Good Faith Estimate

Notice Under the No Surprises Act • Effective January 1, 2022

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.

Your Right to a Good Faith Estimate

Under the No Surprises Act (Section 2799B-6 of the Public Health Service Act), health care providers are required to provide patients who do not have insurance or who are not using insurance with an estimate of the expected charges for medical services. This notice applies to self-pay and uninsured patients.

Because Rooted Health Hormones & MedSpa operates as a direct primary care (DPC) membership practice and does not bill insurance for most services, this notice applies to most services we provide.

What This Means for You

✓You have the right to receive a Good Faith Estimate in writing at least 1 business day before your medical service or item.
✓You can also ask us 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.

Our Membership Pricing

As a direct primary care practice, our membership fees are transparent and published. Your monthly membership constitutes your Good Faith Estimate for included services. Current membership pricing:

Virtual DPC Membership

$99/month

Unlimited virtual visits, messaging, same-day appointments, labs at cost, wholesale medications.

Hormone Optimization Membership

$149–$199/month

Everything in Virtual DPC plus comprehensive hormone testing, BHRT, thyroid optimization, quarterly follow-ups.

Elite GLP-1 Membership

$349/month

Everything in Hormone Optimization plus GLP-1 medication, monthly metabolic monitoring, nutrition coaching, MedSpa discounts.

Add-on services (medspa treatments, IV therapy, additional labs) are priced separately and will be disclosed before any service is rendered. A Good Faith Estimate for any add-on service is available upon request.

Requesting a Good Faith Estimate

To request a written Good Faith Estimate for any service, please contact us:

Rooted Health Hormones & MedSpa, LLC
LaDonna Walker, MSN, APRN, FNP-BC
1120 Hogan Lane, Suite 2B, Conway, AR 72032
Phone: (479) 880-6148
Email: rootedhealthormones@gmail.com

Disputing a Bill

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. For information about your rights regarding bill disputes, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Note: A Good Faith Estimate is not a contract and does not require you to obtain the listed items or services from our practice.