SLEEPTEST, LLC. - Patient Terms & Conditions

I acknowledge and will comply with the following terms and conditions set forth by SLEEPTEST, LLC., prescribed by my clinician, for my optimal healthcare.  

I acknowledge that my clinician has screened me for signs and symptoms of sleep disordered breathing. 

I acknowledge that I am the responsible patient who has been prescribed a home sleep test by referring clinician, and I am the only patient authorized to proceed with the home sleep test. 

I acknowledge and authorize SLEEPTEST, LLC. to store my credit card information on file.

I will complete the requested number of nights prescribed by my clinician immediately upon receipt of the home sleep test device. 

I will return the home sleep test device provided to me by SLEEPTEST, LLC. within 5 business days of receiving, using the prepaid USPS shipping label provided.  

I acknowledge that if the home sleep test device is not returned within 7 days upon receipt, I will be charged a late fee of $15.00 per day, up to $150.00.  

I accept responsibility of any lost or stolen home sleep test device and its parts, provided to me by SLEEPTEST, LLC. I acknowledge and agree that if the home sleep test unit is not returned within 21 days for whatever reason, I will be charged $1,850 for the full replacement cost of the device and it’s contents.  

I acknowledge and authorize SLEEPTEST, LLC. to communicate with me via phone, email and text message.  

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For Medical Insurance Patients: 

On behalf of my referring clinician, I acknowledge and agree to allow SleepTest, LLC. to bill my medical insurance for my home sleep test. I authorize payment of insurance benefits to SleepTest, LLC. for services rendered.

In the event that my insurance carrier sends a check to me for payment in my name, I agree to immediately notify SleepTest, LLC. by calling 630-845-4384. I understand and agree to endorse the check for payment and immediately mail to SleepTest, LLC. at: 425 Quadrangle Drive #120, Bolingbrook IL 60440.

I understand and agree that I may have an insurance copay and/or deductible tied to the medical billing of my home sleep test provided by SLEEPTEST, LLC. and will pay my balance within the time allotted. If a copay and/or deductible payment is made by credit card, I also understand and agree that there are No Refunds for any portion of the payment for the amount due. 

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For Self-Pay Patients: 

On behalf of my referring clinician, I acknowledge and agree to pay SleepTest, LLC. directly for the home sleep test service. 

If my payment is made by credit card, I understand and agree that there are No Refunds for any portion of the payment for the amount due. 

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If you have any difficulty with the sleep test device or completing the sleep test on time, contact us either by telephone at 630-845-4384 or email at info@sleeptest.com, and we will be glad to help you.  

 

Thanks!  Sleep well. 

Sincerely, 

Your SleepTest.com Team