EHR + Biller vs Headway, Alma, Grow: True Cost

Last reviewed: October 8, 2026. Prices come from each company’s public pages on that date.

Billing insurance yourself through an EHR and a percentage biller costs a subscription, per-claim fees, and the biller’s cut. For one clinician seeing 80 insured sessions a month, that comes to about 4.7% to 8.3% of collections in the example below. What you keep is a share of your own contracted rates. On Headway, Alma, or Grow Therapy you are paid the platform’s per-session rate under the platform’s contracts, and none of them publishes those rates. So the honest comparison is a formula: the platform pays more only if its payout per session beats what you would net from your own contract after costs.

Clinicians we talk to ask this in two ways. Some say: if my EHR is about $100 a month and the biller takes a percentage, isn’t that more expensive than a platform? Others are leaving a platform and want to know what they give up, especially referrals. Both questions need the same numbers.

Two different ways of getting paid

• EHR plus biller: you, or your practice, hold the payer contracts. The payer pays your contracted rate. You pay the EHR, its claim fees, and the biller. You also carry the collection risk: denials, patient balances, and payment timing.

• Platform: you are credentialed onto the platform’s contracts and paid its rate for each session. Alma says it credentials members under Alma’s tax ID. Grow says enrollment adds you to Grow’s group contracts and does not transfer outside Grow. Headway says it negotiates rates with health plans and keeps a small percentage of session payments.

That is why a platform’s payout and your own contracted rate for the same CPT code can differ in either direction. A direct contract does not guarantee a higher rate. Our platform reimbursement guide covers why.

What the EHRs charge

These are the published prices for one clinician. All three charge per electronic claim on top of the subscription.

• SimplePractice: Starter $49, Essential $79, and Plus $99 a month on its pricing page, before introductory discounts, plus a $20 annual CPT code fee per clinician. Since October 1, 2026, electronic claims cost $0.39 each for the first 250 a month on every plan, or $1.79 with the optional Insurance Navigator tier. Details: SimplePractice’s October claim fee change.

• TherapyNotes: Solo is $69 a month; Group is $79 for the first clinician and $50 for each additional one. Electronic claims, each claim in an ERA, and each eligibility request cost 14¢.

• Sessions Health: Professional is $39 a month for the first practitioner and $29 for each additional one. Electronic claims start at $0.25 each and eligibility reports are $0.15.

Card processing is extra everywhere: TherapyNotes lists 3.1% plus 30¢ and Sessions Health lists Stripe’s 2.9% plus 30¢. Platforms also deduct card fees in their own way, so we leave processing out of both sides below.

What a percentage biller charges

Billers usually charge a percentage of what is collected. Prospects tell us they have been quoted or are paying anywhere from 4% to 8%, and more for some arrangements. Ask what the percentage applies to, insurance payments only or patient payments too, and whether it includes credentialing, denial work, and patient statements or bills them separately.

Worked example: one clinician, 80 sessions a month

The assumptions, so you can swap in your own:

• 80 insured sessions a month, one claim each, all collected. Real practices lose some to denials and unpaid balances.

• $110 allowed per session under your own contract, including the client’s copay or coinsurance. This is a hypothetical rate, not a payer benchmark. Use your fee schedule.

• EHR plan: SimplePractice Essential, TherapyNotes Solo, or Sessions Health Professional. TherapyNotes also charges for the 80 claims arriving on ERAs. Eligibility checks, add-ons, and card fees are excluded.

• Biller at 4% or 7% of collections.

Collections: 80 × $110 = $8,800. EHR costs: SimplePractice $79 + 80 × $0.39 = $110.20. TherapyNotes $69 + 80 × $0.14 + 80 × $0.14 = $91.40. Sessions Health $39 + 80 × $0.25 = $59.00.

• Sessions Health + 4% biller: $59.00 + $352 = $411.00. You keep $8,389.00, or $104.86 a session.

• TherapyNotes + 4% biller: $91.40 + $352 = $443.40. You keep $8,356.60, or $104.46 a session.

• SimplePractice + 4% biller: $110.20 + $352 = $462.20. You keep $8,337.80, or $104.22 a session.

• Same EHRs + 7% biller: $675.00, $707.40, and $726.20. You keep $101.56, $101.16, and $100.92 a session.

At this volume, the biller’s percentage is the largest cost and the EHR is a smaller one. At lower volume the EHR subscription weighs more per session; at higher volume per-claim fees and the percentage dominate.

What the platforms publish, and what they don’t

• Headway: no membership fees. Its rates vary by license type and plan, and a practice consultant quotes them on a call. It pays every two weeks whether or not the insurer has paid, and says it absorbs the risk of a denied claim. Starting in November 2026, rolling out state by state, it is adding a $9.99 marketplace service fee to every appointment with a new client who found you through its marketplace. Clients you add yourself and health-system referrals are exempt.

• Alma: $95 a month, billed at $1,140 a year, according to its insurance program page. Alma’s membership standards call its rates highly confidential and say a client invoice left unpaid for 60 days is deducted from your payout. Its insurance page mentions fees for claims, coverage checks, and card processing without listing amounts there.

• Grow Therapy: its provider page says pay rates vary by payer, state, session type, and license type, that providers are paid weekly, and that pay is protected from insurance clawbacks. The page does not list a provider fee or rate schedule. Ask Grow for both in writing.

The comparison as a formula

Direct, per month: sessions × your contracted allowed amount × share collected × (1 − biller %) − EHR subscription − sessions × per-claim fees.

