Good Faith Estimate

In compliance with the Federal No Surprise Act that went into effect January 1, 2022, all healthcare providers are required to notify clients of their Federal rights and protections against “surprise billing.” As an out-of-network provider I am required to do so. The Act requires that I notify you of your right to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.

Additionally, I am required to provide you with a Good Faith Estimate of the cost of services. It is difficult to determine the true length of treatment for mental health care, and each client has a right to decide how long they would like to participate in mental health care. Therefore, if you choose to begin treatment with me, I will generate a Good Faith Estimate of what it would cost you out-of-pocket to work with me for a year. Your treatment may not last a year. I will collaborate with you as we go on to determine how many sessions you may need.

The Good Faith Estimate I provide you may be reduced by any out-of-network reimbursements that, if you have an out-of-network benefit, can come to you from your insurer. If you choose to use out-of-network benefits for your care, I will issue you something called a superbill to send to your insurer each month.

Once I have generated a Good Faith Estimate for you please keep it for your records. If you have any questions, please don’t hesitate to ask.

Thank you very much,

Larry Conner MA LPC

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