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Financial Policies

Insurance and Billing Information

We participate with most insurance plans. We must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you cannot provide us with the correct insurance information at the time of visit, you are responsible for paying for the office visit: new patient visit – $300, and follow up appointment – $225.
As a convenience, we submit the bill for physician visits and diagnostic tests to your insurance carrier. If you are insured by a plan we do business with, but don’t have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. Of course, if we receive dual payment on your account, you will be refunded. If your insurance changes, please notify us as soon as possible.
If you are not insured by a plan we do business with, payment in full is expected at each visit. Understanding your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.
Some insurance policies do not include coverage for sleep disorders. Please call your insurance carrier before your appointment to check your benefits so that you have advanced knowledge of your financial responsibility as well as if any referrals will be necessary.

Important: for home diagnostic tests, we require a credit card or HSA card on file.

Co-payments, co-insurance and deductibles

Every insurance plan splits the responsibility for health care costs between the insurer and the patient by setting co-pays, co-insurance and deductibles. For an example, see the section titled, “Covered by insurance”, below. We are required by our contracts to bill our patients for co-pays, co-insurance and deductibles. Failure on our part to bill the patient portion of a bill is a violation of our insurance contracts and can be considered fraud. Please help us by paying your co-payment and any outstanding co-insurance or deductible balance at the time of each visit.

Cancellation Policy

Office visits and sleep studies involve a large commitment of resources on our part. If you cannot come in for an appointment or study, please contact us at least 24 hours in advance to allow us to fill your slot.
Office Visits: If you do not show or don’t call to cancel your appointment at least 24 hours in advance, you will be billed a $75 no-show/cancellation fee.
Sleep Studies: A $175 no-show/cancellation fee applies to any sleep study.

Self-Pay and out-of-network insurance

If you do not have insurance or wish to pay out of pocket, or if we are not in-network with your insurance plan, we require payment in full at the time of service for office visit and full payment in advance for sleep testing. Please call the office for more information about these costs.

Default

Any unpaid patient balances after 120 days or any missed payment exceeding 15 days while on a payment plan are considered in default and are transferred to a collections agency. Once your balance is with a collection agency, we are no longer able to make any payment arrangements with you.
I agree to be responsible for any amounts not paid by my insurance plan. In the event that I default on payment of my account, I understand I am responsible for any and all costs incurred on the collection of my account, including court costs and reasonable attorney’s fees. If the debt is assigned to a third-party collection agency, I agree to be responsible for collection fees and interest due to amounts in default.

How much will I have to pay for my visit or diagnostic test?

The health insurance system is very complex, and unfortunately, we cannot know exactly how much a certain service will cost you. We strongly encourage you to contact your insurance company and ask them about your share of the costs. We are happy to provide you the billing codes for each procedure we do.

Each insurance company has its own schedule of rates for specific services. Your individual rate depends not only on the brand of insurance you have, but also on which level of plan you have. Also, your share of the costs depends on the amount of your deductible, co-insurance, and co-pay.

The rates below are for general guidance. Patients are generally responsible only for a portion of the amounts indicated.

New patient office visit: up to $300
Follow up visit: up to $225
Sleep apnea diagnostic home tests: we bill for each night of testing, up to $2000 for 3 nights of testing.
Overnight EEG testing: we bill for each night of testing, up to $2500 for 3 nights of testing.
In-lab test, polysomnography (PSG): up to $2000 per test
In-lab test for excessive sleepiness (PSG/MSLT): up to $3000 per test
Phone call with provider (generally not covered by insurance): up to $150
Telemedicine visit with provider (sometimes covered by insurance): up to $250


Insurance Overview

“Covered by insurance” – What does this mean?

It DOES NOT mean: that insurance will pay for 100% of the cost.

What it DOES mean: that insurance deems the service or device to be medically necessary and will either apply the cost to your deductible or, if your deductible has been met, will pay for most of the cost, minus your co-insurance and/or co-pay. In the following examples, insurance ends up paying 60% of the cost, even though the services are considered “covered”.

Example 1: say you have health insurance with a $1000 deductible and 10% coinsurance, and none of your deductible has been met for this year. Say you get a diagnostic test that is covered by your insurance. The charge for the test is $2000, and the insurance sets $1500 for the allowed amount.

First, the difference between the $2000 charge and the $1500 allowed amount is written off by the insurance company. It it called “the excluded amount” on your bill. So only $1500 needs to be considered. This is very important – no matter what the charge is, it’s the allowable amount that matters.

So, to take care of the $1500 allowable, you will first need to pay $1000 out of your own funds – that is your deductible amount. The remaining $500 will be shared 90%/10% between your insurance and you, so you will also need to pay 10% of $500, or $50. Your total out of pocket amount will be $1000 plus $50, or $1050. Insurance will contribute $450 toward the bill.

Example 2: your doctor next determines that you need a medical device. Let’s say the charge for the device is $2000 and the allowable amount is again $1500.

Your deductible for the year ($1000) has already been met, so the $1500 device cost will be shared 90%/10% between your insurance and you. Your total out of pocket for the device will be $150. Insurance will contribute $1350 toward the second bill.

Summing it all up:
The charge for the services and devices was $4000, but insurance wrote off $1000, so only $3000 was due to your provider. You paid $1050 toward the test plus $150 toward the device, or $1200 in total. Insurance contributed $1800, or 60%. Plus, you met your $1000 deductible for the year.

Important Notes:
Every insurance plan is different! Please use the above examples only as a general guide to the rules of the game. All insurance plans have limitations. You are responsible to verify that your insurance covers sleep testing and medical devices, if needed.