What SimplePractice and TherapyNotes Actually Cost a Group Practice

The list price is not the price. A group practice owner we spoke to recently went through her bill line by line and found she was being charged fourteen cents every time the system sent a client a text message. Not the subscription. The text messages. Her monthly total was nowhere near what the pricing page had implied, and almost none of the gap was seats.

We spend our days inside working practices, and we talk to the people running them. More than once, an owner has pulled up their invoice mid-call and read it out, half laughing at what they were being charged for. This post is what those bills actually contain. It's the arithmetic the pricing pages leave out.

The short answer

For a group practice, the sticker price on an EHR pricing page typically accounts for somewhere between half and two-thirds of what you actually pay. The rest arrives as per-seat charges for unlicensed trainees, per-transaction fees on claims and ERAs and reminders, payment-processing spread, and third-party tools you buy because the EHR doesn't do the thing.

And none of that counts the largest cost of all, which never appears on an invoice: the staff hours spent working around the software.

What a real invoice looks like

Group practice owners who have walked us through their bills describe the same structure every time. The subscription line is the part they expected. Underneath it sits a column of small charges nobody quotes at the sales stage:

• Every claim submitted, billed individually
• Every ERA received, billed individually
• Every text reminder, at around fourteen cents a message
• Every eligibility check
• Telehealth minutes, metered

Email reminders are usually free. Text reminders are not, which matters because texts are what clients actually read. You are, in effect, paying a per-message fee for the intervention that reduces your no-show rate. Practices notice this eventually, normally when they run the numbers on why a busy month cost more than a slow one at identical headcount.

The second surprise is who counts as a seat. On most platforms an unlicensed trainee costs exactly what a fully licensed clinician costs. As one owner put it about SimplePractice: "it's the same cost for a clinician versus an intern. That also kind of sucks."

That lands hardest on exactly the practices doing the most for the field. A practice running a training program often carries as many trainees as licensed clinicians, and pays full freight for everyone who cannot yet bill independently. If you have ever built a staffing model for a group practice, you know the cohort of associates working toward licensure is the whole growth engine. It is also, on per-seat pricing, a pure cost centre until each of them credentials.

Where these numbers come from. The fee categories above come from practices walking us through their own bills. The list prices below come from the vendors' own pricing pages. Verified against both vendors' pricing pages on 30 July 2026. Vendors change pricing, so confirm before you sign anything.

The four places the money actually goes

1. Seats that don't distinguish who's sitting in them

Per-user pricing is simple, which is its appeal and its problem. It scales linearly with headcount and takes no account of whether that head bills. Interns, supervisees, part-time associates, and administrative staff frequently cost the same as a full-time licensed clinician.

One practice named the ceiling directly: "There's a point where TherapyNotes is going to get too expensive, because it's a cost per user, and they don't offer an enterprise package."

2. Per-transaction fees

Claims, ERAs, text reminders, eligibility checks. Individually trivial. In aggregate, at a practice submitting a couple hundred claims a month, they are a meaningful fraction of the bill, and they grow precisely as you succeed.

3. Payment processing

Card processing sits on top of everything. One practice flagged theirs at roughly 3.25%: "I do have a problem with the credit card fees. That really adds up so much." On a practice collecting $200,000 a year in card payments, a point of spread is $2,000.

4. The tools you buy because the EHR doesn't

This is the one nobody budgets for. Practices routinely run:

• a separate assessments platform, because the EHR doesn't integrate with one
• a separate analytics tool, one practice pays $300 to 400 a month for this alone
• a separate scheduling tool for phone consults, because the EHR's flow is too cumbersome
• a separate claims tool for bulk submission

Each of these is a monthly line item and a place where data stops being connected. One practice described running assessments in an outside tool: "It doesn't integrate, and so they have to pull the assessment reports and feed that back into the EHR. And I can guarantee you some of them aren't even doing that."

That last clause is the real cost. Not the subscription, the assessments that quietly never make it into the record.

The cost that never appears on any invoice

The largest number we have run into isn't a price at all. It was this, from a practice with a couple of dozen clinicians:

"About 20 hours a week of our billing manager goes into converting the information in [our EHR] into a payroll ledger."

Twenty hours a week. Half of a full-time role, permanently, spent moving numbers from one system into a spreadsheet because the EHR can't express how the practice actually pays people.

And how it pays people isn't exotic. One revenue split for day-rate contractor sessions, a different one for off-hours, and for salaried clinicians a split carrying an hourly minimum plus a monthly commission. That's a normal group practice compensation structure. Most EHRs simply have no model for it, so a human becomes the model.

At a loaded cost of $30/hour, 20 hours a week is roughly $31,000 a year, comfortably more than the software itself.

Another practice spends 4+ hours every month doing bulk billing manually through an outside tool. Another has a billing specialist who skips the EHR's eligibility checks entirely and goes direct to insurer portals, because the built-in ones aren't accurate enough to trust.

How to work out your own number

Take your last invoice and add:

1. Base subscription × total seats, including interns and admin staff
2. Per-transaction fees: claims, ERAs, text reminders, eligibility checks
3. Payment processing: your effective rate × annual card volume
4. Adjacent tools: assessments, analytics, scheduling, bulk billing
5. Staff hours: hours per week spent working around the software × loaded hourly cost × 52

Line five is usually the biggest, and it's the only one that isn't on a bill anywhere.

What the incumbents actually charge

SimplePractice publishes Starter at $49, Essential at $79 and Plus at $99 a month. Group practices need Plus, and additional clinicians are tiered: $74 each for two to five clinicians, $72 for six to fifteen, and $69 for sixteen or more. Care Aide, Note Taker and ePrescribe are separate add-ons.

TherapyNotes is $69 a month solo, or $79 for the first clinician plus $50 for each additional one in a group, with unlimited free non-clinical users. Electronic claims, ERAs and text reminders are 14 cents each; email reminders are free. Telehealth, ePrescribe and the AI notes add-on are billed separately.

At ten clinicians that is roughly $747 a month on SimplePractice Plus and roughly $529 on TherapyNotes, before per-transaction fees, add-ons and card processing.

Where Oasys lands

We price at $80 per clinician per month on an annual contract, with no add-ons. At ten clinicians that is $800 a month.

So on sticker price alone we are the most expensive of the three, and you should hear that from us rather than discover it later. What the $80 includes is billing, supervision, scheduling, documentation and payroll reporting, with no per-claim fee, no per-reminder fee, no add-on tier, and no surprise in a busy month.

Whether that is the better deal depends entirely on the arithmetic above. If your practice submits few claims, sends few texts, wants no AI documentation and has someone who does not mind building the payroll ledger by hand, TherapyNotes will cost you less, and we would rather say so than pretend otherwise. If you are paying per transaction on a growing claim volume, buying add-ons to close gaps, and losing half a role a week to spreadsheet work, the comparison looks different.

That is the honest version of our pitch: not the cheapest line item, but a flat one, and one that stops the costs in this post from accumulating quietly.