
GOOD FAITH ESTIMATE
UNDERSTANDING YOUR ESTIMATED COSTS BEFORE STARTING CARE
Important Notice Regarding Billing and Estimates at Allostat Health
Under the No Surprises Act (2021), all medical providers — including concierge and preventive medicine practices like Allostat Health — are required to give patients who are uninsured or paying out-of-pocket a Good Faith Estimate of expected charges. This is designed to protect patients from unexpected medical bills and ensure transparency before receiving care.
This estimate outlines the services you may receive and the potential costs associated with your care. It is not a bill and does not lock you into treatment. Actual charges may differ depending on your medical needs, treatment decisions, and any additional services requested or required throughout your care.
Allostat Health does not contract directly with insurance companies, meaning we operate outside of traditional in-network billing. This allows us to provide personalized, unrestricted care; however, your out-of-pocket costs may differ from what you would pay at an in-network facility. You are welcome to contact your insurance provider to explore in-network alternatives if you prefer.
Disclaimer
This Good Faith Estimate shows the estimated cost for services that are reasonably expected based on your current health information. The estimate is created prior to receiving care and cannot account for unexpected findings, complications, or additional services that may become necessary.
If your final bill exceeds this estimate by $400 or more, you have the right to dispute the charges through the U.S. Department of Health and Human Services (HHS). To begin the dispute process, you must file within 120 days of receiving the first bill. A $25 administrative fee may apply.
More information can be found at: www.cms.gov/nosurprises or by calling 1-800-985-3059.
You may request an updated Good Faith Estimate at any time during your care.
Types of Services Included in Your Estimate
Because every patient’s needs are different, your Good Faith Estimate may include services such as:
Initial Consultation
A comprehensive evaluation of your medical history, health goals, symptoms, and lifestyle factors. This may include ordering diagnostic testing necessary for personalized treatment planning.
Follow-Up Visits
Ongoing appointments to monitor progress, review lab results, adjust treatment plans, and provide medical guidance.
Optimization & Preventive Care Services
Depending on your personalized plan, this may include:
Hormone optimization
Weight management support
Preventive health reviews
Treatment plan development
Lifestyle and performance counseling
Diagnostic Testing
If applicable, lab work and specialty testing will be itemized separately. Costs vary based on labs used and complexity of testing.
What Cannot Be Predicted in Advance
The total cost of your care depends on:
Your individual health goals
Diagnostic findings
Frequency of follow-up visits
Your response to treatment
Any adjustments to your plan over time
Like all medical care, treatment is considered a trial of care — meaning outcomes vary and no specific result can be guaranteed.
Closing Statement
Allostat Health is committed to full transparency, ethical billing practices, and a patient-centered experience. If you have any questions about your estimate, your rights, or your treatment plan, please reach out to us directly so we can review everything with you.
