- Oxygen Equipment
- CPAP/BiPAP Machines
- CPAP Mask
- Mask & Machine Parts
- Supplies & Accessories
- Product & Company Info
NOTICE TO MEDICARE PATIENTS:
I understand that Sleep Restfully, Inc. is accepting me as a private pay patient and I will be responsible for paying for any services or products that I receive. I understand that Sleep Restfully, Inc. will not file a claim to Medicaid, Medicare, or any other third party payor, for the equipment and/or supplies that are provided to me.
We are always glad to provide an invoice and other information so you may bill your insurance carrier. This will not constitute the acceptance of assignment or the acceptances of your insurance company's approval amount as our payment amount. Any payment made to SleepRestfully.com, at the time of sale constitutes the final payment amount accepted by you the customer. You are required to pay the full cash sale price of the equipment prior to shipment. Any and all arrangements between a customer and their 3rd party payers remains between those parties and is outside of any transaction with SleepRestfully.com. You are responsible for the total sale price charged.
To assist you in the completion of your insurance claim form we are providing general instructions for the completion of this form along with a downloadable and printable insurance claim form with information on Sleep Restfully, Inc. prefilled. We cannot guarantee that your insurance company will accept your claim and the amount if any that you will be reimbursed. Please contact your individual insurance company to assist in the determination of any benefits due.
Items usually required by insurance company along with claim form:
Items which must be completed on your claim form:
If you have any questions concerning the completion of your claim form we suggest you contact your insurance carrier prior to sending the form in order to avoid having to resubmit it.
Download Claim Form and Instructions with Sleep Restfully completed information by clicking HERE
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Sleep Restfully, Inc.
3100 Weslayan Street, Suite 373
Houston, TX 77027
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