How does telehealth therapy work?

All sessions are through Doxy.me, a free HIPAA-compliant platform. No account or download required. Your clinician sends a secure room link before each session.Join from a quiet, private space. Avoid public Wi-Fi. All patients must be physically located within California at the time of service.If you have technical issues during a session, your clinician will attempt to reach you by phone. Test your connection at doxy.me before your first appointment by clicking "Test my camera and microphone." Most patients find that sessions from their own home feel more comfortable and candid than in-person office settings.

Associate clinician vs. fully licensed therapist

Associates hold titles such as APCC, ACSW, or AMFT. They hold a provisional California BBS license and practice under direct supervision while completing 3,000 post-graduate clinical hours toward full licensure.All PMHS associates are supervised by Ryan Frost #51777, a board-approved clinical supervisor. The quality of care you receive is not diminished by associate status.Associates are often more recently trained in current evidence-based modalities. Supervision means your care benefits from two clinical perspectives — your clinician's and their supervisor's.

How long are therapy sessions?

Standard sessions are 50 to 60 minutes. Sessions of 53 or more minutes bill under CPT code 90837. Sessions of 38 to 52 minutes bill under CPT code 90834.Your clinician will determine the frequency and session length that best supports your treatment goals. Most patients attend weekly sessions, particularly early in treatment.If you have questions about how your insurance covers specific session lengths or CPT codes, contact your insurer or speak with your clinician before your first appointment. Session length may be adjusted over time as your treatment needs evolve.

How do I get started?

No waitlist. We respond within 12 to 24 hours to get your first session scheduled.You can also use the contact form on our Connect page to tell us a bit about what you are looking for before we speak. There is no obligation and no paperwork until you decide to move forward.Ryan FrostDirector of Clinical Services(530) 604-4309rfrost@pacmhs.comDmitri KolpacoffMental Health Clinician(925) 771-0430dkolpacoff@pacmhs.com

Do you accept insurance?

PMHS accepts Medi-Cal through our contract with Partnership Health Plan of California. We also offer private pay for patients who are uninsured or prefer to pay out of pocket.Not sure whether your specific plan is accepted? Contact us before submitting and we will verify your coverage at no cost.Private pay rates are shared transparently when you reach out. We do not believe cost should be a barrier to care. PHP Medi-Cal patients receive the same clinical attention as any other patient.

What happens after I reach out?

We text you within 12 to 24 hours, often sooner, to confirm you are ready to get started and that we have availability. You will then get an email invitation through SimplePractice to complete your consent forms electronically. Your first appointment is your intake session, a full 50 to 60 minute session where your clinician learns what brings you to therapy and you start building a plan together. There is no separate screening call. And starting with a specific clinician does not obligate you to continue with them if the fit is not right.

Is everything I share in therapy confidential?

What you share is protected under HIPAA and California's Confidentiality of Medical Information Act (CMIA). Limits include mandatory reporting, imminent danger, and valid court orders, all reviewed in your informed consent.Associates participate in required supervision with Ryan Frost, held to the same confidentiality standards as your sessions. Prior to any AI use in your care, you will sign a separate consent form.Questions about what is and is not confidential in your specific situation? Ask your clinician directly before, during, or after any session.

What can I expect from my first session?

Before: You will receive a SimplePractice invitation to complete intake paperwork and informed consent electronically prior to your appointment.During: 50 to 60 minutes. Your clinician asks about your concerns, goals, and history. Together you begin developing a treatment plan. After: If it feels like the right fit, you schedule ongoing sessions.It is normal to feel nervous. Most patients say the first session feels more like a conversation than an evaluation. You are never required to share more than you are ready to.

What should I do if I am in a mental health crisis?

PMHS is not an emergency or crisis service. We do not monitor messages in real time. If you are in immediate danger, contact one of these resources now:988 Lifeline — Call or text 988 | Crisis Text Line — Text HOME to 741741 | Emergency — 911CA Warm Line — (855) 427-3369 for non-crisis peer support. Once safe and stable, reach out through our Connect page to begin ongoing therapeutic support.

