Good Faith Estimate Notice
La Belle Medical Spa
Effective Date: May 1, 2026
Last Updated: April 28, 2026
YOUR RIGHT TO A GOOD FAITH ESTIMATE
Under the No Surprises Act (effective January 1, 2022), you have the right to receive a Good Faith Estimate (GFE) of expected charges for healthcare items and services before your scheduled appointment.
La Belle Medical Spa operates as a cash-pay medical spa, meaning all clients are uninsured or self-pay for the purposes of our services. This notice applies to all clients receiving services at either of our locations in Merced and Turlock, California.
WHAT IS A GOOD FAITH ESTIMATE?
A Good Faith Estimate is a written notice of the expected cost of your treatment before it is performed. It is not a contract and does not require you to obtain the listed services. The estimate includes:
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Expected charges for the scheduled service or services
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Any associated fees applicable to your visit
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The name and location of the La Belle Medical Spa provider performing your service
The Good Faith Estimate is based on information available at the time of your consultation and may not reflect additional services recommended or added during treatment without prior discussion.
WHEN WILL I RECEIVE MY GOOD FAITH ESTIMATE?
At La Belle Medical Spa, your Good Faith Estimate will be provided in person during your consultation prior to scheduling or committing to any service. This ensures our providers can give you the most accurate and personalized estimate based on your individual treatment plan.
If you request a Good Faith Estimate before scheduling a consultation, we will provide one within 3 business days of your request.
WHAT SERVICES DOES THIS COVER?
Your Good Faith Estimate covers all services offered at La Belle Medical Spa including but not limited to:
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Injectable treatments (neurotoxins, dermal fillers, PRF, PRP, and related services)
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Laser and device treatments (laser hair removal, PicoSure, Morpheus 8, Icon, and related services)
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Skin and facial services (facials, chemical peels, microneedling, and related services
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Wellness and body services (IV infusions, vitamin injections, body contouring, and related services
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Memberships, packages, and retail products
YOUR PROTECTIONS UNDER THE NO SURPRISES ACT
If you receive a bill that is $400 or more above your Good Faith Estimate, you have the right to dispute the charges through the federal Patient-Provider Dispute Resolution Process.
To initiate a dispute you must:
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Contact La Belle Medical Spa within 120 calendar days of the date of your bill at manager@labellemedicalspa.com
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If the dispute cannot be resolved directly with La Belle Medical Spa, you may submit a dispute to the federal dispute resolution process through the Centers for Medicare & Medicaid Services (CMS) at www.cms.gov/nosurprises
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There is a fee of approximately $25 to use the federal dispute resolution process. If the independent reviewer sides with you, La Belle Medical Spa is required to pay that fee
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You may also contact the California Department of Consumer Affairs or your state insurance commissioner if you believe your rights have been violated
Please note that initiating a dispute does not adversely affect the quality of care you receive at La Belle Medical Spa.
WHAT THE GOOD FAITH ESTIMATE DOES NOT INCLUDE
Your Good Faith Estimate may not account for:
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Additional services recommended by your provider during treatment that were not discussed at the time of your estimate
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Services required as a result of unforeseen clinical circumstances
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Charges from third-party financing providers such as Cherry
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Retail product purchases made at the time of your visit that were not included in your original estimate
HOW TO REQUEST A GOOD FAITH ESTIMATE
You may request a Good Faith Estimate at any time before your scheduled service. To request one:
Email: manager@labellemedicalspa.com
In Person: Ask any La Belle provider at either of our locations during your visit or consultation
We will respond to all Good Faith Estimate requests within 3 business days.
LOCATIONS
Merced 410 E Yosemite Ave, Suite C Merced, CA 95340
Turlock 121 W Main St, Suite B Turlock, CA 95380
ADDITIONAL RESOURCES
For more information about your rights under the No Surprises Act and the Good Faith Estimate requirement, visit:
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Centers for Medicare & Medicaid Services: www.cms.gov/nosurprises
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California Department of Consumer Affairs: www.dca.ca.gov
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U.S. Department of Health & Human Services: www.hhs.gov