YOUR RIGHT TO RECEIVE A GOOD FAITH ESTIMATE
Effective Date 10/11/2026
Dedicated Fitness & Wellness, LLC (the "Practice") is a self-pay practice. We do not accept or bill health insurance. Under the federal No Surprises Act, you have the right to know what your care will cost before you receive it.
YOU HAVE THE RIGHT TO RECEIVE A "GOOD FAITH ESTIMATE" EXPLAINING HOW MUCH YOUR MEDICAL CARE WILL COST
Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
HOW GOOD FAITH ESTIMATES WORK AT OUR PRACTICE
When you will receive one
- If you schedule a visit or enroll in a program at least 3 business days in advance, we will give you a written Good Faith Estimate within 1 business day of scheduling.
- If you schedule at least 10 business days in advance, we will give you a written Good Faith Estimate within 3 business days of scheduling.
- If you ask for a Good Faith Estimate before scheduling, we will provide one within 3 business days of your request.
Your Good Faith Estimate will be provided in writing, by email or through our patient portal, or on paper if you prefer.
What it includes
Your Good Faith Estimate will list the items and services we expect to charge you for, such as your Initial Comprehensive Wellness Evaluation, program fees, follow-up visits, and any medication costs included in your program price. For ongoing programs billed on a recurring basis, one Good Faith Estimate may cover up to 12 months of expected charges. If your treatment plan changes in a way that affects cost, we will give you an updated estimate.
What it does not include
Laboratory testing is performed by independent laboratories, which bill you directly. Those charges are not included in our Good Faith Estimate. You may ask the laboratory for its own Good Faith Estimate.
A Good Faith Estimate is an estimate, not a contract, and does not require you to receive any service from us.
HOW TO REQUEST A GOOD FAITH ESTIMATE
You may request a Good Faith Estimate at any time, including before scheduling, by contacting us:
Dedicated Fitness & Wellness, LLC
Email: info@dedicatedfitnesswellness.com
Phone: 302-302-6296
Mailing Address: 30782 Molly B Road, Lewes, DE 19958
Website: www.dedicatedfitnesswellness.com
IF YOUR BILL IS HIGHER THAN YOUR ESTIMATE
If you are billed at least $400 more than your Good Faith Estimate, please contact us first so we can review the charges. You also have the right to start the federal patient-provider dispute resolution process. You generally must start the dispute within 120 calendar days of the date on your original bill. Starting a dispute will not affect the quality of the care you receive from us.
To learn more or to start a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.