Good Faith Estimate

Haley Busch, Ph.D., L.P.

Texas State License: 39485

NPI: 1760371470

Good Faith Estimate

As of January 1, 2022, under the No Surprises Act, you are entitled to receive a Good Faith Estimate (GFE) explaining the expected costs of mental health services when you are not using insurance. This is to support financial transparency and allow you to make informed decisions about your care.

At Nuance Therapy, PLLC, I believe in transparency and want you to feel informed and empowered as you begin therapy. This is not a contract and does not obligate you to attend any specific number of sessions. You will only be responsible for each scheduled session at the time of service. No future services will be billed unless explicitly scheduled and agreed to in advance. While it’s hard to predict exactly how many sessions you may need, the information below provides a clear starting point.

Session Rates and Service Codes

Service — Session Length — CPT Code — Rate

Diagnostic Intake — 50 minutes — 90791 — $215

Individual Therapy — 50 minutes — 90834 — $215

Individual Therapy — 80 minutes — 90837 — $345

Estimated Total Cost

Examples based on common therapy timelines:

Weekly for 3 months: $215 per individual session x 12 sessions = $2,580

Biweekly for a year: $215 per individual session x 24 sessions = $5,160

Weekly for a year: $215 per individual session x 48 sessions = $10,320

The total cost of your care will depend on the number of sessions you attend, the duration of those sessions, and your therapy goals (short-term vs. long-term). I typically recommend that new clients begin with 8 weekly sessions ($215 per session x 8 sessions = $1,720) to allow for thoughtful assessment and rapport-building. Depending on the therapy needs and goals, most clients either continue at a weekly cadence or reduce to biweekly sessions. Monthly or as-needed sessions are typically recommended for clients who have met their primary therapy goals but wish to maintain ongoing therapeutic support to maintain and achieve lasting therapy progress. Determining session frequency is a collaborative process between the therapist and client.

Important Information and Your Rights

This Good Faith Estimate is not a binding agreement and is meant to help you understand your financial responsibility.

You can pause or end therapy at any time.

If I provide additional services, such as court appearances, reports, or letters, there may be additional fees, as outlined in your consent paperwork.

You may request a revised Good Faith Estimate at any time.

If the actual charges exceed this estimate by more than $400, you have the right to dispute the bill.

To learn more or file a dispute, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Acknowledgement

I acknowledge that I have received this Good Faith Estimate for individual therapy services provided by Nuance Therapy, PLLC. I understand that this document is for informational purposes and that I may request clarification or updates at any time.