What are the responsibilities regarding co-pays and fees for sleep tests?

When you or your patients undergo a sleep test through SleepTest.com, it is important to understand who is responsible for co-pays and out-of-pocket costs. This guide helps practices explain the costs to patients so they know what to expect and who covers what.

Insurance Verification

After a patient activates their portal and agrees to the Terms of Service, SleepTest.com performs a complimentary insurance check. This check typically takes 24-48 hours. Before proceeding with the sleep test, the patient will receive an email explaining any costs they are responsible for.

Co-Pays and Out-of-Pocket Costs

Patients are responsible for paying their co-pays and any out-of-pocket costs. These costs depend on their insurance plan. For example:

• If the patient's deductible has not been met, they may need to pay part or all of the test cost out of pocket.
• If the patient has co-insurance, they may need to pay a percentage of the cost.
• If the patient has a co-pay, a fixed amount is usually due for each telemedicine visit.

Insurance Coverage Situations

• If the patient’s insurance is out-of-network or they have an HMO that does not cover SleepTest.com, they must pay for the sleep test themselves.
• Patients can choose to pay cash instead of using insurance. This is called the Express/Skip-to-Ship option, which allows patients to skip the pre-test telemedicine visit and pay a set price.

Cash Payment Details

For those choosing the cash payment route, the costs are as follows:

• $285 for the home sleep test lab
• $95 for the pre-test telemedicine visit (if required)
• $85 for the post-test telemedicine visit (if needed)

These fees do not count towards any insurance deductibles or co-insurance.

Who Covers the Costs?

• Patients are responsible for paying their co-pays and out-of-pocket expenses. The practice does not cover these.
• The practice is not responsible for patient insurance costs or cash payments.
• Patients must check with their insurance provider if they have questions about their plan and coverage.

Retesting Fees

If a patient needs to retest due to insufficient data (less than 5 hours of recorded data), a retesting fee of $99 will apply, provided the device is functioning correctly. If a device malfunction is confirmed, retesting is offered at no additional cost.

Being clear with patients about their responsibility for co-pays and out-of-pocket costs helps avoid confusion and allows everyone to focus on getting the care they need.

Let us know if you have any additional questions!