Good Faith Estimate

Effective Date: May 19, 2026

Notice of Right to Receive a Good Faith Estimate

Under the No Surprises Act, patients who are uninsured or who choose not to use insurance have the right to receive a Good Faith Estimate explaining the expected cost of healthcare items and services before receiving care. Healthcare providers are required to provide this estimate to uninsured or self-pay patients when care is scheduled or when an estimate is requested.

Your Right to an Estimate

You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency healthcare services provided by Outlook Chiropractic & Wellness.

This may include, when applicable:

  • Consultation fees
  • Examination fees
  • Digital X-rays
  • Chiropractic adjustments
  • Care plan visits
  • Wellness-related services
  • Other recommended services discussed with you

When You May Receive a Good Faith Estimate

You may receive a Good Faith Estimate if:

  • You do not have health insurance
  • You have insurance but choose not to use it
  • You request an estimate before scheduling care
  • You schedule a healthcare service at our office

A Good Faith Estimate will be provided in writing, either on paper or electronically, depending on your requested method of delivery. Electronic estimates must be provided in a way that you can save and print.

Estimates Are Not a Final Bill

A Good Faith Estimate is not a contract and does not require you to receive services from Outlook Chiropractic & Wellness. It is only an estimate based on the information available at the time it is created.

The actual cost of care may change depending on:

  • Your consultation or examination findings
  • Whether X-rays or additional services are needed
  • Your recommended care plan
  • The number of visits you choose to receive
  • Changes in your health needs or treatment preferences

If Your Bill Is Higher Than Expected

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

You may also contact our office directly if you have questions about your estimate or bill.

Keep a Copy

We recommend that you keep a copy or photo of your Good Faith Estimate for your records.

Questions or Estimate Requests

To request a Good Faith Estimate or ask questions about expected costs, please contact:

Outlook Chiropractic & Wellness
5300 Northland Dr NE, Suite F
Grand Rapids, MI 49525
Phone: (616) 608-6475

Scroll to Top