Accessible Beauty Through Personalized Financial Solutions

The fees indicated on the quote you have been or will be given are for the procedures listed and reflect a compassionate care rate for self-pay patients. Please review the quote to ensure all desired services are included. Any additional discounts given are for the procedural plan as listed. Deviation from that plan may result in loss of discount. La Belle Vie’s quotes are an estimate only and are subject to change at the doctor’s discretion. Our quotes for self-pay patients are inclusive of the following expenses: all operating room (facility) fees, doctor’s fees, anesthesia, implants (when applicable), pre-op and post-op visits and the first two garments.

Fees do not include prescription drugs, necessary laboratory fees or additional garments. Any revisions or touch ups are subject to additional facility, doctor and anesthesia fees. In the event that Lab Work/EKG/Medical Clearance is required prior to surgery, we must receive documentation prior to your pre-operative appointment, or we reserve the right to cancel surgery (please refer to our cancellation policy).

A deposit of $1,000.00 is due at the time you schedule your surgery to reserve the surgery day. Surgery times are scheduled to benefit all patients as determined by the doctor. As such, your time may change so we ask that all patients be flexible with the actual time of their surgery. A deposit holds a date for surgery, not the time. The remainder of the procedure fee is due two (2) weeks (14 days) prior to surgery or at the pre-operative appointment, whichever comes first.

La Belle Vie’s surgery days are all day Wednesdays and Thursdays, Fridays 8:00 am to 1:00pm and every second Tuesday of the month. Surgeries are performed at our Tukwila surgery center at 16400 Southcenter Parkway, Suite 101. Available days should be discussed with our front office staff.

Payments may be made to our office by cash, check, cashier’s check, money order, Visa, MasterCard or through an approved finance company. Dr. Mangubat also accepts Discover and American Express. Third party and business checks are not accepted.

Personal checks cannot be accepted less than two (2) weeks (14 days) prior to surgery. We do offer a 5% cash discount on surgery fees only if the total quoted fee is paid in cash, check or Cashier’s check. Debit and credit card payments toward an invoice do not qualify for and will void the cash discount.

The deposit is fully refundable up to thirty (30) days prior to surgery. Surgery cancellations within 30 days of surgery but prior to your pre-operative visit will NOT be refunded the $1000 deposit. Surgery cancelled after your pre-operative appointment but more than 1 week prior to surgery are eligible for a refund of 50% of the total surgery fee. Surgery cancellations within 7 days of surgery are not eligible for a refund.

We offer Care Credit financing as an option.

You are responsible for ensuring there is no lapse in coverage for services provided. If there are any lapses in insurance or your policy does not cover certain services, you are responsible for all charges. Most insurances cover at least part of a charge but if you have any questions on coverage, we encourage you to talk to our insurance coordinator or call your insurance provider.

Some of the procedures we provide may be covered by insurance in network or out of network. Our insurance coordinator or front office staff can confirm if the procedure you are considering can be billed to your insurance. If your surgery can be billed, please be sure you have completed the necessary insurance paperwork and provided us with a copy of your insurance card. Our insurance coordinator will verify benefits and obtain pre-authorization.

If we are in network with your insurance, she will submit all covered charges to your insurance company. If we are out of network, we will require you to pay the compassionate care rate to our office, and our insurance coordinator will provide you with the necessary documents so you can submit for reimbursement after your surgery has been completed. Be aware that your insurance may not reimburse you for the full fee you paid for surgery but will base their reimbursement on their allowable out of network fee.

If La Belle Vie bills your insurance provider, we will be billing the full surgeon, facility and anesthesia fee, so fees billed to your insurance may differ from the compassionate care fees shown on the quote you will be given. You will be responsible for all deductibles, co-payments, co-insurance amounts or any other patient responsibility indicated by your insurance carrier or our financial policies, which are not otherwise covered by an accepted supplemental insurance.

If you are to receive any insurance reimbursements as a result of claim submission by La Belle Vie, it is your responsibility to ensure that you forward said payment to our office to apply to your outstanding balance.

Surgery can be scheduled once we have received either a signed letter of agreement from your insurance carrier, a prior authorization approval, or it has been verified that prior authorization is not required by your insurance carrier. Surgery times are scheduled to benefit all patients as determined by our surgeons.

Thus, your time may change so we ask that all patients be flexible with the actual time of their surgery. Any patient cost shares for pre-operative visits and surgery, such as deductibles, co-pays and co-insurances are due at the pre-operative appointment, which is usually scheduled for 10-14 days, but can be as much as 30 days before the scheduled surgery appointment.

La Belle Vie’s surgery days are all day Wednesdays and Thursdays, Fridays 8:00 am to 1:00pm and every second Tuesday of the month. Surgeries are performed at our Tukwila surgery center at 16400 Southcenter Parkway, Suite 101. Available days should be discussed with our front office staff.

Payments for any patient cost-shares may be made to our office by cash, check, cashier’s check, money order, Visa, MasterCard or through an approved finance company. Dr. Mangubat also accepts Discover and American Express. Third party and business checks are not accepted. Personal checks will not be accepted less than two (2) weeks (14 days) prior to surgery

We do require 30 days’ notice if you need to cancel your surgery. If surgery is cancelled with less than 30 days’ notice, you may forfeit part, or all of the fees or deposit already paid.

You are responsible for ensuring there is no lapse in coverage for services provided. If there are any lapses in insurance or your policy does not cover certain services, you are responsible for all charges. Most insurances cover at least part of a charge but if you have any questions on coverage we encourage you to talk to our insurance coordinator or call your insurance provider.

You are responsible for informing us of any changes in your insurance status. If you received a new insurance card or have any changes in insurance provider, policy, or coverage, please let our office know as soon as possible. It is important to keep this information up to date so that your medical claims are paid correctly and promptly. If your insurance changes after prior authorization has been obtained, a new prior authorization may be required.

Should collection proceedings or other legal action become necessary to collect an overdue or delinquent account, you understand that La Belle Vie has the right to disclose to an outside collection agency or attorney all relevant personal and account information necessary to collect payment for services rendered.

You are responsible for all costs of collection including, but not limited to late fees, interest due as a result of delinquency, all court costs and fees to the extent allowed by law. If your account is referred to a collection agency, attorney, court, or the past due status is reported to a credit reporting agency, it may have an adverse effect on your credit history; and related portions of your account, including the fact that you received treatment at our offices, may become a matter of public record.