Good Faith Estimate
You have the right to receive a Good Faith Estimate explaining how much your medical care will cost. Purelivity Wellness is a self-pay practice and does not bill insurance, so this right applies to every patient we treat.
1. Your right to a Good Faith Estimate
Under the No Surprises Act, health care providers must give patients who do not have insurance, or who are not using insurance, an estimate of the expected charges for medical services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency services, including related costs such as medical tests, prescription drugs, equipment, and fees. You can ask for one before you schedule a service, and we will also provide one automatically when you schedule.
Make sure to save a copy or take a picture of your estimate.
2. What our services cost
Purelivity Wellness publishes flat pricing, which means the estimate you receive should hold few surprises. Current pricing is:
- Testosterone evaluation — $99, one time. Includes provider consultation, laboratory testing required to make a treatment decision, and your treatment plan.
- Testosterone therapy — $150 per month, if treatment is appropriate for you. Includes medication, supplies, shipping, monitoring laboratory work and provider review.
- Medical weight loss — no evaluation fee. $275 per month for semaglutide or $389 per month for tirzepatide, including medication, supplies, home delivery and dose management.
Full details are on our pricing page. Completing an evaluation does not guarantee that treatment will be prescribed, and you are not charged a monthly price for a programme you do not begin.
3. What an estimate is, and is not
A Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs. The estimate is based on information known at the time it is created.
A Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment, and it is not a contract, a bill, or a guarantee that any particular treatment will be offered to you. If your provider recommends something that was not included in your estimate, you can ask for an updated estimate before you agree to it.
4. If you are billed more than your estimate
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill through the patient-provider dispute resolution process.
You may start the dispute process within 120 calendar days of the date on your bill. There is a fee to use the dispute process. If the dispute resolution entity agrees with you, you will pay the price on the Good Faith Estimate. Starting a dispute will not affect the quality of the care you receive.
5. How to request an estimate
You can request a Good Faith Estimate at any time, before scheduling and without obligation. Contact us at info@purelivitywellness.com or (832) 460-4030 and we will provide one in writing.
When you schedule a service, you will receive a Good Faith Estimate in writing within the timeframes required by law. You may ask any provider for a Good Faith Estimate before you schedule an item or service.
6. More information
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
This notice explains your rights regarding cost estimates. It does not change our Financial Policy, our Terms of Service, or the clinical judgement that determines whether treatment is appropriate for you.