Private Pay Therapy Explained: Why California Executives Choose It

You’re the CFO of a mid-sized tech company. Your insurance offers excellent mental health benefits—$20 copay per session, up to 30 visits per year.

But you’re sitting in your therapist’s office paying $350 out of pocket instead.

Your colleague thinks you’re being financially irresponsible. “Why wouldn’t you use your insurance? You’re literally throwing money away.”

But you know something they don’t: Using insurance would cost you far more than $350.

Across California, executives, physicians, attorneys, and high-level professionals are increasingly choosing to pay for therapy out of pocket rather than use their insurance benefits. This isn’t about money. It’s about privacy, quality, flexibility, and control.

This is the complete guide to private pay therapy—what it is, why it matters, what it actually costs, and whether it’s the right choice for you.

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Table of Contents

1. What Is Private Pay Therapy?
2. How Insurance-Based Therapy Actually Works
3. The Hidden Costs of Using Insurance for Therapy
4. Why California Executives Choose Private Pay
5. The Privacy Advantage: What Private Pay Protects
6. The Quality Difference: Why the Best Therapists Often Don’t Take Insurance
7. The Flexibility Factor: Format, Scheduling, and Treatment Freedom
8. What Private Pay Therapy Actually Costs
9. The ROI Calculation: Is Private Pay Worth It?
10. Insurance vs. Private Pay: Side-by-Side Comparison
11. Superbills and Out-of-Network Reimbursement
12. Tax Deductions and HSA/FSA Options
13. Who Should Choose Private Pay Therapy
14. How to Find Private Pay Therapists in California
15. What to Expect: Logistics and Payment
16. Common Objections Answered
17. The Future of Private Pay Mental Health Care
18. Your Decision Framework

What Is Private Pay Therapy?

Private pay therapy (also called self-pay, out-of-pocket, or cash-pay therapy) means you pay your therapist directly for services without involving insurance companies.

What it looks like:

• You pay the therapist’s full fee at time of service
• No insurance company is billed
• No claims are submitted
• No pre-authorization required
• You receive a receipt for your records
• You may or may not seek reimbursement from insurance later

What it’s NOT:

• It’s not “concierge” or “luxury” therapy (though some private pay practices are premium-positioned)
• It’s not always more expensive (we’ll break down costs)
• It’s not only for the wealthy (though affordability is a real consideration)
• It’s not unethical or insurance fraud (it’s completely legal and common)

The Two Types of Private Pay

1. Pure Private Pay

• You pay out of pocket, period
• No insurance involvement at any point
• No intention to seek reimbursement
• Most protective of privacy

2. Private Pay with Superbill

• You pay therapist directly
• Therapist provides detailed receipt (superbill)
• You submit superbill to insurance for out-of-network reimbursement
• Insurance may reimburse 50-80% of cost
• You still create insurance records (less privacy than pure private pay)

For the rest of this guide, we’ll focus on pure private pay unless otherwise specified.

How Insurance-Based Therapy Actually Works

To understand why people choose private pay, you need to understand what happens when you use insurance for therapy.

The Insurance Process

Step 1: You find an in-network therapist

• Your choices are limited to therapists who accept your specific insurance
• Many specialized or experienced therapists don’t take insurance
• Availability may be limited

Step 2: Therapist diagnoses you

• Insurance requires a mental health diagnosis to pay for treatment
• Common codes: Generalized Anxiety Disorder, Major Depressive Disorder, Adjustment Disorder
• This diagnosis becomes part of your permanent medical record
• You can’t receive insurance-covered therapy without a diagnosis

Step 3: Therapist submits claims

• Each session is reported to insurance with diagnosis code
• Insurance company reviews and approves payment
• They may request treatment notes or justification
• They track frequency, duration, and type of treatment

Step 4: Insurance dictates parameters

• Session length (usually 45-50 minutes, sometimes 60)
• Frequency (they may limit number of sessions)
• Treatment type (may not cover certain approaches)
• Progress reviews (some require periodic justification for continued treatment)

Step 5: Records are created and stored

• Your diagnosis goes into insurance databases
• Claims history is tracked
• Information may be shared with Medical Information Bureau (MIB)
• Records exist permanently

What Insurance Companies Know About Your Therapy

When you use insurance, they have access to:

• Your name and identifying information
• Diagnosis code(s)
• Date of each session
• Duration of each session
• Type of therapy
• Therapist’s name and credentials
• Sometimes: detailed treatment notes (depending on plan and whether you’re audited)

Where This Information Goes

Insurance company databases

• Stored for claim processing and fraud prevention
• Accessible across different insurance companies you may have in the future

Medical Information Bureau (MIB)

• Centralized database used by insurance companies
• May affect future life insurance, disability insurance, or health insurance applications

Background checks

• Some employment background checks can access medical records (with your authorization)
• Security clearance processes may review mental health history

Legal proceedings

• Can be subpoenaed in divorce, custody battles, litigation
• May become evidence in legal cases

Professional licensing

• Some licensing boards require disclosure of mental health treatment
• Records may be requested during licensing renewals or applications

The Hidden Costs of Using Insurance for Therapy

The copay or coinsurance is just the beginning. Here are the real costs of insurance-based therapy:

1. The Privacy Cost

The permanent record:

• Once a diagnosis is in the system, it’s there forever
• Even if you fully recover, the code remains
• Future applications (insurance, some jobs) may ask about mental health history
• You lose control over your private information

Real-world impact:

• Executives facing board scrutiny over mental health history
• Physicians dealing with licensing board questions about treatment
• Security clearance delays or denials
• Life insurance premium increases or coverage denials
• Employment background check complications

What you can’t undo: You can’t remove a diagnosis from insurance records. What seemed like a minor issue (like “Adjustment Disorder” during a stressful period) becomes a permanent label.

2. The Limited Choice Cost

Network restrictions:

• You can only see therapists who take your insurance
• Many of the most experienced, specialized therapists don’t participate in insurance networks
• You’re choosing from a limited pool, not the best fit for you

Why top therapists opt out:

• Insurance reimbursement rates are low (often $80-$120/session vs. $200-$400 private pay)
• Administrative burden is significant (claims, pre-authorization, audits)
• They can maintain smaller caseloads and provide better care with private pay
• They want autonomy over treatment without insurance company interference

What this means for you: The therapist perfect for your needs may not be available through insurance.

3. The Treatment Limitation Cost

What insurance restricts:

Session length:

• Typically capped at 45-60 minutes
• Can’t do extended sessions or intensives even if clinically beneficial

Frequency:

• May limit number of sessions per year
• May require justification for more than X sessions
• Can’t do intensive treatment (3x/week or daily if needed)

Treatment type:

• May not cover certain evidence-based approaches
• May not cover couples therapy or family therapy
• May not cover intensive formats

Diagnosis-based:

• Treatment must “match” diagnosis
• Certain issues may not be covered
• Preventative or growth-oriented therapy often isn’t covered

Real impact: You get what insurance will pay for, not what you actually need.

