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Good Faith Estimate

Your right to a written estimate of what your care will cost, before you receive it.

Avicenna Functional Medicine is a DBA of AIM Microbiome, LLC.

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  1. You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost
  2. How this works at Avicenna

You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
  • If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

How this works at Avicenna

Avicenna Functional Medicine is a cash-pay practice and does not bill insurance. When you schedule care, or whenever you ask, we will give you a written Good Faith Estimate of the expected cost.

Testing and supplement prices are separate from visit fees. If they are part of your plan, ask us about them when you request your estimate.

To ask for a Good Faith Estimate, email info@avicenna.clinic or call (689) 219-0409.

* Our approach complements not replaces conventional medical care. Always consult your physician or qualified healthcare provider before making changes to medications, treatment, or care plan. Read our full Medical Disclaimer.