Dear Pessary Patient:

CCA subscribes to the following policies for patient payment and return of pessaries:

1.  Payment in full is required for the pessary you have been provided with today.

CCA will only bill Medicare for a pessary; all other patients must pay at time of fitting ($60).

 You will receive documentation of proof of purchase and applicable codes.  This documentation should be included with any claim you may choose to submit to your

 insurance company for reimbursement.

 Each insurer is different.  Please contact them regarding their allowable coverage for the pessary.

 2.  Your pessary cannot be returned for a refund once it has left the office. Our highly experienced nurse practitioners use their expertise to carefully fit you with the most effective, most comfortable pessary possible during your initial visit.  We are

 successful at the first fitting with a vast majority of patients.

 However, similar to other medical goods, a used pessary cannot be returned for a refund once it has left the office. We cannot reuse a used pessary, nor can it be returned to the manufacturer.

CCA is aware of the financial ramifications this policy may cause some of our patients. I will personally speak to any patient who has a financial hardship.

Respectfully,

Joel Rosen

Founder/Owner of CCA