4. The Time and Hassle Cost

Administrative burden:

• Finding in-network providers (limited databases, outdated information)
• Pre-authorization requirements for some plans
• Claims denials and appeals process
• Coordinating between therapist and insurance
• Tracking benefits and limits

Session disruptions:

• Time spent on insurance issues in sessions
• Treatment delays due to authorization
• Switching therapists when insurance changes
• Starting over when network changes

Therapist availability:

• Insurance therapists often overbooked (need high volume to compensate for low rates)
• Less availability means less flexibility
• May wait weeks or months for appointments

5. The Quality Compromise Cost

When therapists accept insurance:

• They need to see more clients to make the same income (20-30+ clients/week vs. 10-15 for private pay)
• Less time for each client
• Higher burnout rates among therapists
• Less energy for continuing education and specialization
• More administrative time, less clinical time

What you get:

• Tired therapist seeing you as one of 25+ clients that week
• Generic treatment (no time to specialize or customize)
• Therapist is thinking about next client, not fully present with you
• Less flexibility in scheduling or format

What you don’t get:

• Therapist with mental space for you
• Specialized expertise (specializing means seeing fewer clients)
• Thoughtful, personalized treatment
• Therapist who’s sustainable and not burned out

6. The Professional Risk Cost

For certain professions, insurance records create specific risks:

Physicians and healthcare professionals:

• Licensing boards in many states ask about mental health treatment
• May require disclosure and explanation
• Records can be requested during licensing reviews
• Can affect credentialing at hospitals

Attorneys:

• Bar associations ask about mental health history for character and fitness
• May require disclosure of treatment
• Can be used in malpractice cases to question judgment
• Partnership track implications

Security clearance positions:

• Mental health history is reviewed in clearance process
• Diagnosis codes may trigger additional scrutiny
• Treatment must be disclosed and explained
• Can delay or complicate clearance

Pilots and commercial drivers:

• FAA and DOT have mental health disclosure requirements
• Certain diagnoses can affect licensure
• Treatment must be reported

Public figures and politicians:

• Mental health records can be weaponized by opponents
• Media may obtain and publicize information
• Diagnosis becomes campaign issue

7. The Future Flexibility Cost

Once you’ve used insurance, you’re locked in:

• Can’t undo the records
• Can’t take back the diagnosis
• Future insurance applications may ask about history
• May affect ability to get certain coverage

Scenarios where this matters:

• Applying for life insurance (underwriting reviews mental health history)
• Applying for disability insurance (pre-existing condition clauses)
• Changing health insurance (mental health history follows you)
• Employment applications asking about treatment history

Why California Executives Choose Private Pay

The decision to pay out of pocket isn’t random. Executives have specific, strategic reasons:

Reason 1: Career Protection

The calculation: “If my mental health history becomes public or accessible to my board, competitors, or media—what does that cost me?”

For executives, the answer is:

• Board confidence and job security
• Reputation and public image
• Competitive advantage
• Career trajectory
• Compensation and opportunities

The strategic choice: Pay $5,000-$10,000 per year for complete privacy vs. risk losing a $500,000+ position over mental health disclosure.

Reason 2: Control Over Treatment

What executives value:

• Choosing the best therapist, not just who takes insurance
• Treatment that fits their schedule (evening, weekends, intensive)
• Session length that matches needs (not insurance limits)
• Evidence-based approaches regardless of coverage
• Ability to pause and resume without insurance approval

The autonomy factor: Executives are used to making strategic decisions. They don’t want insurance companies dictating their mental health care.

Reason 3: Time Efficiency

For high-level professionals, time is literally money:

• One client meeting can be worth $50,000+
• One strategic decision can impact millions
• Administrative hassles with insurance waste valuable time
• Delays in treatment are costly (poor decision-making when stressed)

Private pay means:

• No time spent fighting with insurance
• No delays for pre-authorization
• Schedule sessions when you need them
• Start immediately, not after insurance approval

Reason 4: Privacy Protection

What private pay protects:

Professional reputation:

• No records for background checks to find
• No diagnostic codes for licensing boards to question
• No insurance trail for competitors to discover

Personal privacy:

• Family doesn’t need to know specifics (if you don’t want them to)
• Divorce attorneys can’t subpoena detailed treatment records
• Future relationships aren’t affected by mental health disclosure

Organizational privacy:

• HR never knows you’re in therapy
• Board members don’t have access to information
• No questions about “why are you using mental health benefits?”

Reason 5: Quality of Care

Executives expect excellence in every domain:

• Attorney: Top of field, highly specialized
• Financial advisor: Best credentials, proven track record
• Executive coach: Premium expertise, measurable results

Why settle for adequate therapy when you can access the best?

Private pay gives access to:

• Most experienced therapists
• Specialists in executive challenges
• Therapists who can maintain small caseloads
• Providers who aren’t burned out from insurance hassles

Reason 6: Stigma Avoidance

Even in 2025, mental health stigma exists—especially at executive levels:

The reality:

• Boards still question executives with mental health history
• Competitors use mental health as ammunition
• Media scrutinizes public figures seeking treatment
• “Weakness” narratives persist in leadership

Private pay reduces exposure:

• No insurance company knows
• No employer benefits tracking
• No third-party documentation
• Complete discretion

Reason 7: Flexibility for Life Changes

Executive life is unpredictable:

• Frequent job changes (insurance changes with each job)
• Relocation (insurance networks vary by state)
• Company acquisition (benefits may change)
• Early retirement (losing employer insurance)

Private pay provides continuity:

• Keep same therapist regardless of job changes
• No disruption when insurance changes
• Treatment continues uninterrupted
• Relationship isn’t dependent on employment

The Privacy Advantage: What Private Pay Protects

Let’s get specific about what private pay actually protects:

What Gets Recorded with Insurance

In insurance company databases:

• Your personal identifying information
• Diagnosis code (e.g., F41.1 Generalized Anxiety Disorder)
• Each date of service
• CPT code (type of therapy – 90834, 90837, etc.)
• Provider information
• Total sessions and costs

Potentially in Medical Information Bureau:

• Diagnosis summary
• Treatment dates
• Shared across insurance companies

Accessible in certain circumstances:

• Background checks (with your authorization)
• Court subpoenas
• Insurance underwriting (life, disability)
• Professional licensing reviews
• Security clearance investigations

What Gets Recorded with Private Pay

In therapist’s records only:

• Clinical notes (for treatment purposes)
• Your contact information
• Payment records

Not recorded anywhere else:

• No insurance databases
• No MIB
• No third-party systems
• No diagnostic codes (unless you request them)

Accessibility:

• Only accessible via court subpoena (rare and protected)
• Not available to insurance companies
• Not in background check databases
• Not accessible to employers

Real-World Privacy Scenarios

Scenario 1: The Board Appointment

With insurance: You’re being considered for a board seat. The company conducts a background check. Your mental health treatment appears (you authorized the check). Questions arise about your stability and judgment. The opportunity is lost.

With private pay: Background check shows nothing. Your therapy is your business. Board appointment proceeds smoothly.

Scenario 2: The Security Clearance

With insurance: You’re applying for a position requiring security clearance. You must disclose mental health treatment. Your diagnosis of “Major Depressive Disorder” (from a difficult period 5 years ago) triggers additional scrutiny and delays. Clearance is eventually granted but the process is invasive and stressful.

With private pay: You can honestly say you haven’t been diagnosed with a mental health condition or received treatment through insurance. Your therapy remains private.

Scenario 3: The Divorce

With insurance: You’re going through a contentious divorce. Your ex’s attorney subpoenas your insurance records. Your anxiety diagnosis and therapy notes become ammunition in custody arguments.

With private pay: There are no insurance records to subpoena. Your therapy notes are protected by therapist-client privilege. Your mental health care can’t be weaponized.

Scenario 4: The Life Insurance Application

With insurance: You’re applying for a large life insurance policy. The application asks: “Have you been diagnosed with or treated for any mental health condition?” You must disclose your diagnosis. Your premiums are higher, or coverage is denied.

