Mental Health Billing Services: Compare Fees and Fit

For U.S. therapy, counseling, psychology and psychiatry practices

Company sources checked October 6, 2026

A mental health billing service files your insurance claims, follows up on denials and posts payments. The services below use percentage-based pricing.

The percentage is only half the price. What it is charged on, and whether there is a monthly minimum, can matter more.

Here is a real example. Recoup publishes a fee of 3% of the insurance payments it collects, with a $1,000 monthly minimum. On $10,000 a month of eligible ongoing insurance payments, the base fee is $1,000. That is 10%. At $50,000 a month, the base fee is $1,500. That is 3%.

Below are five services side by side, with the fees and limits each one publishes. After that, a tool to check your own quotes. No account or email needed.

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How to read this page. The five companies are listed A to Z. Fees and terms come from each company's own website. "Worth a look if" is our view of fit. It is not a rating of how well a company bills. We have not used these services. These links take you to the providers' own websites. More on how we compare and how we make money.

Not sure you need a billing company at all? Jump to billing company, software, or a network like Headway.

Compare mental health billing services

"Not publicly stated" means we did not find it in the linked company pages. It does not mean the answer is zero. Ask for it in writing.

Osmind 360

Osmind 360 is an EHR and a billing service sold as one package. Osmind says the price is a percentage of collections and covers the EHR, benefits checks, prior authorizations, claims and denial work. Credentialing and CAQH upkeep cost extra.

Its help center also lists implementation fees based on practice size and describes the fee as a share of net collections where permitted. Confirm the fee basis and all extra charges in your proposal.

Know this first: you are buying software and billing together. Osmind's help center describes 360 as an athenaOne-based system distinct from its original EHR. Confirm which platform and migration the current proposal includes. Osmind builds its software for psychiatry and for treatments like Spravato and TMS. If you run a therapy-only practice and like your current system, look at the other four.

Ask for the percentage, any minimum, and the contract length.

Request an Osmind 360 demo

Practice Solutions

Practice Solutions publishes its rate: 6% of collections, with flat pricing on request. It serves mental and behavioral health private practices. It lists Jane, SimplePractice and TherapyNotes as the EHRs it works with, and names Checkpoint too.

Three limits to know:

• The agreement is for one year. The company says it has "favorable termination options." Ask what they are.
• Benefits checks are done when you ask for them, not for every client by default.
• Answering patients' billing questions is an optional add-on. It depends on your EHR.

Also ask which collections the 6% applies to: insurance only, or patient payments too. The company says most practices are up and running in 14 to 30 days, depending on how quickly they supply the required information.

Contact Practice Solutions

Recoup

Recoup publishes its pricing terms. It is 3% of the insurance payments it collects for you. There is no setup fee, and its clearinghouse costs are included. If you keep submitting claims through your existing system, that system's claim charges remain your responsibility. You can leave with 30 days' notice.

The catch is the $1,000 monthly minimum. Three percent equals $1,000 at about $33,333 a month in eligible ongoing insurance payments. Below that, you pay more than 3%. Recoup says so itself and asks smaller practices to talk to it before signing.

Eligible insurance balances from before Recoup takes over are handled under a separate agreement at 10% of what it recovers, and nothing if it recovers nothing. Payments already in transit, existing payment plans and work the previous biller completed but has not posted are excluded from that recovery arrangement.

Recoup says it is built for outpatient practices that bill insurance, with group practices and clinics first. It says it is not built for cash-only practices or for residential, detox or partial-hospitalization programs. Its pricing page does not say who sends patient statements, so ask.

Request Recoup's free analysis

Resilience Billing

Resilience Billing bills only for outpatient mental health practices: therapy, psychiatry and psychological testing. It works inside your EHR, so you can see every claim and payment. TherapyNotes is its main platform. It also works in Tebra and SimplePractice.

Its fee is a percentage of net collections. Resilience defines that as insurance and patient payments, after refunds and adjustments. The number is set in a consultation. Credentialing is billed separately. A full re-check of every client's benefits at the start of a plan year may carry a fee.

Three limits to know:

• It does not serve practices in New York or New Jersey.
• It sends statements and runs cards on file. It does not contact patients about balances or chase unpaid ones.
• Contract terms are not published. They are discussed in the consultation.

Request a Resilience consultation

TheraThink

TheraThink works only with licensed mental health clinicians and groups. Its service page says there are no startup costs and the contract is month by month. Its FAQ says there is no minimum claim count. That makes it one to look at if your volume is low.

