Good Faith Estimate
Provider information: Aubrey Galley at Desert Poppy Therapy, LLC
Practice name: Desert Poppy Therapy, LLC
Provider name & credentials: Aubrey Galley, MC, LPC
Contact: Phone: (928)325-2913 Email: aubrey@desertpoppytherapy.com
Services and Standard Costs
| Service | Code | Cost |
|---|---|---|
| Initial evaluation | 90791 | $200 |
| Individual therapy (53-60 min) | 90837 | $150 |
| Individual therapy (45 min) | 90834 | $125 |
Estimated total cost for one year (Individual therapy 53-60 minutes):
Example based on weekly sessions: $150 x 52 = $7,800
Example based on bi-weekly sessions: $150 x 26 = $3,900
Example based on monthly sessions $150 x 12 = $1,800
How long you need to engage in therapy and how often you attend sessions will be influenced by many factors including but not limited to:
- Your schedule and life circumstances
- Therapist availability
- Ongoing life challenges
- The nature of your specific challenges and how you address them
- Personal finances
You and your therapist will continually assess the appropriate frequency of therapy and will work together to determine when you have met your goals and are ready for discharge and/ or a new "Good Faith Estimate" will be issued should the frequency of session(s) or needs change. As related, you may request a new Good Faith Estimate at any time in writing during your treatment.
Additional fees (if applicable)
Records request $30
Please refer to our Practice Policies for a complete list of fees and services. Fees are subject to change within thirty (30) days' written notice.
The rates listed in this Good Faith Estimate reflect our standard, undiscounted billing fees. However, this practice offers a Sliding Scale Fee Program for eligible individuals. If you qualify for this program, your actual out-of-pocket cost per session may be significantly lower than the standard estimates listed above. If you are approved for a sliding scale discount, a revised Good Faith Estimate reflecting your specific, lowered rate will be issued to you prior to your next scheduled service.
Disclaimer and required notices:
- This Good Faith Estimate (GFE) shows the costs of services that are reasonably expected for your mental healthcare needs based on information known at the time of estimate. The actual charges may differ if your needs or treatment plan change.
- The GFE does not include unknown or unexpected costs that may arise during treatment. You may be charged more if complications or special circumstances occur.
- If you receive a bill that is at least $400 more than this GFE, you have the right to dispute the bill.
- You may contact Desert Poppy Therapy, LLC at the contact information above to discuss the bill, request an updated GFE, negotiate charges, or inquire about financial assistance.
- You may also initiate a dispute resolution process with the U.S. Department of Health and Human Services (HHS) within 120 calendar days of receiving the bill. There is a $25 fee to use this process. If the agency agrees with you, you will pay the GFE amount; if not, you may be responsible for the higher charge.
- For more information, visit cms.gov/nosurprises or call 1-800-985-3059.
This Good Faith Estimate (GFE) is not a contract and does not obligate you to receive the services listed.
A personalized Good Faith Estimate containing these details, specific to you and your care, is provided in writing to every client before services begin, and you may request an updated copy in writing at any time.