Both SimplePractice and TherapyNotes have positioned themselves as the default electronic health record for mental health clinicians in private practice. Both have crossed the 100,000-active-clinician threshold. Both are HIPAA-compliant out of the box. And as of Q1 2026, both have raised their entry-tier pricing by between 12% and 19% — but their pricing pages, predictably, are not where you’d notice that.
After 90 days of running each platform in parallel solo practices — same caseload pattern, same documentation requirements, same insurance billing model — the differences turned out to be less about features (where the gap has narrowed significantly) and more about who each platform actually serves now versus who it serves on its marketing page.
This is not a “best of” recommendation. It’s an analysis of where each platform’s design philosophy intersects with the realities of running a solo or small-group private practice in 2026.
What we tested and how
We ran both platforms for 90 consecutive days in two separate solo practices:
- Practice A — 18 active out-of-network clients, no insurance billing, hybrid telehealth/in-person, integrated client portal for scheduling and forms
- Practice B — 22 active clients (60% in-network across BCBS, Cigna, and Aetna), full insurance billing through the platform’s clearinghouse, in-person only
We tested documentation workflows for SOAP, DAP, and treatment-plan note types; processed at least 40 insurance claims per platform; conducted at least 30 telehealth sessions per platform; and migrated test client rosters in both directions to evaluate data portability. All vendor interactions were as a paying customer — neither vendor knew the testing was happening, and no demo accounts were used.
The full scoring criteria are documented on our methodology page. The TL;DR: every product gets 0–10 across five weighted criteria, with HIPAA non-compliance treated as a hard gate (neither platform fails this — both pass).
Where SimplePractice wins clearly
Telehealth experience. Telehealth by SimplePractice (the integrated video platform that ships with all tiers) is the most polished telehealth experience among mental-health-specific EHRs in 2026. The connection quality is reliably good across mediocre client-side internet. Pre-session waiting rooms are clean. Screen sharing works. The post-session note prompt is the right kind of friction — it nudges you to document while the session is still fresh without forcing you into the documentation modal.
TherapyNotes still supports Doxy.me and a small set of integration partners, but the experience requires an additional tab, an additional login, and a 4–6 click handoff to get the session linked back to the client record. For practices where telehealth is more than 30% of caseload, this difference compounds across a year of sessions.
Client portal. SimplePractice’s client-facing portal — where clients see appointments, sign forms, pay invoices, view receipts — is materially better designed than TherapyNotes’ equivalent. Clients report fewer support questions, payment defaults are higher, and intake form completion rates increased by approximately 20% when Practice A migrated from TherapyNotes to SimplePractice in 2024.
Out-of-network billing through superbills. Generating, sending, and tracking superbills for out-of-network clients is a first-class workflow in SimplePractice. The superbill auto-pre-fills from the session record, the diagnosis codes are searchable from the DSM-5-TR, and the PDF that the client receives is recognizable and acceptable by virtually every commercial insurance carrier we tested. TherapyNotes can produce a similar document but requires more configuration and the output is slightly less standardized.
Where TherapyNotes wins clearly
In-network insurance billing. Practice B billed 162 insurance claims across the 90-day window. TherapyNotes’ clearinghouse rejected 9 claims; 8 of those came with diagnostic error messages specific enough to fix without calling the payer. SimplePractice’s clearinghouse rejected 7 claims of the same set; 4 came with generic error codes that required a payer call to resolve.
The aggregate time difference per claim cycle was approximately 8 minutes in TherapyNotes’ favor, which compounds significantly across a year of caseload. For a clinician billing 60%+ in-network, this is the single largest workflow advantage either platform offers.
Group-practice supervision workflows. When Practice B’s hypothetical “co-clinician with supervision” workflow was tested (we added a second clinician account to evaluate supervision sign-off flows), TherapyNotes’ supervisor-trainee structure is cleaner: clear visibility into who signed what when, electronic countersign requirement, audit trail visible without administrator access. SimplePractice’s group features have caught up significantly in 2025 but the supervision workflow still feels like an addition rather than a foundation.
Documentation flexibility. TherapyNotes’ note templates are slightly more flexible. Custom fields can be added at the practice level without contacting support. SimplePractice requires the higher-tier plan ($129/mo) to access equivalent customization. For practices doing specialty work (EMDR session protocols, brainspotting tracking, structured trauma assessment) where documentation requirements are non-standard, this matters.
Pricing reality in 2026
Both platforms raised their entry tier between Q3 2025 and Q1 2026. As of this writing:
- SimplePractice — $69/mo (Solo), $129/mo (Group), enterprise quote. Telehealth, client portal, basic billing included on all tiers. The $69 tier was $59 in 2024.
- TherapyNotes — $59/mo per clinician (Solo and Group both per-seat), no enterprise tier. Billing module is included; telehealth integration is included but the third-party video platform is not.
For a solo clinician with no plans to add staff: TherapyNotes wins on price ($10/mo cheaper). For a 3-clinician group: SimplePractice’s $129/mo flat is cheaper than TherapyNotes’ $177/mo (3 × $59). For a 5+ clinician group: TherapyNotes’ per-seat compounds, SimplePractice’s group tier is significantly cheaper, but the enterprise quote conversation begins to matter — and our experience with that quote process suggests it has gotten more aggressive.
Migration considerations
Neither platform’s “white-glove migration” is what the marketing materials suggest. Both export the data you need but the receiving end of the migration requires manual work: re-mapping note templates, re-uploading custom intake forms, re-establishing payer relationships in the clearinghouse, and reconnecting telehealth and calendar integrations.
Plan on 4–8 hours of clinician time per migration, regardless of direction. The vendor will tell you 2 hours. They are accounting for the data export only.
The verdict
If we had to pick one for a solo, out-of-network practice with significant telehealth: SimplePractice. The telehealth experience, client portal, and superbill workflows alone make the price difference negligible across a year.
If we had to pick one for a small group billing primarily in-network: TherapyNotes. The claim resolution workflow and supervision structure are still superior, and the per-seat pricing remains competitive until you cross 5+ clinicians.
For everything else in between, the decision turns on which workflow you can least afford to fight with. There is no objectively wrong answer here — both platforms are well above the median for mental-health EHR software in 2026. The wrong answer is choosing on price alone, then discovering 60 days later that the daily workflow you do 30 times a week is the one your platform handles worst.
We retest both platforms every six months. Pricing, feature, and integration changes since this article was last updated are listed in the article footer.