Its fee works differently. TheraThink's FAQ says it charges a percentage of the "allowed amount" on paid claims. The allowed amount is the insurer's payment plus the patient's share. When a claim has patient responsibility, that is a larger fee base than insurer payments alone. The percentage itself is not published.

The FAQ also lists:

• $35 a month for each unique tax-ID/rendering-NPI combination, in months when claims are submitted.
• Credentialing at $130 per commercial insurance application and $270 per Medicare or Medicaid application.
• A plain "No" to whether it handles collections.

You can keep your EHR or use TheraThink's free one. Either way, claims go out through your TheraThink account. Confirm all current fees, including the monthly charge and credentialing, in your written quote.

View TheraThink billing services

Quick ways to narrow the list

• You want to keep your EHR and your workflow. Start with Practice Solutions, Recoup or Resilience. All three say you can keep your EHR. Confirm the supported system, connection and where the work is done.
• Your insurance income is low or uneven. Get any minimum in writing first. A low rate with a $1,000 floor can cost more than a higher rate with no floor.
• You do psychological testing. Ask for current clients who bill testing. "We work with psychologists" is not enough.
• You offer Spravato, TMS or ketamine. Osmind is built for it. Compare the whole package, not just the percentage.
• Patient calls about bills are your real problem. Ask who talks to patients. Sending a statement is not the same as answering the phone.

If you run a residential, detox, PHP or IOP program: this list focuses on outpatient professional practices. Confirm the claim format, payer setup and authorization work needed for your program and care setting. Ask any company for clients at your level of care. One place to start is Medusind, which says it works with clinics, residential, outpatient and substance use treatment programs. We have not compared its fees.

Review Medusind's behavioral health services

What will a mental health billing service cost?

Four things set the price:

1. The rate. For example, 3% or 6%.
2. What the rate is charged on. Insurance payments only, or patient payments too.
3. The monthly minimum. The least you pay, even in a slow month.
4. The extras. Fees per clinician, software, credentialing, old claims.

You will see "typical" ranges online, like 4% to 10%. We could not find a reliable average for mental health billing. Recoup says the same thing on its pricing page. So this page uses real published prices and your own quotes.

How a minimum changes a real offer

These rows use Recoup's published terms: 3% of insurance payments collected, with a $1,000 monthly minimum.

This is our math from the published terms. It excludes the separate old-claim recovery fee and any charges from a submission system you choose to retain.

The same percentage can mean different dollars

Say one paid claim has a $120 allowed amount. The insurer pays $96. The patient owes $24.

Same rate. The second fee is $1.44 higher on this claim. The 6% here is an illustrative rate, not a quoted fee for either arrangement in this example.

One more thing to ask about. A fee on the allowed amount includes the patient's $24, even if the patient has not paid it yet. Ask when the fee is charged, and what happens if the patient never pays.

Compare two quotes with your own numbers

Enter your monthly totals and the terms from two quotes. The tool shows each monthly cost and what is still unknown. It runs in your browser and does not ask for patient information.

A worked example. These two quotes are made up. The practice receives $20,000 a month from insurers and $5,000 from patients.

Quote B has the lower rate. It still costs the same each month, because it is charged on more dollars and has a higher minimum. The first-year figures assume the same monthly activity and include setup; the $400 old-claims recovery fee is separate. Click "Load example" in the tool to see these numbers.

A matching price does not mean a matching service. Check that both quotes cover the same work. The next sections show how.

Do you need a billing company, software, or a network like Headway?

These are three different kinds of help. Pick the one that fits the work you want to hand off.

Software. If your claims are simple and your volume is low, software plus your own billing work may cost less than a percentage. Compare the subscription, claim charges and your time. Know the per-claim cost first. As of October 1, 2026, SimplePractice charges $0.39 per electronic claim for the first 250 claims a month on any subscription plan using Insurance Essentials. Free claims no longer come with any plan. At 80 claims, that is $31.20 in claim-submission charges, before your subscription and other applicable charges.

SimplePractice's Insurance Navigator upgrade adds automation and phone guidance at $1.79 for each of the first 250 submitted claims, replacing the lower claim rate. Its 30-day trial is advertised for November 2026, with a waitlist open now. That support is different from hiring a company to take responsibility for your billing work. Ask exactly which tasks you would still handle.

Networks. Headway says it offers free credentialing and a platform with no subscription fee. You join its network and it files your claims. Its help center explains that it retains a share of session payments that varies by plan and billing code; there is no single public percentage. Ask for your rate per session. Once you are eligible for payment, it schedules payouts twice a month, on the 15th and last day, based on when you confirm the sessions.

