Good Faith Estimate Notice

Your Right to Receive a Good Faith Estimate

Under federal law, you have the right to receive a “Good Faith Estimate” explaining how much your medical care or services from providers and facilities will cost before you receive services.

You can also ask your healthcare provider for a Good Faith Estimate before you schedule a service.

Institute for Beauty, Wellness & Regenerative Medicine is committed to transparency and helping you understand your expected costs before receiving care.

This estimate is provided in clear, understandable language to help you make informed decisions about your care.

Practice Payment Policy

Institute for Beauty, Wellness & Regenerative Medicine is a self-pay practice. All services provided by our practice are elective and are provided on a self-pay basis. We do not bill insurance, Medicare, Medicaid, or other third-party healthcare payers, and we do not submit insurance claims or provide documentation for insurance reimbursement.

Patients are provided with pricing information before treatment. Payment for services is the sole responsibility of the patient and is due in full before or at the time services are rendered, depending on the procedure or service provided.

Procedure fee estimates provided by our practice are generally valid for six (6) months unless otherwise stated.

Who Is Eligible to Receive a Good Faith Estimate

You have the right to receive a Good Faith Estimate if you:

Do not have health insurance, or
Are choosing not to use your insurance for your care (self-pay)

What the Good Faith Estimate Includes

A Good Faith Estimate outlines the expected total cost of your scheduled, non-emergency medical care or services. This may include:

Surgeon fees
Facility fees
Anesthesia fees
Medical tests, prescriptions, or related services

These estimates are based on the information available at the time and are designed to help you plan financially for your procedure.

The Good Faith Estimate is based on information known at the time and does not include any unknown or unexpected costs that may arise during treatment. Actual charges may differ.

Additional Providers or Services

In some cases, your care may involve other providers or facilities, such as anesthesia services, surgical centers, or laboratory services.

You may receive separate Good Faith Estimates from these providers, as they are responsible for providing estimates for their own services.

We will include information about other expected charges when reasonably available; however, some services may be billed independently.

When You Will Receive Your Estimate

If you schedule your procedure at least 3 business days in advance, you will receive your estimate within one (1) business day.

If scheduled 10 or more business days in advance, you will receive your estimate within three (3) business days.

You may also request a Good Faith Estimate before scheduling, and we will provide it within three (3) business days.

(These timelines are defined by federal regulation.)

Your Right to Dispute a Bill

If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to initiate a federal patient-provider dispute resolution process.

You must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

Be sure to save a copy or take a picture of your Good Faith Estimate.

For more information about the dispute process, visit the Centers for Medicare & Medicaid Services (CMS) website at https://www.cms.gov/nosurprises or call 1-800-985-3059.