Effective August 1st, 2026.

This page provides the complete detail behind the Practice Policies and Financial Agreement form you sign when you begin care with Michigan Wellbeing Therapy Clinic (MI Wellbeing LLC). It is referenced by that form and forms part of it. We may update this page from time to time, and the effective date above will change when we do.

Appointments and Cancellations

Clients are required to cancel or reschedule appointments at least 24 hours in advance to avoid being charged for the session. If a cancellation or reschedule request is made with less than 24 hours' notice, the client may be responsible for the full session fee. This policy is in place because appointment slots are reserved exclusively for the client, and cancellations with insufficient notice often prevent the clinic from scheduling other clients who may need services. The standard meeting time for psychotherapy is 53 minutes, unless otherwise agreed upon between the clinician and the client. A $10.00 service charge will be applied for any returned checks due to insufficient funds or other issues requiring special handling.

Fees, Billing, and Insurance

At MI Wellbeing, we accept several major insurance plans and also welcome clients who prefer to pay privately. While we are happy to help with submitting claims and verifying benefits, it is important to know that you are ultimately responsible for any costs not covered by your insurance. This includes deductibles, co-pays, co-insurance, or services that your plan may not cover. By providing your insurance information, you authorize MI Wellbeing LLC to release information necessary for claims processing and authorize payment directly to MI Wellbeing LLC.

The cost for the intake session and ongoing sessions is determined by your insurance and depends on whether you have a deductible or co-pay. You are always welcome to check with your insurance company directly to clarify these details. If your plan covers more than what was charged upfront, we will refund you the difference. If it covers less than expected, or denies the claim, we will charge your card on file for the remaining amount. We ask that all clients keep an active payment method on file so that everything runs smoothly.

We understand that insurance can be confusing, and we are happy to help walk you through the process. If, for any reason, your insurance does not cover your sessions, you would be responsible for our out-of-pocket rate, which starts at $165 per session and may vary slightly depending on the therapist.

Payment authorization. By providing your credit card information to MI Wellbeing LLC, you authorize us to charge your card on file for all applicable fees, including but not limited to session fees, co-payments, co-insurance, deductibles, late cancellation fees, no-show fees, amounts not covered by insurance, returned check fees, and any other outstanding balances. You agree to maintain current card information on file and to notify us immediately if your card is lost, stolen, expires, or is declined. Charges will be processed automatically as fees become due. You have the right to dispute charges within 30 days of the charge date. This authorization remains in effect until revoked in writing, though revocation does not apply to charges already incurred.

Good Faith Estimate

Under the No Surprises Act, health care providers are required to give clients who do not have insurance, or who choose not to use their insurance, an estimate of the expected charges for services. This is called a Good Faith Estimate.

Your Good Faith Estimate is calculated as follows: your clinician's session rate multiplied by the anticipated frequency of sessions (weekly, biweekly, or monthly) multiplied by the number of weeks in a year (52). For example, if your session rate is $165 and you attend weekly sessions, your estimated annual cost would be $165 multiplied by 52 sessions, which equals $8,580. If you attend biweekly sessions, your estimate would be your session rate multiplied by 26, which equals $4,290.

Please note that this estimate is not a contract or guarantee of total costs. Actual charges may differ based on changes in session frequency, additional services requested, or changes in treatment needs. Your clinician will discuss any anticipated changes with you as they arise.

You have the right to receive a personalized written Good Faith Estimate specific to your treatment plan upon request. If you receive a bill that exceeds your Good Faith Estimate by $400 or more, you may dispute the charges. For more information about your rights under the No Surprises Act, visit cms.gov/nosurprises or call 1-800-985-3059. By signing the Practice Policies and Financial Agreement, you acknowledge that you have been informed of your right to receive a Good Faith Estimate and understand how estimated costs are calculated.

Records, Reports, and Professional Services Fees

MI Wellbeing LLC is committed to supporting our clients' overall wellbeing, which sometimes includes coordination with schools, other providers, parents, attorneys, or other parties, as well as preparing records, reports, and letters upon request.