Alma charges a membership fee. Its insurance-program page lists annual membership at $1,140. A separate provider offer advertises $600 for the first year. Confirm the offer available to you, when payment is due, and the renewal price. Alma's help center says participants in its insurance program are credentialed under Alma's tax ID. Its insurance-program page says new members must join that program and credential with at least one of the listed payer partners.

That last point is the big one. With Alma, you work under Alma's insurance contract, not your own. Headway says its payer agreements are separate from any insurance contracts you hold independently. Before you join either one, ask two things. What will I be paid per session? Do I stay in-network if I leave?

Mostly self-pay? A full billing service may fix very little for you. Recoup says outright that it is not built for cash-only practices.

Match the service to the care you give

"Mental health billing" covers very different work. Ask each company to show it knows yours.

Therapy and counseling billing services

Individual psychotherapy codes are based on the time actually spent providing psychotherapy. A Medicare contractor's guide lists 90834 for 38 to 52 minutes and 90837 for 53 minutes or more. Crossing that threshold can change the appropriate code; payment still depends on the payer's rules and the claim. Ask how the biller checks documented psychotherapy time against the code before a claim goes out.

Two more things worth asking about:

• Medicare and license type. Since January 1, 2024, marriage and family therapists and mental health counselors who meet Medicare's qualification rules can enroll and bill independently. Their Medicare fee schedule is set at 75% of the clinical psychologist amount. Ask who checks each clinician's eligibility and handles enrollment.
• Telehealth. Rules differ by insurer. CMS's February 26, 2026 FAQ says Medicare's in-person visit requirements for mental health telehealth at home are delayed until after December 31, 2027. The rules differ for new and established patients and include exceptions. Ask how the biller checks the rules, place of service and modifiers for each payer and date of service.

Psychiatry billing services

When an eligible psychiatrist or psychiatric nurse practitioner provides both a distinct evaluation and management (E/M) service and psychotherapy, billing may involve an E/M code plus a psychotherapy add-on code, such as 90833. The documentation must support both services and the psychotherapy time. Ask the biller for an example of how it checks those requirements and the payer's rules.

Psychology billing services

If you provide psychological or neuropsychological testing, ask for a testing-specific workflow. Testing administration and scoring are distinct from evaluation and report work, and the same time cannot be counted twice. Ask how the biller tracks who did each part and checks any prior-authorization requirement for your plans. Ask for current clients who bill testing. Resilience names psychological testing in its scope.

Group practices

Check each clinician's enrollment and network status with the payers you plan to bill. Do not assume a new hire is in-network just because the group is. Ask who tracks every clinician's status with every payer, and who fixes it when a claim is denied for that reason.

Behavioral health carve-outs

Some plans have a separate company administer behavioral health benefits. Blue Cross and Blue Shield of Alabama explains that it does not process behavioral health claims for members whose employer has chosen such a carve-out. Ask how the biller checks each client's benefits and confirms the correct claim destination before services begin.

Substance use treatment

Federal Part 2 privacy rules apply to federally assisted substance use disorder programs, and some requirements also apply to organizations receiving Part 2 records. If that includes your practice or records, ask how the biller handles the applicable consent and disclosure requirements. Recoup says its scope includes outpatient substance use treatment.

Get the work in writing

"Full service" means different things at different companies. Ask each one to say who does what.

The companies above already answer some of these differently. Practice Solutions checks benefits on request. Resilience sends statements but does not call patients about balances. Recoup's 3% covers enrolling with payers to send claims and receive payment reports, which is not the same as credentialing. That is why you ask.

Know where your billing data will live

"Keep your EHR" can mean three things. The biller works inside your system. Or the biller uses its own system next to yours. Or you move to the biller's system. Ask the company to show you where a claim is entered and where a payment is posted.

Confirm four things before you sign:

1. One set of books. How do they keep your EHR and their system from showing different balances?
2. Your access. Do you keep your own logins and see all the work?
3. Your exit. What do you get when you leave? Who works the open claims? When does their access end?
4. Your patients. Who sends statements, fixes wrong balances and approves refunds?

Put the business associate agreement in place first. If your practice is covered by HIPAA, an outside biller that handles protected health information for you is generally a business associate. Have the required written agreement, called a BAA, in place before sharing that information. HHS explains the requirements, including the arrangements for subcontractors.

