the Essurance Promise Program to patients who are covered by Medicaid or Medicare.
Please refer your patients to the Essure Confirmation Test brochure for more information on the Essurance Promise Program. Patients and providers may also call the Essurance Promise Program Information Center at 855-323-7873 to learn more. |
| ©2011 All rights reserved. Conceptus and Essure are registered trademarks, and Essurance Promise is a trademark, of Conceptus, Inc. All other trademarks are property of their respective owners. CC-2683 31MAY11F |
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