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.
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 $2,500 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.
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 #130, Bolingbrook IL 60440.
I understand and agree that I may have a deductible and/or co-insurance responsibility tied to the medical billing of my home sleep test provided by SleepTest, LLC. and I can be offered a prompt discount payment. I will pay my balance due within 90 days of the date my statement was mailed for the service provided. If I do not take advantage of the prompt discount payment option within 90 days of the date my statement was mailed, I will incur an additional charge of $25.00. If I do not pay the balance due within 120 days of the date my statement was mailed, I will be responsible for the full balance.
If a 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.
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.
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 firstname.lastname@example.org, and we will be glad to help you.
Thanks you! Sleep well, live well, be well.
Your SleepTest.com Team