With private pay: You haven’t been formally diagnosed through insurance. You can truthfully answer that you haven’t received treatment for a diagnosed condition (assuming your therapist hasn’t diagnosed you for insurance purposes).

Scenario 5: The Medical Licensing Renewal

With insurance: You’re a physician renewing your license. The state medical board asks about mental health treatment. You must disclose and explain. The board requests your records. Your licensing renewal is complicated and stressful.

With private pay: You have more control over disclosure. Your therapy records aren’t in insurance databases. You can choose how much to share.

The HIPAA Misconception

Many people believe: “HIPAA protects my therapy records, so using insurance is fine.”

The reality: HIPAA protects your records from unauthorized disclosure, but:

• It doesn’t prevent disclosure to insurance companies (that’s required for payment)
• It doesn’t prevent subpoenas in legal proceedings
• It doesn’t prevent information sharing with MIB
• It doesn’t prevent your authorization of background checks

HIPAA is important, but it’s not absolute privacy.

The Quality Difference: Why the Best Therapists Often Don’t Take Insurance

This isn’t about elitism. It’s about economics and sustainability.

Why Top Therapists Go Private Pay

1. Compensation Matches Expertise

Insurance reimbursement rates:

• $80-$150 per session (varies by insurance and region)
• After overhead, therapists net $50-$100 per session
• To earn $100,000/year, need to see 20-25 clients per week

Private pay rates:

• $200-$400 per session for specialized care
• After overhead, therapists net $150-$300 per session
• To earn $100,000/year, need to see 8-12 clients per week

What this means: Private pay therapists can see fewer clients, provide better care, avoid burnout, and still earn sustainable income.

2. Specialization Requires Smaller Caseloads

To specialize in executive mental health:

• Extensive continuing education (executive coaching training, organizational psychology, trauma certification)
• Time to stay current on research
• Mental space to really know each client deeply
• Ability to customize treatment

Insurance model doesn’t support this:

• High volume requirement leaves no time for specialization
• Can’t afford to limit clientele to specific population
• Generic treatment is faster and easier

Private pay enables:

• True specialization
• Deeper expertise
• Customized, sophisticated treatment

3. Administrative Burden Reduction

Insurance therapists spend significant time on:

• Claim submissions and tracking
• Pre-authorization requests
• Dealing with denials and appeals
• Insurance company audits
• Keeping up with changing policies
• Coding and documentation requirements

Time breakdown for insurance therapists:

• 50 minutes: session
• 10-15 minutes: documentation
• 5-10 minutes: claim submission
• Result: 65-75 minutes per billable session, paid for 50

Private pay therapists:

• 50 minutes: session
• 10 minutes: clinical notes
• Result: 60 minutes total, paid fairly

More time for actual therapy, less administrative hassle.

4. Treatment Autonomy

With insurance, therapists must:

• Assign diagnosis (even when client doesn’t meet criteria)
• Justify treatment approach to insurance company
• Limit session length to what insurance covers
• Sometimes change treatment based on insurance feedback
• Demonstrate “medical necessity”

With private pay, therapists can:

• Provide treatment based on clinical judgment alone
• Use approaches that aren’t insurance-approved
• Offer flexible session lengths
• Focus on growth, not just symptom reduction
• Make decisions based on what helps, not what insurance covers

5. Sustainability and Longevity

Insurance therapists:

• Higher burnout rates
• Shorter careers in the field
• More likely to leave private practice
• Less satisfaction with work

Private pay therapists:

• Lower burnout (seeing fewer clients)
• Longer, more sustainable careers
• Higher job satisfaction
• Better able to maintain empathy and presence

What this means for you: Your private pay therapist is more likely to be energized, present, and effective.

The Cream Rises to the Top

Market dynamics:

• The most sought-after therapists can fill their practice with private pay clients
• They don’t need insurance panels to get referrals
• Their expertise and reputation bring clients
• They can be selective about caseload size

What you get access to: When you’re willing to pay privately, you gain access to therapists who might otherwise be completely booked or unavailable through insurance networks.

The Flexibility Factor: Format, Scheduling, and Treatment Freedom

Private pay removes constraints that insurance imposes.

Session Length Flexibility

Insurance typically covers:

• 45-50 minutes (CPT code 90834)
• Sometimes 60 minutes (CPT code 90837)
• Rarely anything longer

Private pay allows:

• 50 minutes (standard)
• 75 minutes (extended)
• 90 minutes (deep work)
• 2-3 hours (intensive sessions)
• Full-day intensives
• Whatever length is clinically appropriate

Why this matters: Complex issues need more time. Couples work needs more time. Crisis situations need more time. Intensive healing requires concentrated sessions.

Frequency Flexibility

Insurance may limit:

• Number of sessions per year (e.g., 20-30 sessions)
• Frequency (may question more than weekly)
• Require justification for continued treatment

Private pay allows:

• Weekly when you need intensive support
• Twice weekly during crisis
• Daily during intensive treatment programs
• Bi-weekly during maintenance
• Monthly check-ins
• Quarterly intensives
• Whatever frequency serves your needs

Why this matters: Life doesn’t follow insurance company timelines. Crisis requires immediate intensive support. Maintenance doesn’t require weekly sessions.

Schedule Flexibility

Insurance therapists often:

• Work standard business hours (limited evening/weekend availability)
• Book months in advance (high volume)
• Can’t accommodate last-minute needs
• Have rigid schedules

Private pay therapists often:

• Offer evening and weekend sessions
• Have more availability (smaller caseload)
• Can accommodate urgent needs
• Work with your travel schedule

Why this matters: Executives have unpredictable schedules. Therapy should fit your life, not force you to rearrange everything.

Treatment Approach Flexibility

Insurance limits:

• May only cover certain CPT codes (types of therapy)
• May not cover couples therapy, family therapy, or group therapy
• May not cover newer or alternative approaches
• Treatment must match diagnosis

Private pay allows:

• Any evidence-based approach
• Integration of multiple modalities
• Couples intensives
• Group therapy for executives
• Coaching-informed therapy
• Whatever works clinically

Why this matters: You get what you need, not what insurance will pay for.

Continuity of Care

Insurance creates disruption:

• When you change jobs (new insurance, new network)
• When insurance changes networks (lose your therapist)
• When you hit session limits (forced break in treatment)
• When you move (insurance networks are location-specific)

Private pay provides:

• Same therapist regardless of job changes
• No disruption from insurance changes
• Treatment continues as long as needed
• Keep your therapist even if you relocate (telehealth)

Why this matters: The therapeutic relationship is the foundation of healing. Insurance disruptions destroy that continuity.

What Private Pay Therapy Actually Costs

Let’s break down the numbers honestly.