What if I have a bad session or feel worse after therapy?

This is more common than most people realize and does not mean therapy is not working. Processing difficult experiences frequently feels uncomfortable before it improves. Some sessions will be harder than others.Consistently feeling worse or unsupported is important clinical feedback. Tell your clinician directly — that honesty leads to the most meaningful adjustments in your treatment approach.If the therapeutic fit is not right, we will help you find someone who is. Ruptures in the therapeutic relationship are normal and expected. Effective therapy is the ability to repair them.

Can I switch therapists if it is not the right fit?

Yes. You do not need a reason beyond "this doesn't feel right." Therapeutic fit is one of the strongest predictors of clinical outcomes in therapy research.If you want to work with a different clinician at PMHS, let us know and we will facilitate the transition. If PMHS is not the right fit at all, we will support you in finding someone who is.You will never be pressured to stay, and we will never make leaving harder than it needs to be. Your continuity of care is the priority, not our retention rate. If needed, we will provide records, referrals, or any documentation to support a smooth transition.

What happens if I miss a session?

We require at least 24 hours notice for any cancellation or rescheduling. Late cancellations and no-shows may be subject to a fee as outlined in your informed consent agreement.Patients who miss three consecutive sessions without contact may be discharged per our patient abandonment prevention policy. If your circumstances change, contact us — we do not hold prior gaps against you.If a barrier is affecting your attendance, tell your clinician before missing a session. Most barriers are solvable when identified early. We would rather adjust the plan than lose you from care.

Do you prescribe medication?

No. PMHS is a 100% virtual, therapy-only clinic. Our clinicians are licensed mental health counselors and therapists, not physicians, psychiatrists, or nurse practitioners. We do not prescribe or manage medications.If medication is something you are considering, consult your primary care physician or a licensed psychiatrist. We coordinate with any prescribing provider with your written consent.PMHS maintains a relationship with a Bay Area psychiatrist who sees patients virtually. Ask your clinician about a referral if a psychiatric evaluation or medication management would benefit your care.

Do you offer evening or weekend appointments?

Yes. PMHS offers evening and limited weekend availability. Specific times vary by clinician. When you reach out, let us know your scheduling constraints and we will find a time that works.Because we are fully virtual, there is no commute and no waiting room. Most patients find telehealth significantly easier to fit into a busy schedule than in-person appointments.Session frequency is flexible. Weekly is the clinical standard, biweekly once you reach a point of stability. Your clinician will discuss frequency during intake and revisit it as your needs change.

How do I know if therapy is working?

Early signs include naming emotions more easily, noticing your own patterns, and having more space between a trigger and your reaction. Progress is often subtle before it becomes obvious.Concrete markers appear over months: better sleep, fewer depressive episodes, stronger relationships, and a clearer sense of your own values and what you want.Your clinician will check in on your treatment goals regularly. If you are unsure whether therapy is helping, bring that question into the session. It is one of the most useful conversations you can have. Often the clearest sign it is working is how you handle something now compared to six months ago. Still have questions? We are happy to help. Reach out to get your first session scheduled or ask any questions before getting started. Connect With Us My Care &rsaquo; Privacy Privacy &Confidentiality. Our work is governed by California law, the Board of Behavioral Sciences, and federal HIPAA standards. Back to My Care Analytics & Site DataThis site uses Google Analytics to collect anonymized data: pages visited, time on site, and general region. No personally identifiable information is collected automatically.IP anonymization is enabled. We do not use advertising pixels, session recorders, or third-party tracking tools. You may opt out via the Google Analytics Opt-out Add-on.Under the California Consumer Privacy Act (CCPA), you have the right to opt out of the sale of personal data. We do not sell yours. Google Analytics data is used solely to improve the patient experience on this site and is never shared with advertisers or used to make clinical decisions about individual patients. Minimal Data CollectionWe collect only what you voluntarily provide — typically your name, phone number, and email address — used solely to respond to you and schedule your care. We do not market to you or share your data with third parties.If you contact us and do not become a patient, your information is not kept beyond responding to you. No marketing lists, no follow-up campaigns.Active patient records are stored within SimplePractice, our HIPAA-compliant EHR. Under HIPAA, you have the right to access your records, request corrections, and file a complaint with HHS without retaliation. Patient ConfidentialityYour health information is protected under HIPAA and California's Confidentiality of Medical Information Act (CMIA). All sessions are conducted through a HIPAA-compliant, end-to-end encrypted platform.Your employer, family, and insurance company cannot access your records without your signed written consent. All release-of-information requests are handled through formal authorization forms within SimplePractice.Minors aged 12 and older may have the right to consent to certain mental health treatment without parental consent under California Health & Safety Code §124260. Your clinician will explain these provisions during informed consent. Professional Ethics & Legal LimitsOur clinicians are bound by the ethical codes of the American Counseling Association (ACA) and CAMFT, as well as licensing requirements enforced by the California Board of Behavioral Sciences (BBS).Mandatory disclosure obligations include suspected child abuse under CANRA, elder or dependent adult abuse, and imminent danger to the patient or an identifiable third party under the Tarasoff duty to warn.These limits are not loopholes. They exist to protect the most vulnerable. Every patient is informed of these limits in full before services begin. Questions about your specific situation belong in conversation with your clinician. Informed CommunicationEmail and contact forms are not encrypted to the same clinical standard as our telehealth platform. Use them for general questions only. Do not share diagnoses, clinical details, or sensitive information through these channels.Once active, all clinical communication occurs through SimplePractice's secure messaging system. Your clinician does not use personal email or text messaging for clinical matters.Voicemails are checked during business hours only. We do not monitor communications in real time. For anything urgent, always use the crisis resources on our Connect page rather than waiting for a callback. Operational SafeguardsAll patient records are stored within SimplePractice under a HIPAA Business Associate Agreement. Clinical devices are encrypted and password-protected. Access is limited strictly to authorized personnel on a need-to-know basis.All clinical staff complete training on HIPAA compliance, telehealth security, and California confidentiality law. These trainings are completed at onboarding and reviewed regularly.In the event of a data breach affecting your protected health information, PMHS is required to notify you within 60 days of discovery under the HIPAA Breach Notification Rule. We have internal procedures in place to identify, contain, and report any such incident and will never withhold breach information from affected patients. Legal Notice No therapeutic relationship through this website Visiting this site or submitting a form does not create a therapist-patient relationship. Services formally begin only after intake paperwork, informed consent, and scheduling with a licensed or pre-licensed clinician. My Care &rsaquo; Insurance & Fees Insurance &Payment Options. We accept a range of insurance plans. Cost details are always reviewed with you before your first session. Back to My Care Accepted Insurance & Payment What we accept We accept the following insurance plans and payment options for therapy services. Partnership Health Plan of California Medi-Cal Medicare Medi-Medi Private pay (HSA/FSA, credit/debit, or check) Out-of-network superbills available for reimbursement Estimated co-pays, deductibles, and out-of-pocket costs are reviewed and explained during your intake process before the first session. Don't see your plan? Contact us. Coverage changes frequently and we may be in-network with additional plans not listed here. Understanding Your Costs What to expect Cost details are always reviewed before your first session. Here is what to know in advance. Medi-Cal and Partnership Health Plan patients typically owe no out-of-pocket cost for covered sessions. Private pay rates are shared when you reach out, before your intake session is scheduled. Standard session rates typically range from $100 to $175 per session depending on session type and length. Sliding-scale fees are available based on financial need — ask during intake and we will work with you. Out-of-network patients can request an itemized superbill for possible reimbursement from their insurer. HSA and FSA cards are accepted. Therapy qualifies as an eligible medical expense under most plans. Confirm with your insurer whether preauthorization is required before your first session. Questions about your specific situation? Reach out before your first appointment and we will walk you through it.

What is the difference between a counselor, therapist, and psychologist?

Counselor: master's-level clinician (MSc or MA), licensed as LPCC or registered as APCC in California. Trained in evidence-based talk therapy and mental health treatment. PMHS clinicians hold this credential. Therapist: not a legally protected title in California. It broadly describes LPCCs, LMFTs, and LCSWs. Psychologist: doctoral-level (PhD or PsyD), licensed to diagnose and administer psychological testing. Psychiatrist: a medical doctor whose primary role is medication management, not talk therapy. PMHS clinicians provide licensed master's-level talk therapy. For medication management or psychological testing, we coordinate referrals with appropriate providers.

Does Medicare cover telehealth therapy at PMHS?

Yes. PMHS accepts Medicare and Medi-Medi. Outpatient mental health services delivered via telehealth are a covered benefit under Medicare Part B. Medicare patients are typically subject to a 20% coinsurance after meeting their Part B deductible. Medi-Medi patients may owe nothing if Medi-Cal covers the remaining cost share. We verify your specific benefits during your intake session.

What is a superbill and how do I use it?

A superbill is an itemized receipt containing your diagnosis code, CPT billing codes, session dates, and provider credentials. You submit it to your insurance company to request reimbursement for out-of-network services. PMHS provides superbills to private pay patients upon request. Reimbursement rates and eligibility vary by plan. HSA and FSA cards can also be used to pay for sessions directly.

What does private pay cost?

Private pay rates are shared transparently when you reach out. Rates vary by session type and clinician. Sliding-scale fees are available based on financial need. HSA and FSA cards are accepted. Out-of-network superbills are available upon request.

How long does therapy typically last?

There is no fixed answer. Treatment length depends on your presenting concerns, goals, and progress. Short-term work for a specific issue may resolve in 8 to 16 sessions. Longer-term support for complex or chronic presentations may continue for a year or more. Your clinician will review your treatment goals regularly.

Do you treat children? What is the minimum age?

Yes. PMHS provides therapy for children, teens, and adults. There is no strict minimum age, but telehealth requires a child who can engage meaningfully in a video session. In practice, most child patients are 6 years and older. Patients under 18 require written parental or guardian consent before services begin.

Can both partners be seen individually at PMHS?

Generally, no. When one clinician sees both partners individually, a dual-relationship conflict arises that compromises clinical objectivity and confidentiality for both patients. The standard practice is for each partner to work with a different provider, or for one partner to be seen individually while couples sessions are conducted separately.

What languages do you offer sessions in?

Sessions are currently conducted in English. If you require services in another language, including Spanish, contact us and we will discuss interpreter options or refer you to a bilingual provider. Medi-Cal patients have the right to interpreter services at no cost under California Health and Safety Code Section 1367.04.

What happens if my internet goes out mid-session?

Your clinician will wait briefly, then attempt to reach you by phone to continue by voice or reschedule. A disconnection due to technical failure does not count as a late cancellation and will not result in a fee. Test your connection at doxy.me before each session to reduce the likelihood of disruptions.

Can I join a session from my car or a non-home location?

Yes, as long as you are physically located in California and have a private, stable connection. A parked car with cellular data works well. Avoid public Wi-Fi and any location where you cannot speak freely. Do not join a session while driving.

Is my session ever recorded?

No. Sessions are never recorded without your explicit written consent. Doxy.me does not record by default, and PMHS does not record sessions for any purpose including training or quality review. Written consent would be required before any recording takes place.

What happens to my records if I stop treatment or PMHS closes?

Clinical records are retained for a minimum of seven years from the date of last service under California law, or until a minor patient turns 25, whichever is longer. Records are stored securely in SimplePractice under HIPAA-compliant protocols. You can request your records at any time through the patient portal.

Can my employer find out I am in therapy?

No. Your participation in therapy is protected under HIPAA and California's Confidentiality of Medical Information Act. PMHS will not disclose your information to your employer, family, or any third party without your written authorization. The only exceptions are mandatory reporting obligations outlined in your informed consent.

How do I request my records?

Submit a written records request through the SimplePractice patient portal or by contacting your clinician directly. Under HIPAA, we are required to respond within 30 days. A reasonable fee may apply for copying. Psychotherapy process notes require a separate specific authorization. Progress notes and billing records are accessible upon request.

My Care › Where We Serve › Sierra County

Sierra County.

Sierra County is designated a Frontier County, one of the most remote in the nation. Telehealth therapy, no cost for PHP members.

Last updated: August 2026

Back to Where We Serve

SIE

39.5661° N, 120.8272° W

Sierra County

Downieville Loyalton Sierraville

Sierra County is California's second-least populous county (Sierra County, California, n.d.), with roughly 3,150 residents spread across 953 square miles of rugged Sierra Nevada terrain (SimpleMapLab, n.d.). Downieville is the county seat, and Loyalton is the only incorporated city. The entire county has exactly one traffic light, and it was removed for a time after an accident before being reinstalled.

With this few residents spread across this much mountain terrain, local mental health providers are extremely limited. PMHS provides telehealth therapy to PHP members throughout Sierra County, regardless of how remote the address, on the same terms as anywhere else in California.

Coverage & Access

PHP covers outpatient therapy with no session cap for medically necessary care and no copay for most Medi-Cal members. Sierra County is officially designated a Frontier County: no hospital, no pharmacy, no traffic light, and a single mountain pass connecting its east and west halves that can become impassable in winter. For a county this remote, telehealth is not a convenience, it is often the only realistic way to see a therapist regularly.

You do not need a referral, a member card, or prior authorization to reach out. Submit the intake form and we will contact you within 12 to 24 hours, no matter how far out the address.

Language Support

PMHS arranges interpreter support for patients across Sierra County, including Spanish and other languages. Note your language preference when you submit the intake form and we will have it ready before your first appointment.

Do I Qualify?

Your Medi-Cal is enrolled through Partnership HealthPlan of California, based in Sierra County
You are physically located in California at the time of each session
Any age qualifies — EPSDT covers medically necessary care for members under 21
No referral or prior authorization is required to start

Why Telehealth Works Here

Sierra County is the second-least-populated county in California, a place of steep river canyons and high valleys where Downieville and Loyalton anchor opposite sides of the crest and Highway 49 threads the rest together. There is no hospital, no local specialty care to speak of, and the practical map for services has always pointed outward, to Nevada County, to Reno, to wherever a long drive ends. Winter cuts the county roughly in half when the passes load with snow. In a place this small and this remote, telehealth is not one option among several; it is the difference between a Sierra County resident having a therapist and not having one.

Care From PMHS

PMHS serves Sierra County PHP members with individual therapy for depression, anxiety, isolation, and trauma, plus adolescent care under EPSDT for the county's small but real number of young people. Telephone sessions stand fully equal to video, which matters where mountain connectivity is thin, and the video platform requires no download when it is used. Evening and weekend appointments fit seasonal and trade work. Covered PHP members pay nothing, need no referral, and face no waitlist. We respond within 12 to 24 hours, and consultations are typically held within the same week.

Both PMHS clinicians, Ryan Frost, LMFT, and Dmitri Kolpacoff, APCC, see patients throughout Sierra County. There is no assignment by location — whichever clinician has availability is the one who reaches out to you.

Your First Session

After you reach out, your clinician contacts you directly, always starting with a text, then by phone or email depending on what you prefer, to confirm you are ready to get started. You will then get an email invitation from SimplePractice, our patient portal, to finish setting up your account and sign your consent forms electronically. From there you schedule a time directly with the clinician who reached out to you, typically within the same week for Sierra County patients. Your first appointment is a full intake session, 50 to 60 minutes, not a short screening call, and this is also when your Partnership HealthPlan coverage is confirmed. Sessions run on Doxy.me, a HIPAA-compliant video platform that requires no download and no account, and phone-only sessions are available if your internet is unreliable.

What PMHS Does Not Provide

Crisis or emergency services — call or text 988, or call 911, if you are in immediate danger
Court-ordered evaluations or forensic assessments
In-person appointments — PMHS is 100% telehealth by video or phone
Sessions while you are physically outside California

Local Hospitals & Emergency Care

If you are experiencing a medical emergency, call 911 or go to the nearest emergency room. PMHS provides outpatient therapy and is not a crisis or emergency service.

Eastern Plumas Health Care

500 1st Ave, Portola (Plumas County). The nearest acute care emergency room for most Sierra County residents. (530) 832-6500.

Western Sierra Medical Clinic

Downieville. Primary care clinic serving Sierra County residents. Not a hospital or emergency facility.

Crisis & Mental Health Resources

988 Suicide & Crisis Lifeline

Call or text 988, available 24/7 for anyone in emotional distress or suicidal crisis, anywhere in the county.

Sierra County Behavioral Health Crisis Line

Call 1-888-840-8418, the 24-hour toll-free crisis and access line for Sierra County residents.

If You Move Counties

If you move to a county Partnership HealthPlan does not cover, you will typically lose your PHP eligibility — this is what we have seen happen with our own patients. If that happens, we talk through your options with you directly. That usually means private pay with PMHS, or asking your Medi-Cal case manager about what is called an in-county transfer, which reassigns your coverage to a PHP county. An in-county transfer requires traveling to that county to see your primary care provider, since PHP coverage is tied to where your primary care is based. There is no need to sort this out alone — reach out and we will walk through what makes sense for your situation.

Where Is Sierra County?

Approximate location. PMHS is 100% telehealth, so this map is here to help you get oriented, not to confirm eligibility — what qualifies you is your PHP enrollment, not your exact address.

View larger map

Getting to Know Sierra County

Sierra County has fewer than 3,500 residents and no hospital of its own. What it has is some of the most intact Sierra Nevada landscape in California, including the North Yuba River corridor, the Sierra Buttes above Sardine Lake, and the historic mining town of Downieville.

Sardine Lake Sierra Buttes Trail North Yuba River Trail Downieville Historic District Tahoe National Forest

Sierra County FAQ

Our county has almost nothing. Is this actually available to me?

Yes. Your PHP enrollment in Sierra County is complete eligibility by itself. No local office, hospital, or referral is required for you to start therapy by video or phone.

Which works better up here, video or phone?

Whichever your connection supports. Phone sessions are fully covered and clinically complete, and many patients in the canyons use them exclusively. Video is there when your internet allows it.

Do I have to cross the pass for anything, ever?

No. Intake, paperwork, and every session happen remotely. The only requirement is that you are physically in California at the time of each session.

Here is how to find out in under 2 minutes.

Check your Medi-Cal card

If it says “Partnership HealthPlan” or “PHP” anywhere on the card, you are enrolled.

Call PHP Member Services

Call (800) 863-4155 Mon–Fri 8am–5pm and ask if you are enrolled. They confirm in under a minute.

Let us verify for you

Fill out our form with your Medi-Cal ID and county. We verify your PHP benefits directly during your intake session at no cost.

Don’t Have Partnership HealthPlan?

You may still have options in Sierra County.

This page covers Medi-Cal members enrolled through Partnership HealthPlan. If your coverage is a different Medi-Cal managed care plan, Medicare, or private insurance, visit our Insurance & Fees page to see what PMHS accepts and what your options are. If you are in crisis right now, do not wait on insurance questions — call or text 988, or use the crisis resources listed below.

Also Serving Nearby

Telehealth Coverage in Neighboring Counties

Plumas County County→ Yuba County County→ Nevada County County→

Ready to get started?

Serving Sierra County. You just reach out.

Submit our short intake form and we will verify your Partnership HealthPlan coverage during your intake session at no cost.

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Sierra County.

Here is how to find out in under 2 minutes.

You may still have options in Sierra County.

Telehealth Coverage in Neighboring Counties

Serving Sierra County. You just reach out.

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