Your Rights and Protections Against Surprise Medical Bills (No Surprises Act)
When you receive care at Nourished Roots Nutrition, you are entitled to protections under federal law against surprise billing or balance billing.
What Is “Balance Billing” (Sometimes Called “Surprise Billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. If you see a provider who isn’t in your health plan’s network, you may owe additional costs or the entire bill. “Balance billing” happens when you’re billed for the difference between what your health plan pays and what the provider charges.
The No Surprises Act protects consumers from many forms of balance billing. While Nourished Roots Nutrition is an outpatient private practice (not a hospital or emergency setting), the law still gives you important rights if you are uninsured, out-of-network, or choose to self-pay.
Your Rights If You Are Uninsured or Self-Pay
If you do not have insurance or choose not to use insurance for your services:
You have the right to receive a Good Faith Estimate (GFE) of the expected cost of your care.
You will receive this estimate in writing before your first appointment and/or upon request.
The estimate will include the expected costs for the services you are scheduling and may also include other services that are reasonably expected to be provided.
If you receive a bill that is $400 or more than your Good Faith Estimate, you can dispute the bill.
Dispute Resolution Process
If you are billed for more than the Good Faith Estimate provided:
You may contact Nourished Roots Nutrition first to discuss the charges.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).
To do so, you must submit your dispute within 120 calendar days of the date on your bill.
There is a $25 administrative fee to start the process.
If the agency reviewing your dispute agrees with you, you will only have to pay the amount of your Good Faith Estimate, plus the $25 fee.
To learn more or to begin the dispute process, visit: https://www.cms.gov/nosurprises or call 1-800-985-3059.
Questions or More Information
For questions about your rights under the No Surprises Act, you can contact:
Nourished Roots Nutrition at isabelle@nourished-roots-nutrition.com or (929) 235-8539.
The Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/nosurprises
Good Faith Estimate
Effective September 23, 2025
Details of the Estimate
The following is a detailed list of expected charges based upon your dietitian’s rate for medical nutrition therapy services for up to 6 months. The estimated costs are valid for 6 months from the date of this Good Faith Estimate, unless we send you an updated estimate.
Disclaimer
This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your medical nutrition therapy needs. The estimate is based on the information Nourished Roots Nutrition LLC has gathered from previous clients. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above.
What Is “Balance Billing” (Sometimes Called “Surprise Billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. If you see a provider who isn’t in your health plan’s network, you may owe additional costs or the entire bill. “Balance billing” happens when you’re billed for the difference between what your health plan pays and what the provider charges.
The No Surprises Act protects consumers from many forms of balance billing. While Nourished Roots Nutrition is an outpatient private practice (not a hospital or emergency setting), the law still gives you important rights if you are uninsured, out-of-network, or choose to self-pay.
Your Rights If You Are Uninsured or Self-Pay
If you do not have insurance or choose not to use insurance for your services:
You have the right to receive a Good Faith Estimate (GFE) of the expected cost of your care.
You will receive this estimate in writing before your first appointment and/or upon request.
The estimate will include the expected costs for the services you are scheduling and may also include other services that are reasonably expected to be provided.
If you receive a bill that is $400 or more than your Good Faith Estimate, you can dispute the bill.
Dispute Resolution Process
If you are billed for more than the Good Faith Estimate provided:
You may contact Nourished Roots Nutrition first to discuss the charges.
You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS).
To do so, you must submit your dispute within 120 calendar days of the date on your bill.
There is a $25 administrative fee to start the process.
If the agency reviewing your dispute agrees with you, you will only have to pay the amount of your Good Faith Estimate, plus the $25 fee.
To learn more or to begin the dispute process, visit: https://www.cms.gov/nosurprises or call 1-800-985-3059.
Questions or More Information
For questions about your rights under the No Surprises Act, you can contact:
Nourished Roots Nutrition at isabelle@nourished-roots-nutrition.com or (929) 235-8539.
The Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/nosurprises
Good Faith Estimate
Effective September 23, 2025
Details of the Estimate
The following is a detailed list of expected charges based upon your dietitian’s rate for medical nutrition therapy services for up to 6 months. The estimated costs are valid for 6 months from the date of this Good Faith Estimate, unless we send you an updated estimate.
Disclaimer
This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your medical nutrition therapy needs. The estimate is based on the information Nourished Roots Nutrition LLC has gathered from previous clients. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above.
