You have the right to a Good Faith Estimate explaining how much your medical care at Upstream Functional Medicine will cost. Healthcare providers are required to estimate the cost of services for patients who are self-paying or not using their insurance because the provider is out of network for their benefits. This estimate should include the total expected costs of any non-emergency items or services, including costs like medical tests, prescription drugs, equipment, and hospital fees that are being billed directly by the provider. This allows you to make the best decision about your own healthcare services and expenses. 

 

Upstream Functional Medicine provides non-emergency outpatient services, medical lab testing, prescription medications, and over-the-counter vitamins and supplements.. Upstream Functional Medicine does not sell equipment or hospital services.

 

There are 2 ways medical visits and health coaching services are billed at Upstream Functional Medicine:

  1. As part of a prepaid PROGRAM OR SUBSCRIPTION that is not based on the amount of time you spend with the doctor and nurse/health coach at each visit.
  2. As an HOURLY rate based on the number of minutes you spend receiving services with the doctor or nurse/health coach.

PRE-REGISTRATION IS REQUIRED FOR ALL PREPAID PROGRAMS/SUBSCRIPTIONS. 

If you are not registered for a medical or health coaching program at the time of your visit with the doctor or health coach at Upstream Functional Medicine, you will be billed at the HOURLY rate, which is $500/hour for medical visits (pro-rated at $125/15-minutes), and $200/hour for health coaching visits (pro-rated at $50/15-minutes); additionally, you will be billed for Dr. Julia’s time to answer any patient portal or texting messages at a rate of $125/15-minutes. Completion of medical letters, forms, and other paperwork is also billed at a rate of $125/15-minutes. 

 

Lab services (blood work and other lab testing) prescribed by the doctor at Upstream Functional Medicine may or may not be eligible for insurance reimbursement. When you choose to pay for lab services out of pocket, or when insurance reimbursement for those services is not available, you will be given an estimate of the price for the cost of those labs. 

 

This Good Faith Estimate is not a contract, and signing it does not obligate you to obtain the  services estimated. The Good Faith Estimate is an estimate and may not include any unknown or unexpected costs that may arise during treatment. Therefore, actual items, services, and charges may differ from the Good Faith Estimate.

 

Remember to keep a copy of your signed Good Faith Estimate for future reference. 

 

For questions regarding this law, the No Surprises Act, please see: www.cms.gov/nosurprises.