Brief communications, such as a short phone call or email exchange, are typically provided at no additional charge as part of your treatment. However, when coordination of care or professional consultations exceed 20 minutes, you will be charged your clinician's out-of-pocket session rate for the time involved. This includes, but is not limited to, extended phone consultations with parents, guardians, other providers, attorneys, or third parties; extended email exchanges requiring clinical review or detailed responses; and attending school meetings (such as IEP or 504 meetings), court appearances, or other in-person or virtual meetings on your behalf. If in-person attendance is required, the clinician's out-of-pocket rate applies to all time involved, including travel time to and from the location.

MI Wellbeing LLC charges for all records, reports, and letters based on the time required to prepare them at the clinician's out-of-pocket rate, with a minimum charge of 15 minutes. For specialized reports, letters, or forms requiring additional professional time (such as disability determinations, legal reports, treatment summaries for third parties, letters to schools or employers, or completion of extensive paperwork), a minimum charge of 30 minutes applies. Time-based charges include review of records and history; preparation and drafting of reports or letters; consultation with other providers if necessary; and completion of specific forms or questionnaires. Payment is required before the release of records, reports, or letters, and depending on the nature and scope of the request, we may require payment in advance before services are rendered.

Please note that these professional services are not typically covered by insurance and are the client's financial responsibility. For court-related services specifically, please refer to the Court Involvement section below for additional details regarding retainer requirements.

Court Involvement

MI Wellbeing LLC discourages clients from involving their clinician in legal proceedings. Clinicians at our practice are treatment providers, not forensic evaluators, and our role is to support your therapeutic goals rather than to serve as witnesses or experts in legal matters. If you are involved in legal proceedings and anticipate needing forensic evaluation or expert testimony, we recommend seeking a professional who specializes in forensic work.

If a clinician is subpoenaed or otherwise required to provide testimony, the client agrees to pay the clinician's out-of-pocket session rate for all time involved. This includes preparation, record review, travel time to and from court (regardless of distance), waiting time, and actual testimony. A minimum retainer of five (5) hours is required and must be paid in advance before any court-related preparation begins. Any unused portion of the retainer is non-refundable. If the time involved exceeds the retainer, additional hours will be billed at the same rate and are due upon receipt of invoice.

If court-related records, reports, or preparatory work are needed but do not require a court appearance or testimony, these services will be charged in accordance with the Records, Reports, and Professional Services Fees section above. This includes preparation of treatment summaries for attorneys, responses to subpoenas for records only, completion of legal forms, and written declarations that do not require in-person testimony. The client who requested services, or whose treatment is the subject of the legal proceeding, is responsible for all court-related fees, regardless of which party issued the subpoena. Your clinician will discuss anticipated fees with you before proceeding with any court-related service.

Retention of Records

In accordance with Michigan law and professional standards, MI Wellbeing LLC retains client records for a minimum of seven (7) years following the last date of service. For clients who were minors at the time of treatment, records are retained for seven years after the last date of service or until the client reaches age 25, whichever is longer. After the retention period has passed, records may be securely destroyed. If you need copies of your records after your treatment has ended, please contact our office. Standard fees for records preparation may apply.

Notice of Privacy Practices

Effective August 23, 2026.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Our Commitment to Your Privacy

At MI Wellbeing LLC, we understand that your health and mental health information is personal, and we are committed to protecting the privacy of your protected health information (PHI) in accordance with applicable federal and state laws. This notice applies to all staff, clinicians, contractors, interns, and affiliates working under or on behalf of MI Wellbeing LLC. It describes how we may use and disclose your PHI, your rights concerning this information, and our legal duties.

We are required by the Health Insurance Portability and Accountability Act (HIPAA) and Michigan law to maintain the privacy and security of your protected health information, provide you with this Notice of Privacy Practices outlining our legal duties, and comply with the terms of this notice as currently in effect. We reserve the right to update this notice at any time, and changes will apply to all health information we maintain. An updated notice will be made available on our website and by request.

In the unlikely event that there is a breach of your unsecured protected health information, MI Wellbeing LLC will notify you in accordance with the HIPAA Breach Notification Rule. You will be notified in writing without unreasonable delay and no later than 60 days following discovery of the breach. The notification will include a description of what happened, the types of information involved, steps you can take to protect yourself, what we are doing to investigate and mitigate the breach, and contact information for further questions. We take the security of your information seriously and have safeguards in place to prevent unauthorized access to your records.

II. How We May Use and Disclose Your Health Information

We may use or disclose your PHI without your written authorization for the following purposes.

