Therapy fees & insurance

Session fees

• Individual therapy 50 minutes $220
• Couples therapy 50 minutes $240
• Couples therapy 75 minutes $360

Sessions range $220–$360. Longer sessions are prorated, and a limited sliding scale is available for those who qualify.

Money is one of the last things people feel comfortable raising with a therapist, and one of the first things they need to know. If you're quietly working out whether you can afford this, that's a practical question, not a rude one, and I'd rather you ask it out loud than decide the answer in your head and never call.

The standard therapy hour is 50 minutes, and that's what an individual session is built around. Couples work often needs 75 minutes, and that isn't an upsell: two people each need real airtime, and the harder conversations take time to open, to work through, and to land somewhere useful before the hour ends. A shorter couples session can be enough for a check-in, and is often not enough for the conversation that brought you in. What you pay depends on the format and the length, which is why individual therapy and couples therapy sit at different points on the same fee schedule.

What the fee covers

You're buying a licensed clinician's time and attention, and licensure in California isn't a formality. A marriage and family therapist completes a graduate degree, then thousands of supervised clinical hours, then state exams, before the Board of Behavioral Sciences will issue a license, and it has to be renewed and kept current with continuing education after that. I'm a Licensed Marriage and Family Therapist (CA LMFT #139263), and you can verify my license with the California Board of Behavioral Sciences for free. If you're comparing therapists, checking the license is a reasonable thing to do, and no good clinician will mind.

The fee also carries the cost of running a small practice: an office, professional liability coverage, secure record keeping, scheduling and billing, clinical consultation, and the training that keeps the work current. And it pays for time you never see. Notes, coordination, and thinking about your situation between sessions are part of the work, not extras.

Payment

I ask for a credit card or HSA card on file at the first session, which is charged after each appointment.

Insurance & out-of-network

I don't accept or bill insurance directly. If you have out-of-network benefits, you can seek reimbursement through your own plan. I'll provide a superbill on request that you can submit to your insurer.

The reasons are structural rather than personal. When a practice joins an insurance panel, the panel sets the contracted rate rather than the practice, a billable mental health diagnosis has to go into your record, and the insurer can review or limit the course of treatment. For me, that puts too many third parties in the room.

I want to be honest that this is a real cost to you, not just a preference of mine. Out of network means you pay the practice directly, and if you want your insurance to contribute, you pursue that yourself afterward. It's worth finding out in advance exactly what your plan will do, because the answer varies more than people expect.

What to ask your insurance company

Call the member services number on the back of your card and ask, in this order:

• Do I have an out-of-network outpatient mental health benefit at all? Some plans don't. HMO and Medi-Cal coverage is generally built around a closed network, so care outside that network often isn't covered.
• What's my out-of-network deductible for this benefit, and how much of it have I already met this year?
• Once the deductible is met, what percentage of the allowed amount is reimbursed, and what's the allowed amount for the service codes my therapist will bill?
• Is there a limit on the number of sessions per year?
• Is pre-authorization required, and does anything have to be filed before the first appointment?
• How do I submit a claim, and is there a deadline after the date of service?

Write down the date, the name of the person you spoke to, and the reference number for the call. I can tell you which service codes will appear on your superbill, so you're asking about the right ones. And the percentage people quote to themselves, "my plan covers 70 percent", is a percentage of the plan's allowed amount, not of what you actually paid. That difference is where most of the surprise lives.

Your right to a Good Faith Estimate

This one is federal law and worth knowing. Under the No Surprises Act, if you're uninsured or you're choosing not to use insurance to pay, you're entitled to a written Good Faith Estimate of the expected cost of your care before treatment begins. For ongoing therapy, that estimate can cover the sessions expected over a period of time rather than a single visit. There's also a dispute process if the final bill exceeds the estimate by a set threshold, currently $400 or more.

You don't have to ask for it politely or wait to be offered it. It's your right, and it applies to any provider you approach. Ask me for one and I'll provide it.

If the fee is out of reach

A limited sliding scale is available for those who qualify, and the only way to find out is to ask. Asking is ordinary. Something like this is plenty:

Your fee is more than I can manage right now. Do you have a sliding scale, and if not, is there someone you'd point me toward?

Nobody thinks less of you for that sentence. Sometimes the useful answer isn't a lower fee but a different rhythm: meeting every other week for a stretch, or working in a focused block with a clear scope. And sometimes the answer is that I'm not the right fit for your budget right now. If that's where we land, I'll say so and help you look elsewhere.

There are genuinely lower-cost routes in California, and they aren't consolation prizes:

• County behavioral health services, which serve residents with Medi-Cal or limited income.
• Community mental health and nonprofit counseling agencies, which often run sliding scales of their own.
• Training clinics, where pre-licensed associates and trainees see clients at reduced fees while a licensed clinician reviews the work week to week.
• Your employer's assistance program, which often includes a set number of free counseling sessions and is easy to forget you have.
• A college or university counseling center, if you or your adult child is a student.
• Your own plan's in-network directory, which is the cheapest route if you have mental health coverage and someone on the panel is a good fit.

Scheduling & cancellations

Sessions are typically scheduled weekly, in person at the Santa Rosa office or by telehealth anywhere in California. If you need to cancel or reschedule, please give at least 48 hours' notice.

The fee isn't the whole cost of therapy. There's also the drive across town, the half day off work, the childcare. Those costs are invisible on a fee schedule, and they're part of why a standing appointment gets hard to keep. Meeting by secure video removes most of them, which is part of why I offer online therapy anywhere in California alongside in-person sessions. A session you can actually keep on a hard week is worth more than one you cancel, and it's worth talking about rather than defaulting to whichever is cheaper.