Therapy Payment Plans: Separate Old Debt From New Visits
By George Ruan • October 7, 2026
Last reviewed: October 7, 2026.
Write the plan so each payment says how much covers the new visit and how much goes to the old balance. Verify the old balance first, then make sure the EHR’s automatic billing won’t charge the full balance anyway. A plan that lives only in a chart note does not change what the billing system charges.
Sections
How practices usually structure therapy payment plans
The plans practices send us almost all take the same shape: a fixed amount charged after each session, split between that day’s copay and a set payment toward the old balance, until the balance is gone. Some instead set a lower per-session amount while the client works through a high deductible. Monthly invoicing to whoever pays, such as a family member or sponsor, is the other common pattern.
For example, with invented numbers: a client has a verified $300 old balance and a $30 copay. The plan charges $50 after each session, $30 for that visit’s copay and $20 toward the old balance. After 15 sessions the old balance is paid and charges drop back to the copay.
Verify the old balance first
List the dates of service the plan covers and compare them with the payer’s EOBs, payments already collected, credits and any secondary insurance still pending. Leave out anything still waiting on insurance. SimplePractice’s client-billing guide separates invoiced balances from uninvoiced appointments, so check both before quoting a number.
For an in-network client, the amount owed is set by the payer’s allowed amount and the client’s plan. A payment plan changes when the client pays, not how much; practices we work with tell clients plainly that the contracted amount itself isn’t negotiable.
Put it in writing
The old balance amount and the dates of service it covers.
The per-session or monthly amount, and how it splits between new visits and the old balance.
How it is collected: card on file after each session, or an invoice.
What happens if a payment fails or a visit’s cost changes.
Who on staff keeps the billing settings matching the agreement.
Turn off full-balance AutoPay
SimplePractice’s AutoPay guide says enrolled clients are charged their full invoiced balance. That collides with any installment plan.
What we have seen go wrong: a practice wrote “do not autopay, on a payment schedule” in two clients’ charts, and both were still charged automatically. The note doesn’t touch the setting. The fix was turning off automatic billing for those clients and offering to refund the extra charges.
For the practices we bill for, Bomi turns SimplePractice AutoPay off and charges the amounts agreed with the practice instead, holding a charge and asking the practice when something unexpected comes back, such as a denial.
When a client asks for time
Hold charges for a set number of days while the client decides between paying in full and paying over time, with a clear date when the normal charge runs.
If the client already has a credit on the account, apply it first and charge the card only for the rest.
Don’t routinely waive required copays or deductibles as part of a plan; that can conflict with payer contracts.
Keep the plan reconciled
After each payment, confirm it posted to the right invoices and that the old balance went down by the planned amount. If a payment fails, follow the agreement rather than doubling the next charge; for SimplePractice, see SimplePractice Card Declined: What to Check Next. When the balance reaches zero, switch the charge back to the normal amount.
Related Guides
Frequently Asked Questions
Can a payment plan include the next therapy visit?
Yes, and the cleanest plans do: one amount charged after each session that covers that visit’s copay plus a fixed slice of the old balance. Write down the split so each payment is posted the same way.
Will SimplePractice AutoPay follow my payment plan?
No. AutoPay charges the full invoiced balance. Turn it off for clients on a plan and collect the agreed amount another way.
Can I lower an in-network client’s balance as part of the plan?
Generally no. The contracted amount and the client’s cost sharing are set by the payer and the plan. A payment plan spreads the payments out; it doesn’t reduce what is owed.
Sources
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About Bomi
Founded by George Ruan, Dax Earl, and Andrey Goder, Bomi helps independent therapists and group practices with insurance billing, credentialing, and payer follow-up. Bomi grew out of Dax’s experience helping his mother with her therapy practice, with a clear purpose: reduce the administrative burden of insurance while keeping practice owners in control.
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