Separately kept psychotherapy notes have extra protection. A biller may need clinical documentation to support a claim. But HIPAA distinguishes psychotherapy notes kept apart from the medical record from ordinary progress summaries, diagnoses and session-time records. Sharing those separate notes usually requires the patient's authorization. A BAA alone does not authorize unrestricted access to them.

This page covers buying questions. Have your own legal or compliance adviser review the contract and BAA.

Switch billing services without losing track of open claims

A billing handoff can leave claims and payments unaccounted for. Six steps help keep them in view.

1. List the open work. Unpaid claims, denials, appeals in progress, patient balances. Write down the amounts and any deadlines.
2. Agree who owns what. Who works claims sent before the switch? Who posts payments that arrive later? Get the price for each.
3. Start insurer setup early. Confirm which payer connections and remittance arrangements need to change. That paperwork runs on the payers' clocks.
4. Pick a cutover date. Set the old biller's last day to send claims and the new biller's first. This helps prevent double claims and double statements.
5. Check the handoff weekly. Match claims sent, payments posted and deposits received. Send gaps to a named person.
6. Close out. Keep your reports and exports. Remove the old biller's access as the contract allows.

The companies handle this differently. TheraThink says it can take all your clients at once or start with only new ones. Resilience says it works existing unpaid claims alongside new ones. Recoup records old insurance balances on day one and prices them separately.

Copy this request for a written proposal

Send the same questions to two or three companies. Then you can line up the answers.

Fill in the blanks before you send. Do not include patient names or claim details.

Subject: Billing proposal request for our mental health practice

Hello,

We are comparing billing services for an outpatient mental health practice. Please send a written proposal.

About us:
- State(s):
- Clinicians (number and license types):
- Services (therapy, psychiatry, testing, other):
- Main insurers:
- EHR and billing system:
- Insurance payments per month (about):
- Patient payments per month (about):
- Old unpaid insurance claims (about):
- How billing is handled now, and why we are looking:

Please answer these in writing:

1. Do you support our state, clinicians, services, insurers and EHR?
2. What is your fee, and what exactly is it charged on: insurance payments, patient payments, or allowed amounts?
3. Is there a monthly minimum? Any fees per clinician, per claim, for software, or for setup? Please show a sample invoice using our numbers.
4. Who does each of these: benefits checks, authorizations, credentialing, claim submission, denials and appeals, payment posting, underpayments?
5. What do you do for patient billing: statements, questions, refunds, unpaid balances?
6. How do you handle claims that are already unpaid when you start, and what does that cost?
7. What reports and access do we get? Please include a sample open-claims report with no patient details.
8. What are the contract length, renewal terms, notice to cancel and any exit fees? What data do we keep?
9. Will you sign a business associate agreement before we share any patient data? Do you use subcontractors?

Please also list anything that would stay our job.

Thank you,

Return to billing services

Questions practices ask before hiring a biller

Is a billing service worth it for a solo therapist?

It depends on the minimum and on your time. At $10,000 a month in insurance payments, a $1,000 minimum takes 10%. A service with no minimum, software you run yourself, or a network like Headway may fit better. Run your numbers in the quote tool first.

Will a billing company guarantee I get paid?

Do not assume so. A clean claim, a benefits check and prior authorization do not guarantee insurer payment. BCBSIL explicitly states that eligibility, plan terms and the claim still matter. Be careful with any company that promises a set collection rate without explaining how it is measured.

Does the billing company need to be in my state?

No. Billing is done online and by phone. What matters is whether the company serves your state and knows your payers, especially your state's Medicaid plans. Check for limits. Resilience, for one, does not serve New York or New Jersey.

Do these services bill Medicare, Medicaid and EAPs?

Some say they do. TheraThink lists EAP, Medicare, Medicaid and TRICARE on its service page. Ask about your exact plans by name, and confirm each clinician is enrolled.

What if my practice is mostly self-pay?

You may not need insurance billing at all. Look at tools for payments, statements and superbills instead. For clients who are uninsured or choose not to use insurance, check CMS's good faith estimate rules. They generally require a written estimate when an eligible client requests one or schedules care at least three business days ahead. Paying a copay or deductible does not by itself make someone self-pay.

How we checked

We read each company's own pricing, service and FAQ pages on October 6, 2026. We chose companies that focus on outpatient mental health and publish enough about their fees or scope to describe fairly. This is not a list of every billing service.

We did not test these companies, get private quotes, or check their billing results or security. A company's website shows what it advertises. It does not prove how it performs. The math on this page is ours and uses the inputs shown.

Prices change. Confirm every number in your written agreement.

Read our comparison methodology, see how we make money, or report an error.

Compare billing services

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