Thank you for choosing Dr. Bradley Smith and the Dream Sleep Center. We are committed to providing the best treatment for our patients and we charge what we believe to be reasonable and customary fees for our region and specialty. The following statement explains our Financial Policy, which we ask you to please read over thoroughly. In choosing our office to serve you, you have agreed to any financial responsibility on your part.
Patient Billing: All applicable co-pays, deductibles, and coinsurance, and patient balance amounts are due at the time of service. These are a contract that you hold with your insurance company. Please help us to uphold the integrity of these contracts at each visit. Your balance owed may be different depending on your contractual agreement with your insurance company.
Insurance Billing: Our office participates with most insurance companies and it is your responsibility as the patient to provide our office with accurate and complete personal and insurance information prior to being seen by the Provider. It is also your responsibility to notify us of any billing changes in order to have claims submitted accurately. As a courtesy our office will check benefits with your insurance, but it is recommended that you verify with your insurance what benefits are covered as well. Please be aware that some, and perhaps all of the services provided may not be covered services or may not be considered medically necessary under Medicare or other respective medical policies. If that is the case then those procedures will be considered self pay or non-covered services.
Surprise Billing: Surprise billing is an unexpected balance bill that is sent to you after the insurance has paid the claim. Sometimes this happens when you have an emergency or when you schedule a visit at a facility that has an agreement with the insurance, but are unexpectedly treated by a non-cooperating provider and are billed for the balance after the insurance payment. For more information please visit www.cms.gov/nosurprises/consumers.
Claim Submission: Our office will submit claims and assist in any way we reasonably can to help ensure that your claims get paid. If your insurance company needs more information from you directly, it is your responsibility to comply in order to get them paid. Please remember that it is your responsibility to for any balances that are not paid by your insurance company.
Non-Covered Services/Self Pay: These are services that are not covered by your insurance and will need to be paid in full at time of service unless prior financial arrangements have been made with our billing office. Any self pay patient will need to pay in full at the time of their appointment. If you have any questions about what is covered, please contact our office before your visit.
Account balances: Any account balance is expected to be paid in full prior to any new services being rendered.
Referrals and Authorizations: We do accept patients without referrals. However, if your insurance requires that you have a referral from your primary care physician and you do not have one at the time of your visit with our office, you will be financially responsible for the services provided and payment be collected in full at the time of your appointment. The same will apply for any procedure that will need a prior authorization from your insurance stating that they will cover it. If an authorization is denied and you would like to still continue with treatment, it will be considered a self pay service and will have to be paid at the time of the appointment.
Missed appointments/Canceled less than 48 hours: We make it a priority to provide you with the highest quality of care, so please help us to serve you better by keeping scheduled appointments. Unless canceled at least 48 hours prior to your scheduled appointment, our office will charge you a $35 missed appointment fee for the first 2 office visits missed and $85 for each subsequent office visit missed. This fee is NOT covered by insurance and will need to be paid before scheduling your next appointment. Repeatedly missed or late appointments may result in a dismissal from our practice.
Any patients that have no-show/no-call to any appointment will be discharged from this practice after three (3) occurrences and will not be rescheduled. EMERGENCY SERVICES ONLY will be provided for a period of 30 days from the last missed appointment.
Patient collection fees: You will be sent 3 statements of your financial responsibility after payment and/or explanation of benefits is received from your insurance(s). Our office will add 3% interest to any unpaid balance after 60 days. Also, a $5 finance fee on any balance after 60 days, an additional $5 fee after 90 days, additional $15.00 fee after 120 days. In the event that the patient defaults, the patient will pay court costs, attorney fees and similar expenses related to the enforcement rights or privileges hereunder.
Payment arrangements can be made on a case by case basis. You will need to contact our billing office to discuss the options.
Any payments that are disputed or any checks that come back as insufficient funds will result in a $50.00 fee in addition to any other fees that are charged to us by the bank. Such fees along with the $50.00 will need to be paid immediately.
Assignment of Benefits: I, the undersigned, certify that I (or my dependent) have benefits and coverage with the insurance I presented. I authorize the release of any information necessary to process claims and assign Dr. Bradley Smith and the Dream Sleep Center, all insurance benefits, payable to me for services rendered. I understand that I am financially responsible for charges not covered by insurance.