Sweet Dreams Sleep Center, Incorporated

3-15-2017Dear ***,Sorry we haven't responded sooner but we had a snow storm and the office was closed.I would like to start by saying I am confused as to why the patient didn't contact our office with her concerns and questions regarding her insurance companies explanation of benefitsWe would
have been more than willing to take time to explain this to herWe try very hard to answer all questions our patients have understanding their insurances but at times we can't get all the answers for themOur charges might seem high but this does not affect the patient it is more for demographics for an area on the procedure and enables us to get the maximum allowed benefits for our patient. A patients' allowable amount for a procedure is not given to us and we do not get the information till we received the explanation of benefits (EOB)Again what we charge does NOT affect the patient and they are not billed for the differenceWe go by the allowable amount only and what their insurance say is the patients' responsibility as show on their EOB.We received a referral from her doctor asking us to do a home study to aid in his treatment of this patientAt this time her insurance was Medicare and *** *** and the test was performedBoth her insurances at this time paid for her procedure and the patient did not have any deductible or copay, Her report was read by a sleep specialist doctor and sent to her referring doctor for any further tests he felt was neededBoth doctors at this point recommended a CPAP Tritation since she already had the home study so we scheduled her for this procedure* Her referral did not reflect a new insurance so we did not check her benefits.The patient came in for her next test and showed us a new insurance cardRather than rescheduling the test and inconveniencing the patient we performed the testWe are participating in *** but this was a Medicare PPO and we are not at present participatingOur therapist is not aware of all the insurance plans and since the insurance company was closed our respiratory therapist advised the patient we would treat her like we were in network and not charge her more than $out of pocket as his courtesy discount.On 2-12-we received the insurance EOB from *** informing us of the allowed amount we can charge for the CPAP Tritation test (not charged amount) of $and the patient would owe $for a deductible and $for a copay, and they paid us $Since we told her that we would treat her as an in network patient we did just that and the deductible and copay was waived and she was only billed as agreed for $105.00. I do not understand her statement that medicare would not pay because the test was done incorrectly since *** her medicare did pay for the test, They paid what they would allow under her chosen plan.The test indicated that she needed a CPAP machine for her treatment and her drsent us a prescription for the machine which we in submitted to the DME company so they may continue her treatment.The DME company called and asked for further information which is not available on a home sleep study only on a PSG in lab study which was not orderedThe needed information is on the test she received CPAP tritation in lab but they needed it on a diagnostic test so they asked us to contact the patient to receive this test for her medicare insuranceThis does not mean the test was incorrect only the information for her insurance company by the supplier was needed on a study done in lab not a home study.We would more than gladly perform this test for the patient in order to ensure she is receiving the correct treatment and she is perfectly welcomed to call with any further questions or concerns.In conclusion charges submitted to insurance companies do not get billed to patientsThe policy they choose tells us the allowable amount and any deductibles or copay that the patient is responsible for and what we are allowed to receive for the service.Also all our tests were correct, read by a sleep specialist and sent to her referring specialist doctor for review and what would be the next step in her treatment, The (DME) equipment company and her insurance company needed the additional information to supply her with a CPAP machine.Sincerely,Cora Lee L.Office Manager