SimplePractice's new insurance pricing (October 2026): what it costs your practice
TL;DR
- From October 1, 2026, SimplePractice charges for every submitted insurance claim on every plan. The free claims on Essential and Plus go away.
- The new rate is $0.39 per claim (Insurance Essentials), stepping down to $0.33 above 1,000 claims a month. Subscription prices for Starter, Essential, and Plus don't change.
- Starter users pay less than before. Essential and Plus users pay more at almost every volume. A Plus practice submitting 300 claims a month goes from $66 to $116.
- A new add-on, Insurance Navigator, costs $1.79 per claim and adds AI claim checks, automatic benefits verification, and phone access to insurance specialists.
- Eligibility checks become $0.15 each on Starter and Essential. Plus keeps them free until 2027.
If you bill insurance through SimplePractice, your October invoice will look different. This article walks through exactly what changes, using SimplePractice's own published numbers, so you can work out what it means for your practice before the first bill arrives.
What is changing on October 1, 2026
Until now, how much you paid per claim depended on your plan. Starter paid $0.50 a claim. Essential got 10 free claims a month and paid $0.35 after that. Plus got 35 free claims and paid $0.25 after that.
SimplePractice announced the change to customers at the start of September, with a webinar on September 2, for an effective date of October 1. It applies to existing subscribers as well as new ones. From October 1, SimplePractice standardises claim pricing across all three plans. Every plan pays the same per-claim rate, there are no free claims, and the rate steps down with volume:
| Claims submitted in a month | