If you’ve been searching for a therapist in Vancouver, WA, you’ve probably noticed something. A lot of practices, including ours, don’t take insurance.

We get that this can be frustrating. Therapy is already a big step, and figuring out how to pay for it shouldn’t feel like another hurdle. We want to be honest with you about why we made this choice, what it means for your care, and how we can still help you make therapy work financially.

We have thoughtfully decided on a private pay model because we believe it’s how we can provide the best possible chance at real, lasting change.

What Insurance Actually Asks of Therapy

On the surface, using insurance for mental health care seems like a no-brainer. You pay your premium, you get a service, the insurance company covers the cost. Simple.

In reality, insurance companies don’t just cover therapy. They direct it.

To approve coverage, insurance companies require a few things that most clients are never told about up front:

A diagnosable mental health condition. Your therapist has to assign you a diagnostic code from the DSM, and that diagnosis becomes part of your permanent medical record.
Justification for ongoing care. Sessions are often capped, reviewed, or denied if the insurance company decides you’re “no longer medically necessary,” even if you and your therapist disagree with your insurer.
Specific session lengths and modalities. Insurance typically covers a 45 to 53 minute session. Longer formats like therapy intensives, Ketamine Assisted Psychotherapy, or extended EMDR sessions usually aren’t covered, even when they’re the most effective option for your situation.
Access to your records. Insurance companies can request your treatment notes, treatment plans, and progress reports as a condition of payment.

None of this is hidden. It’s just rarely talked about until you’re already in the middle of it.

What Private Pay Protects

When we decided to be out of network, we did it because we wanted our clinical decisions to be guided by one thing: what’s actually going to help you.

Here’s what that looks like in practice.

Your Privacy Stays Yours

A diagnosis on your permanent record can follow you in ways you might not expect. It can affect life insurance applications, certain professional licenses, security clearances, and more. We’re not saying this to scare anyone, and there are absolutely times when a formal diagnosis is helpful and warranted. But that should be a conversation you have with your therapist based on what serves you, not a requirement to access care.

With private pay, what happens in our office stays in our office. No outside reviewer is reading your notes. No company is deciding what counts as “enough” progress.

Your Care Isn’t Dictated by a Stranger

When an insurance company tells a therapist what kind of therapy is “approved,” what length sessions are reimbursable, and how many you’re allowed, the therapist isn’t really the one making clinical decisions anymore.

At Refuge, we use modalities like EMDR, Ketamine Assisted Psychotherapy, therapy intensives, somatic work, Internal Family Systems, and creative arts therapy. Some of these involve longer sessions, multi-day formats, or combinations of approaches that simply don’t fit inside an insurance billing code. Being out of network means we can offer you what actually works, not just what gets reimbursed.

Your Therapist Has the Time and Energy to Show Up for You

Insurance reimbursement rates are often well below what private practices need to operate sustainably. The result, across the field, is therapists carrying overloaded caseloads, spending hours per week on insurance paperwork, and burning out.

Being private pay allows our team to keep smaller caseloads, invest in advanced training, and bring real presence into the room with you. You’re not session number 45 of the week. You’re the most important person in the room.

Our mission is to help people be well and thrive, and our clinicians are no exception.

Your Time Isn’t Wasted

Many of our clients come to us after months or years of weekly talk therapy that didn’t move the needle. Part of why traditional therapy can stall is that it’s structured around what insurance will pay for, not around what would actually help. With trauma in particular, an hour a week of talking can sometimes keep you stuck rather than help you heal.

We’re trained in approaches that work with the whole nervous system, not just thoughts and feelings. That’s how real change happens, and often more efficiently than the “few tools and call me in six months” approach.

How to Make Private Pay Work for You

We hear you. Even when you understand the why, the question of cost is real. Here are the options most of our clients use.

Superbills for Out of Network Reimbursement

If you have insurance and want to use it, there’s a good chance your plan includes some out of network mental health benefits. We’re happy to provide you with a superbill, which is a detailed receipt with a diagnosis code that you submit to your insurance company for partial or full reimbursement.

A quick call to your insurance can tell you a lot. Ask:

Do I have out of network mental health benefits?
What is my out of network deductible, and how much have I met?
What percentage of the session fee will be reimbursed?
Is there a session limit?

Many clients are surprised to find their plan covers a meaningful portion of out of network therapy.

HSA and FSA Accounts

Health Savings Accounts and Flexible Spending Accounts can typically be used to pay for therapy at Refuge. Check your individual plan for details, but for many clients this is a tax-advantaged way to invest in their care.

Care Credit

For Ketamine Assisted Psychotherapy and therapy intensives, Care Credit can help spread the cost over time. Clients apply directly and we’re happy to share more information.

Transparent Pricing

We don’t hide our rates. Each practitioner’s page lists current session fees so you know exactly what to expect before you reach out.

The Bottom Line

We chose to be out of network because we believe deeply in the work we do, and we want to do it well. We want to give your care the time, focus, and clinical freedom it deserves. We want your records to be yours. And we want our team to be rested, trained, and genuinely present when you walk through our door in Salmon Creek.

If you’re weighing the cost of therapy at Refuge, we’d encourage you to also weigh the cost of staying stuck. Quality care that actually creates change is one of the best investments you can make in the rest of your life.If you have questions about fees, superbills, or whether Refuge is the right fit, we’d love to talk.

Book a free 15 minute consultation and we’ll walk through it together.