Platform, per month: sessions × platform payout per session − membership − per-session platform fees (for example, Headway’s $9.99 on qualifying marketplace sessions).

In the example, the break-even platform payout is about $101 to $105 a session, depending on the EHR and biller. Add membership: on Alma, $95 a month is $1.19 a session at 80 sessions, so its payout would need to be about $106 to match Sessions Health plus a 4% biller. If a platform pays you less than your break-even for the same code and payer, direct billing nets more. If it pays more, or if you cannot get a direct contract at a comparable rate, the platform nets more.

Run it per payer and per CPT code. A 90837 and a 90834 pay differently, and so do Aetna and a Blue plan. Our guide to finding your contracted fee schedule explains how to get the direct-rate side of the formula.

What a platform gives you that a biller doesn’t

The arithmetic leaves out things the platforms really do provide, and some of them are worth more than the fee difference:

• Referrals. Headway has a client marketplace; Grow features providers in its directory and with partners such as Zocdoc; Alma members receive consultation requests. A biller does not find you clients. This is the trade-off prospects raise most often when comparing.

• Paid regardless of the insurer. Headway pays on schedule whether or not the plan has paid and absorbs denials; Grow says pay is protected from clawbacks; Alma has a payout policy for client payment issues. With your own contracts, a denial or an unpaid balance is your loss until someone fixes it.

• Fast credentialing at no extra charge. Grow says credentialing with Grow averages 5–7 days and Alma says about 45 days. Direct contracts take roughly 30 days to 6 months per payer in our experience.

• Built-in tools. Claims and payments run inside the platform, and Headway and Alma include note tools, so there may be no separate EHR to pay for or set up.

• Education and community. Grow offers free CE; Alma membership includes CE courses and workshops.

Malpractice coverage is not one of the differences: Headway, Alma, and Grow all require you to carry your own policy. Grow recommends a carrier and Headway lists carriers its providers recommend, but you buy the policy either way. Alma asks for a current policy with $1 million per claim and $3 million aggregate.

What direct contracts give you that a platform doesn’t

• Contracts under your own tax ID that stay with you if you change billers or EHRs.

• Payers and products a platform does not offer where you practice, such as Medicaid, Medicare, or a regional plan.

• A path to a group: rostering associates, supervised billing where payers allow it, and contracts under the practice.

• Your own rate history and fee schedules, which you can review and negotiate.

Many clinicians do both: keep a platform for one payer with a strong rate and go direct for the rest. If you are moving off a platform, Leaving Headway, Alma, or Grow covers the credential-first sequence, client sourcing rules, and each platform’s exit deadlines.

How to run your own numbers

1. Pull 90 days of completed sessions by payer and CPT code, plus what was actually paid and what is still unpaid.

2. Ask each platform for your per-session payout by payer and code, and every fee, in writing.

3. Get the fee schedule for each direct contract you hold or are offered. Do not use a platform rate as a stand-in.

4. Price your EHR at your real claim volume, plus eligibility checks and the extra clinicians you plan to add.

5. Apply the biller’s percentage to the collections it actually covers, and subtract a realistic share for denials and unpaid balances.

6. Put a number on referrals: how many of your current clients came from the platform, and what it would cost to replace them.

Bomi’s terms

Bomi bills inside SimplePractice, TherapyNotes, and Sessions Health. Our pricing is 4% of net collections received each month, month-to-month. Your EHR, payment processing, and other pass-through costs are paid separately. Credentialing is $50 per insurance company per clinician, with the first four free when you choose Bomi Billing, and ongoing credentialing maintenance is included in the 4%. We do not refer clients. We have a commercial interest in this comparison, so check our numbers with the same formula.

Related Guides

• Therapy Platforms: Rates, Referrals & Control

• Leaving Headway, Alma, or Grow: How Therapists Transition

• SimplePractice Price Increase: What Changes

Frequently Asked Questions

Is a platform cheaper than an EHR plus a biller?

It depends on the platform’s payout per session compared with your own contracted rate after EHR and biller costs. In our example of 80 sessions at a $110 contracted rate, direct billing nets about $101 to $105 a session. A platform paying more than that for the same session nets more; one paying less nets less, before the value of its referrals.

Does Headway charge therapists a fee?

Headway has no membership fee; it keeps part of the payer’s payment. Starting in November 2026, state by state, it adds a $9.99 fee to each appointment with a new client who found you through its marketplace. Clients you add yourself and health-system referrals are exempt.

How much does Alma cost?

Alma’s insurance program page lists membership at $95 a month, billed at $1,140 a year. You are paid Alma’s rates, which Alma treats as confidential, and its public pages mention claim, coverage-check, and card fees without listing amounts.

Can I use my own insurance contracts on Headway, Alma, or Grow?

Generally not for the sessions you bill through them. Alma credentials members under Alma’s tax ID, and Grow adds you to Grow’s group contracts, which do not transfer when you leave. A contract you hold yourself stays yours.

Sources

SimplePractice: Pricing

SimplePractice: What’s changing with insurance pricing

TherapyNotes: Pricing and subscription options

Sessions Health: Pricing

Headway: How does Headway make money?

Headway: Understanding the marketplace service fee

Alma: Insurance program for therapists

Alma: Membership overview

Alma: Getting credentialed with Alma’s insurance program

Grow Therapy: For providers

Grow Therapy: Enrollment and credentialing FAQ

Grow Therapy: Malpractice insurance requirements