Good Faith Estimate Notice

(No Surprises Act)

Effective Date: January 6, 2026

Under federal law, including the No Surprises Act, health care providers are required to provide a Good Faith Estimate (GFE) to clients who are uninsured or who choose not to use insurance.

Your Right to a Good Faith Estimate

You have the right to receive a written Good Faith Estimate of expected charges for therapy services provided by Michigan Wellbeing.

This estimate:

• Is based on information known at the time

• Reflects expected costs for scheduled services

• Is not a contract and does not obligate you to receive care

Billing Protections

If you receive a bill that is $400 or more above your Good Faith Estimate, you may have the right to dispute the charges through a federal patient-provider dispute resolution process.

More information is available at: www.cms.gov/nosurprises

How to Request an Estimate

Good Faith Estimates are provided:

• Automatically when scheduling self-pay services, or

• Upon request before beginning treatment

To request a GFE or ask questions:

Email: Info@MIWellbeing.org
Phone: (248) 266-5775‬

Michigan Wellbeing Commitment

We are committed to transparency, ethical care, and compliance with both Michigan law and federal regulations regarding client rights and billing practices.