California Private Pay Rates (2025)

Standard sessions (45-50 minutes):

• General therapists: $150-$250
• Specialized therapists: $200-$350
• Executive-specialized: $250-$400
• Top-tier specialists: $350-$500

Extended sessions (75-90 minutes):

• $300-$500 (typically)
• $400-$650 (executive specialists)

Intensive sessions (3 hours):

• $800-$1,200 (general)
• $1,000-$1,500 (specialized)
• $1,200-$2,000 (top-tier)

Couples intensives (full day, 6-8 hours):

• $2,000-$4,000
• $3,000-$5,000 (executive-specialized)

Regional variation:

• San Francisco/Bay Area: Highest (20-30% above state average)
• Los Angeles/Orange County: High (10-20% above average)
• San Diego: Moderate (at state average)
• Sacramento/Central Valley: Lower (10-20% below average)

Monthly Cost Scenarios

Weekly 50-minute sessions:

• Low end: $600-$1,000/month
• Mid range: $1,000-$1,400/month
• High end (executive specialist): $1,200-$1,600/month

Bi-weekly sessions:

• Low end: $300-$500/month
• Mid range: $500-$700/month
• High end: $600-$800/month

Monthly sessions + quarterly intensives:

• Regular months: $250-$400
• Intensive months: $1,200-$1,800
• Annual average: $500-$700/month

Annual Investment

Ongoing weekly therapy:

• $7,200-$12,000/year (general)
• $10,000-$16,000/year (specialized)
• $15,000-$20,000/year (premium executive care)

Flexible model (varies by need):

• $4,000-$8,000/year (average)

What You’re NOT Paying With Private Pay

No copays: (Sounds obvious, but worth noting)

No surprises: You know the cost upfront every time

No denials: No “this session wasn’t covered” months later

No deductibles: No waiting to meet deductible before coverage starts

No coinsurance: No percentages to calculate

No balance billing: Therapist can’t bill you for difference between their rate and insurance payment

No out-of-network penalties: All fees are transparent

Comparing to Insurance

Scenario 1: Good insurance

• $30 copay per session
• 30 sessions covered per year
• Annual cost: $900

vs. Private pay:

• $300 per session
• 24 sessions per year
• Annual cost: $7,200

Difference: $6,300/year

But remember:

• Insurance created diagnostic codes in your record (permanent)
• Limited to in-network therapists
• Limited to 45-50 minute sessions
• Limited to 30 sessions
• Administrative hassles
• Privacy completely compromised

Scenario 2: High-deductible plan

• $3,000 deductible
• After deductible: $50 copay
• 24 sessions per year
• Cost: $3,000 + (24 x $50 if you meet deductible) = ~$4,200

vs. Private pay:

• $300 per session
• 24 sessions
• Annual cost: $7,200

Difference: $3,000/year

Same privacy and choice concerns apply.

Cost Per Hour of Other Professional Services

For context, executives regularly pay:

Attorneys: $400-$800/hour
Executive coaches: $500-$1,000/session (monthly or bi-weekly)
Business consultants: $300-$800/hour
Financial advisors: 1-2% of assets annually (often $10,000+/year)
Personal trainers: $100-$200/hour
High-end hairstylist: $150-$300/appointment

Private pay therapy: $200-$400/hour

Mental health care is comparable to—or less than—other professional services executives use.

The ROI Calculation: Is Private Pay Worth It?

Let’s approach this like the business decision it is.

What Untreated Mental Health Issues Cost

Career costs:

• Poor decision-making (anxiety impairs judgment)
• Missed opportunities (can’t perform at your best)
• Damaged relationships with key stakeholders
• Reputation harm (emotional outbursts, erratic behavior)
• Forced resignation or termination
• Potential cost: $100,000-$1,000,000+ in lost income

Health costs:

• Cardiovascular disease (chronic stress)
• Autoimmune conditions
• Chronic pain
• Substance use disorders
• Medical bills and treatment
• Potential cost: $50,000-$500,000 over lifetime

Relationship costs:

• Divorce (average cost: $50,000-$100,000+)
• Damaged relationships with children
• Lost friendships and support networks
• Potential cost: Immeasurable emotional impact + $50,000-$200,000 financial

Quality of life costs:

• Years of suffering that could be avoided
• Missing your children’s lives while emotionally numb
• Achieving success but being unable to enjoy it
• Potential cost: Your actual life and happiness

What Effective Therapy Returns

Career benefits:

• Better decision-making (one good strategic decision can be worth millions)
• Enhanced leadership presence
• Improved relationships with board, team, stakeholders
• Career longevity (not burning out and having to step down)
• Potential value: $200,000-$2,000,000+ over career

Health benefits:

• Reduced risk of stress-related illnesses
• Better sleep (impacts everything)
• Healthier coping mechanisms
• Longer, healthier life
• Potential value: $100,000-$500,000 in avoided medical costs + years of life

Relationship benefits:

• Protected marriage
• Better parenting
• Stronger support network
• Genuine connection and intimacy
• Potential value: Priceless emotional well-being + $100,000-$500,000 avoided divorce/family costs

Quality of life:

• Actually enjoying your success
• Peace of mind
• Emotional regulation
• Sense of purpose
• Potential value: Everything

The Privacy ROI

What privacy protects:

• Board confidence and job security
• Competitive advantage (mental health can’t be weaponized against you)
• Professional reputation
• Future opportunities (no history to explain)
• Peace of mind (no worry about disclosure)

What’s this worth?

Scenario: You’re a C-suite executive earning $500,000/year. Your mental health history becomes known to the board during a sensitive period. Questions arise about your stability. You’re asked to step down.

Cost of using insurance: Lost position, income, reputation
Cost of private pay: $10,000/year
ROI of privacy: 50:1 ($500,000 protected vs. $10,000 invested)

The Quality ROI

Better therapist means:

• Faster progress (fewer total sessions needed)
• More effective treatment (better outcomes)
• Sustainable results (less relapse)

Scenario:

• Insurance therapist: 52 sessions over 2 years, moderate improvement, some relapse = 104 sessions @ $30 copay = $3,120 + 2 years of ongoing struggle
• Private pay specialist: 24 sessions over 6 months, significant improvement, sustainable practices = 24 sessions @ $300 = $7,200 + resolution in 6 months

Time value: 18 months of improved well-being, better performance, and quality of life
Financial value: Resume full functioning 18 months sooner (immeasurable career value)

The Formula

Annual investment in private pay therapy: $5,000-$15,000

Potential return:

• Career protection: $100,000-$1,000,000+
• Health improvement: $50,000-$500,000+
• Relationship preservation: $50,000-$500,000+
• Quality of life: Immeasurable

ROI: Conservative estimate 10:1, realistic estimate 50:1 or higher

The “I Can’t Afford It” Calculation

Many executives think: “I can’t afford $10,000/year for therapy.”

But they’re spending:

• $15,000/year on luxury car payment
• $8,000/year on golf club membership
• $12,000/year on fine dining and entertainment
• $20,000/year on vacations
• $10,000/year on wardrobe

The question isn’t “Can I afford therapy?”
It’s “Can I afford NOT to invest in my mental health?”

For most executives earning $150,000+/year, private pay therapy is 3-7% of gross income. Less than car payments, comparable to gym memberships and personal training.

Insurance vs. Private Pay: Side-by-Side Comparison

Let’s make this crystal clear:

Superbills and Out-of-Network Reimbursement

There’s a middle ground: Pay privately, then seek reimbursement.

What Is a Superbill?

A superbill is a detailed receipt that includes:

• Your name and identifying information
• Therapist’s name, credentials, and NPI number
• Date of service
• Diagnosis code (if applicable)
• CPT code (type of service – e.g., 90834 for 45-minute session)
• Cost of service
• Amount paid

It’s essentially an invoice formatted for insurance submission.