Treatment, payment, and health care operations (TPO). We may use your information to provide care, coordinate treatment, bill for services, and conduct internal operations such as quality review or training. Examples include sharing information between clinicians or with other health care providers involved in your care (treatment), contacting your insurance company for coverage and reimbursement (payment), and supervising clinicians, evaluating service quality, and improving care delivery (operations). Disclosures for treatment are not subject to the "minimum necessary" rule, as full information may be required for clinical decision-making.

Legal disclosures. If you are involved in a legal matter, we may disclose your PHI in response to a court order, subpoena, discovery request, or other lawful process; when required by law, regulation, or government authority; and after reasonable efforts to notify you or obtain a protective order when applicable.

III. Uses and Disclosures That Require Your Written Authorization

Certain disclosures require your explicit written permission.

Psychotherapy notes. Your psychotherapy notes are kept separately from your general medical record and will not be disclosed without your written authorization unless used by your treating clinician, used for internal supervision or training, required by law or regulation (such as audits or investigations), necessary for legal defense in a proceeding you initiate, required to avert a serious and imminent threat, or needed by a coroner or medical examiner.

Marketing and sale of PHI. MI Wellbeing LLC does not and will not sell your PHI or use it for marketing purposes without your explicit written authorization.

IV. Uses and Disclosures That Do Not Require Authorization

We may use or disclose your PHI without your consent in the following legally permitted circumstances: when required by law (such as reporting child, elder, or dependent adult abuse); for public health purposes (such as controlling disease or preventing injury); to oversight agencies (such as audits, investigations, or licensing boards); in connection with legal proceedings (such as court orders or defense against legal claims); to law enforcement, when required or permitted by law; to medical examiners or coroners, for the purpose of identifying a deceased person or determining cause of death; to avert a serious threat to the health or safety of a person or the public; for research, provided protocols comply with HIPAA regulations; for workers' compensation or similar programs; for specialized government functions, such as military or national security operations; and to provide appointment reminders or suggest treatment alternatives.

V. Disclosures Involving Family or Others Involved in Your Care

We may share limited PHI with individuals involved in your care or payment (such as a spouse or parent) unless you object, and you may restrict these disclosures by submitting a written request.

For minor clients (under 18), parents or legal guardians generally have the right to access their minor child's health information. However, there are important exceptions under Michigan law where minors may consent to their own treatment or where disclosure to parents may not be in the minor's best interest. In such cases, we will follow applicable state and federal laws regarding what information may be shared with parents or guardians. We encourage open communication between minors and their parents while respecting the therapeutic relationship and legal confidentiality requirements.

VI. Your Rights Regarding Your PHI

Right to request restrictions. You may request limits on how your PHI is used or disclosed. While we are not obligated to agree, we will accommodate reasonable requests whenever feasible.

Right to request confidential communications. You may request that we contact you in a specific way (for example, only by phone, or at a different address), and we will honor reasonable requests.

Right to access your records. You may request to review or receive a copy of your PHI, excluding psychotherapy notes, which are subject to different protections. Requests will be completed within 30 days, and reasonable copy fees may apply.

Right to amend records. You may request that we correct information you believe is inaccurate. We may deny your request if the record is complete and accurate, but you have the right to submit a written statement of disagreement.

Right to an accounting of disclosures. You may request a list of non-routine disclosures we made of your PHI in the last six years, excluding disclosures for treatment, payment, or health care operations.

Right to receive a copy of this notice. You may request a printed or electronic copy of this Notice at any time.

Right to file a complaint. If you believe your rights have been violated, you may file a complaint with MI Wellbeing LLC or directly with the U.S. Department of Health and Human Services (HHS). You will not face retaliation for filing a complaint.

VII. Consent to AI and Transcription Tools

We use HIPAA-compliant note-taking and AI tools for transcription and documentation. Audio recordings, where used, are for supervision, consultation, or quality review only; all data is protected under HIPAA and the Michigan Mental Health Code; AI tools are used solely for administrative and documentation support under clinician supervision; and you may withdraw your consent at any time without penalty or effect on services. A full description is in the Use of AI and Transcription section of our Care and Confidentiality Details page.

Questions about this page or any of our policies are always welcome. Please contact our office or speak with your clinician.