At the Garden Refuge, we rely on a group of direct-pay clients who choose to work with our most experienced counselors. This structure supports our nonprofit mission of providing counseling services to underserved populations.

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What does “self-pay” or direct pay mean?

Self-pay simply means that clients pay directly for counseling services rather than using insurance. It keeps therapy private, straightforward, and focused entirely on your goals without requiring a mental health diagnosis or outside approval. Session fees are paid at the time of service, and care is guided solely by what is clinically appropriate and personally meaningful for you.

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How self-pay supports our mission

Garden Refuge is a self-funded nonprofit. We do not depend on unstable grant funding to operate because we never want disruptions in funding to force us to reduce our staff or stop client care as we support the community. Self-pay clients make it possible for us to sustain a strong clinical team, maintain consistent services, and protect the long-term stability of the organization.

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Our telehealth counselors work primarily with direct-pay clients, which creates reliable income and allows our single office location to remain open and available for underserved individuals and families who need in-person access. This model helps us extend care ethically and responsibly to those who might otherwise go without support.

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Benefits of choosing self-pay counseling

• Privacy – Insurance companies only reimburse therapy that is tied to a formal mental health diagnosis. With direct pay, no diagnosis is required and no personal information is shared with insurance companies.

• Permanent Medical Record – The diagnoses become part of your health record. This information may be accessed later by insurance carriers, medical systems, or in rare cases, affect eligibility for certain jobs or security clearances.

• Freedom of focus – Therapy can center on growth, relationships, stress, or life transitions, not just medical necessity. Insurance often dictates session frequency, length, and duration. They may deny continued care if they believe treatment is no longer “medically necessary,” even if client still has need.

• Choice of clinician – You can work with specialized therapists regardless of insurance networks.

• Flexible care – Session frequency and duration are determined by your needs, not coverage limits.

• Couples & Family Limitations – Insurance typically does not cover relational therapy unless one partner is diagnosed, shifting the focus from the relationship to an “identified patient.” It is that person who will receive the medical diagnosis on insurance billing paperwork.

• Supports community care – Your investment directly sustains services for vulnerable populations.

 

Choosing self-pay at Garden Refuge not only protects your autonomy and confidentiality, it actively helps make compassionate counseling available to others.​ Thank you.