How Out-of-Network Reimbursement Works

Step 1: You pay your therapist the full fee at time of service

Step 2: Your therapist provides a superbill (some provide automatically, some upon request)

Step 3: You submit the superbill to your insurance company for out-of-network reimbursement

Step 4: Insurance reviews and reimburses a percentage (typically 50-80% of their “allowed amount”)

Step 5: You receive reimbursement check or direct deposit

The Pros and Cons

Pros:

• You recover some cost (often 50-80%)
• You still choose your therapist (not limited to in-network)
• You still get flexible treatment

Cons:

• You still create insurance records and diagnostic codes
• You lose the complete privacy of pure private pay
• There’s administrative work involved
• Reimbursement may be less than you expect
• You’re still subject to session limits and potential audits

When It Makes Sense

Good candidates for superbill/reimbursement:

• You have excellent out-of-network benefits (80% reimbursement)
• Privacy isn’t your primary concern
• You want to offset some cost
• You’re not in a profession with licensing concerns
• You’re okay with diagnosis codes in your record

Not recommended if:

• Privacy is paramount (public figure, clearance position, etc.)
• You’re in a profession with licensing board questions
• Your out-of-network benefits are poor (under 50% reimbursement)
• You want zero insurance involvement

How to Maximize Reimbursement

Check your benefits:

• Call insurance: “What are my out-of-network mental health benefits?”
• Ask about: Reimbursement percentage, deductible, annual limits
• Get it in writing if possible

Understand “allowed amounts”:

• Insurance has a predetermined “allowed amount” for each CPT code
• They reimburse a percentage of THAT, not your therapist’s actual fee
• Example: Therapist charges $300. Insurance “allowed amount” is $150. They reimburse 80% of $150 = $120, not $240.

Keep detailed records:

• Save all superbills
• Track what you’ve submitted vs. received
• Monitor your annual limits

Submit regularly:

• Monthly submissions are easier to track
• Don’t wait until year-end
• Keep copies of everything

What Your Therapist Needs to Provide

Most therapists who offer superbills will include:

• All required identifying information
• Appropriate diagnosis code
• Correct CPT code
• Their NPI number and licensing information

Some therapists won’t provide superbills:

• They may operate as pure private-pay only
• They may not want to assign diagnoses
• They may not want any insurance involvement
• This is their right; ask upfront if superbills are available

Tax Deductions and HSA/FSA Options

Private pay therapy has tax advantages that partially offset costs.

Federal Tax Deductions

Mental health care is a qualified medical expense:

• Can be deducted if you itemize deductions
• Must exceed 7.5% of your adjusted gross income (AGI)
• Includes therapy, psychiatry, prescribed medications

Example calculation:

• AGI: $200,000
• 7.5% threshold: $15,000
• Medical expenses (including therapy): $20,000
• Deductible amount: $5,000

How it works:

• Keep all receipts from your therapist
• Provide to your accountant with other medical expenses
• Include on Schedule A (itemized deductions)

No insurance required:

• You don’t need to submit insurance claims to deduct therapy costs
• Private pay receipts are sufficient documentation

HSA (Health Savings Account)

If you have an HSA:

• Therapy is a qualified expense
• Pay with HSA card or reimburse yourself
• Pre-tax dollars (saves ~25-40% depending on tax bracket)
• Keep receipts in case of audit

Example savings:

• Therapy cost: $10,000/year
• Tax bracket: 32% federal + 9.3% CA = 41.3%
• Tax savings: $4,130
• Net cost: $5,870

HSA advantages:

• Money rolls over year to year (unlike FSA)
• Can invest HSA funds
• Triple tax advantage (contributions, growth, withdrawals all tax-free for medical)

FSA (Flexible Spending Account)

If you have an FSA:

• Therapy is a qualified expense
• Must use funds within plan year (or small rollover)
• Pre-tax contributions
• Same tax savings as HSA

FSA considerations:

• Estimate annual therapy costs carefully (FSA funds are use-it-or-lose-it)
• If you’re planning to start therapy, can increase FSA contribution
• Check your plan’s specific rules

California State Taxes

California also allows medical deductions:

• Same rules as federal (itemize, 7.5% AGI threshold)
• State tax savings in addition to federal

Combined savings example:

• Therapy: $10,000/year
• Federal bracket: 32%
• CA bracket: 9.3%
• Combined savings: $4,130
• Net cost: $5,870

Keep Good Records

What to save:

• All receipts from therapist
• Bank statements showing payment
• HSA/FSA statements
• Insurance reimbursements (if applicable)

How long to keep:

• IRS recommends 3 years
• 7 years if you’re being very cautious
• Digital copies are fine

Working with Your Accountant

Tell your accountant:

• You’re paying for therapy out of pocket
• Whether you’re using HSA/FSA
• Whether you want to deduct (if itemizing makes sense)

They’ll advise on:

• Whether itemizing beats standard deduction
• How to optimize HSA/FSA contributions
• Proper documentation and record-keeping

Who Should Choose Private Pay Therapy

Private pay isn’t right for everyone. Here’s how to know if it’s right for you:

Strong Candidates for Private Pay

1. High-income professionals ($150,000+/year)

• Can afford $300-400/session without financial strain
• Value time and convenience
• Want access to best providers
• Understand ROI of mental health investment

2. Executives and senior leaders

• Privacy is professionally important
• Need flexible scheduling
• Want therapist who understands leadership
• Can’t afford career risks from mental health disclosure

3. Public figures and high-visibility professionals

• Politicians, media personalities, public company executives
• Mental health disclosure could be weaponized
• Privacy is not paranoia—it’s risk management

4. Licensed professionals with disclosure requirements

• Physicians, attorneys, pilots, security clearance holders
• Licensing boards ask about mental health treatment
• Want to minimize records that trigger disclosure requirements

5. People in competitive industries

• Where mental health could be used against you
• Where perception of “weakness” has consequences
• Where confidentiality is strategic advantage

6. Those seeking specialized expertise

• Want therapist with specific training (executive stress, trauma, couples work)
• Willing to pay for specialization
• Quality matters more than cost

7. People with privacy concerns

• Don’t want employer knowing about therapy
• Concerned about future implications of diagnosis
• Value complete control over their information

8. Those wanting treatment flexibility

• Need intensive formats or extended sessions
• Want couples intensives or family therapy
• Don’t want insurance limitations on treatment

Less Ideal Candidates

Private pay may not be the best choice if:

Financial constraint is real:

• $300-400/session would create genuine hardship
• Would have to choose between therapy and necessities
• Income under $100,000/year and no savings

Insurance benefits are excellent:

• Low copay ($10-20)
• No session limits
• Access to good providers in network
• Privacy isn’t a major concern

You’re in crisis and uninsured:

• Need immediate help
• Can’t afford private pay
• Should explore community mental health, sliding scale, or crisis services

You don’t have privacy concerns:

• Not in visible position
• No licensing disclosure requirements
• Comfortable with insurance records
• Want to maximize insurance benefits

The Middle Ground

You might choose a hybrid approach:

• Start with private pay for a few months
• Transition to insurance once stable
• Use insurance for maintenance, private pay for intensive work
• Use private pay for certain issues (couples therapy) and insurance for others (individual therapy)

How to Find Private Pay Therapists in California

Here’s where to look:

Online Directories

Psychology Today

• Filter for “private pay” or “self-pay”
• Filter by location, specialization, issues
• Most comprehensive therapist directory
• psychologytoday.com/us/therapists

GoodTherapy

• Filter for private pay
• Detailed profiles
• goodtherapy.org

TherapyDen

• Social justice-oriented directory
• Private pay options
• therapyden.com

Specialized Practices

Search terms:

• “Private pay therapy [your city]”
• “Executive therapy California”
• “Concierge therapy [your area]”
• “Self-pay therapist [specialty]”

What to look for:

• Practices that explicitly state “private pay only”
• “We don’t accept insurance” language
• Executive or professional-focused practices
• Premium positioning usually indicates private pay

Professional Referrals

Ask:

• Executive coaches (they often know specialized therapists)
• Your attorney or accountant (they work with other executives)
• Trusted colleagues (discreetly)
• Other mental health professionals

Professional networks:

• YPO (Young Presidents’ Organization)
• Vistage groups
• CEO peer groups
• Industry associations

Telehealth Platforms

California-licensed private pay therapists:

• Many offer statewide service via secure video
• Expands your options beyond local geography
• Convenient for busy schedules

What to Ask When Contacting

Initial questions:

1. “Are you accepting new clients?”
2. “Do you accept insurance, or are you private pay only?”
3. “What’s your session fee?”
4. “What’s your experience with [your issue/industry]?”
5. “What session formats do you offer?”
6. “What’s your availability?”

