Orrick Marriage and Family Therapy Professional Corporation
DBA: Libby Orrick Therapy
1996 Union Street, Suite 300
San Francisco, California 94123
Email: libby@libbyorrick.com
Phone: (415 )857-2386
EIN: 9-3644340
NPI: 1740904424
Good Faith Estimate for Psychotherapy Services
Under the No Surprises Act, you are entitled to receive this Good Faith Estimate outlining the expected costs of psychotherapy services. While it is not possible to predict exactly how many sessions will be necessary or appropriate for any individual or couple, this document provides a general estimate based on typical frequency and fees.
Your actual total cost will depend on the number of sessions attended, your specific needs, and any changes to the treatment plan discussed with your therapist.
This estimate is not a contract and does not require you to receive services from Orrick Marriage and Family Therapy Professional Corporation. It is not a recommendation or prediction of the exact number of sessions you may need.
Session Fees
● Individual Therapy (50 minutes): $250 per session
● Couples Therapy (75 minutes): $325 per session
Most clients attend therapy once per week, but frequency may vary based on your goals and circumstances.
Sample Cost Estimates
(Based on CPT 90837 – 60 min psychotherapy; diagnosis code: F41.1 – Generalized Anxiety Disorder*)*
Individual Therapy
Duration | Sessions | Cost | CPT Code | Diagnosis Code
1 month | 4 | $1,000 | 90837 | F41.1
2 months | 8 | $2,000 | 90837 | F41.1
3 months | 12 | $3,000 | 90837 | F41.1
12 months | 48 | $12,000 | 90837 | F41.1
Couples Therapy
Duration | Sessions | Cost | CPT Code | Diagnosis Code
1 month | 4 | $1,300 | 90837 | F41.1
2 months | 8 | $2,600 | 90837 | F41.1
3 months | 12 | $3,900 | 90837 | F41.1
12 months | 48 | $15,600 | 90837 | F41.1
*Diagnosis code is an example; actual code will depend on your clinical assessment.
If you continue treatment beyond the estimated period, your total cost will increase proportionally based on the agreed-upon session frequency and duration. If your plan changes, you will be provided an updated Good Faith Estimate.
Rights and Disputes
You have the right to dispute a bill that exceeds your Good Faith Estimate by more than $400.
If this occurs, you may:
● Contact your therapist to discuss the discrepancy.
● Ask to update the estimate or negotiate the bill.
● Request information about available financial assistance.
You may also initiate a dispute resolution process through the U.S. Department of Health and Human Services (HHS) within 120 days of receiving the bill. Please note that HHS may charge an administrative fee associated with initiating the dispute resolution process. If the agency agrees with you, you will pay only up to the estimated amount. If HHS disagrees with you and agrees with Orrick Marriage and Family Therapy Professional Corporation, you will be obligated to pay the higher amount on your bill.
To learn more or begin this process, visit: www.cms.gov/nosurprises or call HHS at 1-800-985-3059.
Additional Notes
This Good Faith Estimate is not a contract and doesn’t obligate you to receive services from Orrick Marriage and Family Therapy Professional Corporation (DBA Libby Orrick Therapy). This estimate does not include any unexpected costs or complications that may arise during treatment. Changes in frequency, duration, or scope of treatment may result in changes to your total charges.
Your therapist reserves the right to terminate services if therapy is not progressing, boundaries are violated, or continued care is not clinically appropriate. You may discontinue therapy at any time. Referrals will be provided as needed.