If they seem like a good fit:

• Request a brief consultation (many offer 15-20 minute calls)
• Ask about their approach and philosophy
• Discuss your specific needs and concerns
• Determine if you’d work well together

Red Flags

Avoid therapists who:

• Are vague about fees or experience
• Pressure you to start immediately without consultation
• Can’t articulate their approach clearly
• Seem to promise unrealistic results
• Don’t have proper licensing (verify on state board website)
• Don’t offer secure telehealth platforms

Green Flags

Good signs:

• Clear, transparent pricing
• Professional website and communication
• Specific expertise in your needs
• Thoughtful responses to your questions
• Proper credentials and licensing
• Secure systems and clear policies

What to Expect: Logistics and Payment

Once you’ve found a therapist, here’s how private pay actually works:

Initial Contact and Consultation

Typical process:

1. You contact therapist (phone, email, contact form)
2. They respond within 24-48 hours
3. Brief phone consultation (free, 15-20 minutes)
4. If good fit, schedule first session
5. Complete intake paperwork

What intake paperwork includes:

• Contact information
• Emergency contact
• Medical history (general)
• Current concerns and goals
• Consent forms
• Financial agreement

Payment Structures

Most common models:

1. Pay-per-session:

• Pay at time of service
• Credit card, debit card, or ACH transfer
• Most flexible option

2. Retainer model:

• Pay for multiple sessions upfront (e.g., 4 sessions)
• Use credits as you attend
• Common in executive therapy practices

3. Monthly subscription:

• Fixed monthly fee
• Includes set number of sessions
• Predictable budgeting

4. Package pricing:

• Discounted rate for committing to X sessions
• Pay upfront or in installments
• Less common but some therapists offer it

Accepted Payment Methods

Typically accepted:

• Credit cards (Visa, Mastercard, Amex)
• Debit cards
• HSA/FSA cards
• ACH/bank transfer
• Some accept Venmo, Zelle (though less common for privacy)

Rarely accepted:

• Cash (increasingly uncommon)
• Checks (some therapists still accept)
• Cryptocurrency (very rare)

Cancellation Policies

Standard policies:

• 24-48 hour cancellation notice required
• Late cancellations charged full or partial fee
• No-shows charged full fee
• Emergencies may be exempt (therapist discretion)

Why policies exist:

• Therapist holds that time for you
• Can’t fill last-minute cancellations
• Time is their inventory

Your responsibility:

• Understand policy before starting
• Give notice as early as possible
• Communicate about scheduling conflicts

Receipts and Documentation

What you’ll receive:

• Itemized receipt after each session
• Summary statement (if requested)
• Superbill (if you want to seek reimbursement)

What receipts include:

• Date of service
• Amount paid
• Service provided (therapy session)
• Therapist’s information

For tax purposes:

• Keep all receipts
• Digital copies are fine
• File with other medical expenses

Session Logistics (Online Therapy)

Platform:

• HIPAA-compliant video (Zoom for Healthcare, Doxy.me, SimplePractice, etc.)
• Secure, encrypted
• Link provided before session

Requirements:

• Stable internet connection
• Private space
• Computer, tablet, or phone with camera
• Headphones recommended (for privacy)

Best practices:

• Test technology before first session
• Be in California during session (licensing requirement)
• Minimize distractions
• Treat it like an in-person appointment (not driving, not multitasking)

Confidentiality and Records

What therapist maintains:

• Clinical notes (for treatment purposes)
• Your contact information
• Payment records
• Signed consent forms

What’s protected:

• Everything you discuss in session
• Therapist-client privilege applies
• Records are secure and encrypted

Exceptions to confidentiality:

• Imminent harm to self
• Imminent harm to others
• Child or elder abuse
• Court order/subpoena (though content often protected)

First Session Expectations

What happens:

• Comprehensive assessment (45-50 minutes)
• Discussion of your concerns and goals
• Therapist explains their approach
• Collaborative treatment planning
• Q&A about process

What you should leave with:

• Clear sense of treatment approach
• Initial goals identified
• Next session scheduled
• Homework or action steps (maybe)
• Feeling heard and understood

Common Objections Answered

Let’s address the hesitations people have about private pay:

“I can’t afford it”

The reframe: Can you afford NOT to address your mental health?

Consider:

• What untreated mental health is costing you (career, health, relationships)
• Whether it’s truly unaffordable or just feels expensive
• What you currently spend on less impactful things
• HSA/FSA funds that reduce cost
• Tax deductions that offset expense

If it’s genuinely unaffordable:

• Look for sliding scale providers
• Consider group therapy (more affordable)
• Explore community mental health centers
• Ask potential therapists if they have any lower-cost options
• Some therapists reserve a few sliding-scale spots

“My insurance covers therapy—why not use it?”

The question: What does using insurance actually cost you?

Consider:

• Permanent diagnostic codes in your record
• Limited choice of providers
• Privacy compromised
• Treatment limitations
• Is the copay savings worth these tradeoffs?

For executives: The privacy risk alone often outweighs the financial savings.

“Isn’t this just for rich people?”

The reality: Private pay serves a range of incomes

Who uses private pay:

• Wealthy executives (yes)
• Middle-class professionals who prioritize mental health
• People with privacy concerns regardless of income
• Anyone who values specialized care

It’s not about being rich—it’s about priorities:

• Same people who pay for personal trainers
• Who invest in professional development
• Who hire financial advisors
• Who pay for quality in other domains

“How do I know if the therapist is worth it?”

Valid concern. Here’s how:

Check credentials:

• Licensed? (Verify on CA Board of Behavioral Sciences website)
• Specialized training? (Ask about certifications)
• Experience with your issues? (Ask for specifics)

Consultation call:

• Do they understand your concerns?
• Can they articulate their approach?
• Do you feel heard?
• Does their experience match your needs?

Trial period:

• Commit to 3-4 sessions
• Assess if you’re making progress
• You’re not locked in forever

Trust your gut:

• Do you feel comfortable?
• Do you trust them?
• Are they professional and boundaried?

“What if I lose my job and can’t afford to continue?”

Options:

Discuss with therapist:

• Some offer temporary reduced rates
• Some offer less frequent sessions
• Some can refer you to sliding-scale options

Use savings/HSA:

• If you’ve been contributing to HSA, use those funds
• Mental health care during job transition is crucial, not optional

Adjust frequency:

• Move from weekly to bi-weekly or monthly
• One session a month is better than none

Plan ahead:

• If job loss is possible, discuss with therapist proactively
• Build emergency fund that includes therapy costs

“I don’t want my spouse to know I’m spending this much”

Consider:

Why the secrecy?

• Is money really the issue, or is it stigma about therapy?
• Would your spouse support therapy if they understood the value?
• Are you hiding therapy itself, or just the cost?

If cost is the concern:

• Frame it as health care investment (would they object to $300/month for physical health?)
• Show the ROI (better mood, better relationship, better parenting)
• Use individual discretionary funds if you have separate finances

If therapy itself is the concern:

• Your mental health is not negotiable
• You have a right to private health care
• If relationship doesn’t allow therapy, that’s a bigger issue to address

“What if my private pay therapist isn’t as good as I hoped?”

You can switch:

• You’re not locked into a therapist forever
• Give it 3-4 sessions to assess fit
• If it’s not working, find someone else

How to switch professionally:

• Be honest: “I don’t think this is the right fit for me”
• Ask for referrals to other therapists
• Don’t ghost—have a final session to wrap up

You have complete control:

• That’s one of the advantages of private pay
• No insurance barriers to switching
• Find someone who’s actually right for you

The Future of Private Pay Mental Health Care

Private pay is growing. Here’s where it’s headed:

Current Trends

1. Increasing demand for private pay:

• More executives and professionals choosing it
• Privacy concerns driving growth
• Dissatisfaction with insurance limitations

2. Therapist migration to private pay:

• Burnout from insurance hassles
• Desire for sustainable caseloads
• Better compensation

3. Specialized private pay practices:

• Executive-focused
• Trauma-specialized
• Couples intensives
• Niche populations

4. Technology integration:

• Better telehealth platforms
• Secure payment processing
• Between-session support apps
• AI-assisted (but human-delivered) care

5. Hybrid models emerging:

• Coaching + therapy integration
• Group + individual combinations
• Intensive + maintenance models

What’s Coming

More transparency:

• Clear pricing on websites
• Outcome data sharing
• Client reviews and testimonials

Greater accessibility:

• More therapists offering sliding scale alongside private pay
• Group therapy options at lower price points
• Technology reducing costs

Insurance evolution:

• Some plans offering better out-of-network benefits
• Recognition that private pay reduces their costs too
• Possible integration of private pay into benefits packages (stipends)

Legitimization:

• Private pay becoming mainstream, not fringe
• Medical establishment recognizing value
• Research on outcomes compared to insurance-based care

The Two-Tier Reality

Uncomfortable truth: Mental health care is becoming two-tier:

Tier 1: Insurance-based

• Adequate for many needs
• Accessible and affordable
• Limited choice and flexibility

Tier 2: Private pay

• Premium for complex needs
• Specialized and flexible
• Higher cost, better outcomes for specific populations

This isn’t ideal from equity standpoint (everyone deserves excellent care), but it’s the market reality.

What needs to change:

• Insurance reimbursement rates that allow therapists to provide quality care
• Public mental health funding
• Reduced stigma so more people seek help earlier
• Universal access to quality mental health care

Until then: Those who can afford private pay will choose it, and the gap will persist.

Your Decision Framework

Here’s how to decide if private pay is right for you:

Step 1: Assess Your Situation

Answer these questions:

1. What’s my annual income? _______
2. Can I afford $300-400/session without financial hardship? YES / NO
3. Do I have privacy concerns related to my profession or position? YES / NO
4. Am I in a licensed profession with disclosure requirements? YES / NO
5. Do I value access to specialized therapists? YES / NO
6. Have I been dissatisfied with insurance-based therapy before? YES / NO
7. Do I need flexible scheduling or intensive formats? YES / NO
8. Is my employer or insurance likely to change soon? YES / NO

If you answered YES to 4+ questions: Private pay is likely a good fit

If you answered YES to 2-3 questions: Consider your priorities and weigh options

If you answered YES to 0-1 questions: Insurance-based therapy may be sufficient

Step 2: Calculate the True Cost

Insurance option:

• Copay per session: $_______
• Sessions per year: _______
• Annual out-of-pocket: $_______
• Privacy cost: (How much is complete confidentiality worth to you?)
• Quality/choice limitation: (Can you find the right specialist in-network?)

Private pay option:

• Cost per session: $_______
• Estimated sessions per year: _______
• Annual cost: $_______
• Minus tax savings (if applicable): $_______
• Net annual cost: $_______

ROI consideration:

• What could untreated mental health cost me? $_______
• What could effective treatment be worth? $_______

Step 3: Try It

You don’t have to commit forever:

1. Find a private pay therapist who seems like a good fit
2. Commit to 4-6 sessions (about $1,200-2,400)
3. Assess progress and value
4. Make a longer-term decision after trying it

Questions to assess after 4-6 sessions:

• Am I making progress?
• Do I trust this therapist?
• Is the cost sustainable?
• Is the value worth the investment?
• Do I feel better equipped to handle my challenges?

Step 4: Make the Choice That’s Right for You

There’s no universally right answer:

Choose private pay if:

• Privacy is important to you
• You can afford it comfortably
• You want access to specialists
• Flexibility matters
• You’ve tried insurance therapy and it wasn’t enough

Choose insurance if:

• Cost is a significant barrier
• Privacy isn’t a major concern
• You have good in-network options
• Your benefits are excellent
• You’re comfortable with the trade-offs

Choose a hybrid if:

• You want some reimbursement but also some choice
• You’re willing to create some records for partial cost recovery
• Your out-of-network benefits are strong
• Privacy is less critical

The best choice is the one that gets you the help you need.

How CEREVITY Approaches Private Pay

At CEREVITY, we’re a private-pay-only practice. Here’s why and how it works:

Why We’re Private Pay Only

We made a deliberate choice:

✅ To protect client privacy completely

• No insurance companies involved ever
• No diagnostic codes unless you request them
• No third-party access to your information
• Complete discretion for executives and professionals

✅ To provide the highest quality care

• Small caseloads (10-15 clients per therapist, not 25-30)
• Time to specialize in executive mental health
• Energy to be fully present with each client
• Sustainable practice that prevents therapist burnout

✅ To offer true flexibility

• 50, 75, 90, or 180-minute sessions based on need
• Weekly, bi-weekly, monthly, or intensive models
• Evening and weekend availability
• Treatment determined by what helps, not what insurance covers

✅ To serve our specific population well

• California executives need privacy
• High-achieving professionals value specialized expertise
• Our clients can afford private pay and prioritize their mental health
• This model attracts the clients we serve best

Our Fee Structure

Standard sessions:

• 50 minutes: $300-350
• 75 minutes: $400-475
• 90 minutes: $500-600

Intensive sessions:

• 3 hours: $1,200-1,500

Couples intensives:

• Half day (4 hours): $2,000-2,500
• Full day (6-8 hours): $3,500-4,500

Payment:

• Credit card, debit card, HSA/FSA
• Pay per session or monthly retainer
• Receipts provided for all services

What You Get

For your investment, you receive:

✅ Specialized expertise

• Therapists with extensive executive/professional experience
• Understanding of leadership, organizational dynamics, high-stakes stress
• Clinical training in burnout, anxiety, trauma, couples work

✅ Complete confidentiality

• No insurance involvement
• Minimal records
• Secure, encrypted platforms

✅ Personalized treatment

• Evidence-based approaches (CBT, ACT, trauma-informed, somatic)
• Customized to your specific needs and goals
• Practical tools + deeper insight

✅ Measurable outcomes

• Clear treatment plans
• Regular progress assessment
• Expected improvement within 3 months

✅ Convenience

• Online sessions statewide
• Flexible scheduling
• No commute, no waiting rooms

Most importantly: Support that actually fits your life and helps you lead effectively while living sustainably.

Your Next Step

If you’ve read this far, you’re seriously considering private pay therapy.

Here’s the truth: The “perfect time” doesn’t exist. You’re busy now. You’ll be busy next month. There will always be a reason to wait.

But waiting doesn’t make the problems go away. It just means you face them alone for longer.

Three Options

Option 1: Schedule a Consultation

Talk to us with no obligation:

• 15-minute call to discuss your needs
• Learn if we’re the right fit
• Ask any questions about private pay
• Make an informed decision

📞 Call (562) 295-6650
🌐 Visit cerevity.com/get-started

Option 2: Do More Research

That’s fine too:

• Explore other private pay therapists
• Talk to colleagues who use private pay
• Calculate your specific costs
• Read our other resources

But don’t research forever. At some point, you have to start.

Option 3: Stay Where You Are

You can also choose to:

• Continue managing on your own
• Wait until things get worse
• Hope it resolves itself
• Use insurance despite the trade-offs

That’s your choice. But ask yourself: Is it working?

Final Thoughts

Private pay therapy isn’t about luxury or excess. It’s about getting mental health care that actually fits the life you’re living.

It’s about:

• Privacy when your career depends on it
• Quality when adequate isn’t enough
• Flexibility when your schedule is unpredictable
• Specialization when general practice doesn’t address your needs
• Control when insurance limitations don’t serve you

For California executives and professionals, private pay is often the difference between:

• Therapy that works vs. therapy that’s just okay
• Progress vs. plateau
• Privacy vs. permanent records
• Thriving vs. surviving

The investment is real. The return is greater.

You’ve spent your career building something meaningful. You’ve invested in your education, your skills, your professional development.

Your mental health deserves the same investment.

Three months from now, you could be:

• Leading with more clarity and confidence
• Sleeping through the night
• Present with your family
• Managing stress without it managing you
• Enjoying the success you’ve worked so hard to achieve

Or you could still be here, reading articles about therapy, wondering when you’ll finally take the step.

The choice is yours.

📞 Call (562) 295-6650
🌐 Visit cerevity.com/get-started

CEREVITY: Private Pay Therapy for California Executives

Complete confidentiality. Specialized expertise. Flexible formats. Measurable results.

Because your mental health is worth more than a copay can buy.

Frequently Asked Questions

Is private pay therapy legal?

Yes, completely legal. You have the right to pay for healthcare services out of pocket. Many people choose private pay for various medical services (cosmetic procedures, alternative medicine, etc.). Therapy is no different.

Can I use both insurance and private pay?

You can’t use both for the same therapist simultaneously. But you could:

• Use insurance for one therapist (general support)
• Use private pay for another (specialized work)
• Switch from insurance to private pay with same therapist
• Use insurance until you hit limits, then private pay

Will my therapist tell my insurance company I’m seeing them privately?

No. If you’re paying privately, your therapist has no contact with your insurance company. There’s nothing to report.

What if I have an FSA or HSA?

You can still use those funds for private pay therapy. FSA/HSA money can pay for any qualified medical expense, whether insurance is involved or not.

Do private pay therapists provide worse care than insurance therapists?

The opposite is often true. Private pay therapists:

• See fewer clients (more time and energy for each)
• Can specialize (don’t need to be generalists to fill caseload)
• Have less administrative burden (more time for clinical work)
• Are less burned out (sustainable practice model)

How do I know if my therapist is qualified if they don’t take insurance?

Check their license:

• California Board of Behavioral Sciences: bbs.ca.gov
• Search by name to verify active license
• Check credentials (PhD, PsyD, LCSW, LMFT)
• Ask about specialized training and experience

Can I switch from insurance to private pay mid-treatment?

Usually yes, but discuss with your therapist:

• Some therapists work both ways
• Some are private pay only
• Transitioning may require paperwork
• Your choice to make

What if I can’t afford the full rate?

Options:

• Ask if therapist offers sliding scale (some do)
• Look for group therapy (more affordable)
• Consider less frequent sessions (bi-weekly vs. weekly)
• Explore community mental health centers
• Some therapists reserve limited sliding-scale spots

Is private pay therapy confidential from my employer?

Yes. Your employer has no way to know:

• You’re not using company insurance benefits (they don’t track who doesn’t use benefits)
• Your therapist has no contact with your employer
• Your mental health care is completely private

Can my spouse/partner find out if I don’t want them to?

Legally, your therapy is confidential. Practically:

• They’ll notice the expense (unless you have separate finances)
• They may wonder where you are during sessions
• Consider whether hiding therapy is healthy for your relationship
• Many couples therapists recommend honesty about seeking individual therapy

What happens if I need a diagnosis for other purposes?

Your therapist can provide one if clinically appropriate:

• You can request a diagnosis letter
• It won’t have been submitted to insurance
• You control who sees it
• Only provide diagnosis when you choose to

Will private pay therapy show up on background checks?

No. Background checks typically access:

• Criminal records
• Credit reports
• Employment history
• Sometimes insurance records (with your authorization)

Private pay therapy creates no insurance records, so there’s nothing for background checks to find.

How long do I need to commit to private pay therapy?

No long-term commitment required:

• Try 3-4 sessions to see if it works
• Continue as long as it’s valuable
• Stop when you’re ready
• No contracts (typically)

What if my insurance changes and the therapist becomes in-network?

Discuss with your therapist:

• Some will continue private pay relationship
• Some will bill insurance if you want
• You choose which way to proceed

Is private pay therapy “better” than insurance therapy?

It’s different, not inherently better:

• Better for specific needs (privacy, specialization, flexibility)
• Not better for everyone or every situation
• Right fit depends on your circumstances

Can I get a receipt for private pay therapy?

Yes, always:

• Itemized receipt after each session
• Includes date, service, cost, payment method
• For your records (taxes, reimbursement, budgeting)

What if I lose my job and can’t continue?

Discuss with your therapist:

• Some offer temporary reduced rates
• Some can adjust frequency (monthly vs. weekly)
• Some can refer you to lower-cost options
• Communication is key

Do I have to pay in advance?

Depends on therapist:

• Most accept payment at time of service
• Some offer retainer models (pay for multiple sessions upfront)
• Some offer monthly subscriptions
• Ask about their specific payment structure

Can I negotiate the rate?

You can ask, but:

• Most private pay therapists have set rates
• Some offer sliding scale for limited spots
• Some are firm on their fees
• Respect their business decisions

What if the therapist isn’t helping?

You can switch:

• Give it 3-4 sessions to assess
• If not working, find someone else
• You’re not locked in
• Switching is normal and fine

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Related Articles:

• Executive Therapy California: The Complete Guide
• Best Therapist for Executives in California: What to Look For
• How to Know If You’re Burned Out: Signs, Symptoms, and Next Steps
• The 3-Hour Therapy Intensive: When Weekly Sessions Aren’t Enough
• Why More Executives Are Paying Out-of-Pocket for Therapy

About CEREVITY

CEREVITY is California’s premier private-pay therapy practice for executives and high-achieving professionals. We provide specialized, confidential mental health care designed for the unique challenges of leadership.

Our therapists have extensive experience working with:

• C-suite executives and senior leaders
• Physicians and medical directors
• Attorneys and firm partners
• Tech founders and engineers
• Entrepreneurs and business owners
• Anyone in high-pressure, high-visibility roles

We offer:

• Complete confidentiality (private pay only)
• Flexible formats (50-180 minute sessions)
• Statewide online access
• Evidence-based approaches
• Measurable results within 3 months

Start your journey toward sustainable high performance:

📞 (562) 295-6650
🌐 cerevity.com/get-started

Serving professionals across California from San Francisco to San Diego, Sacramento to Los Angeles, and everywhere in between.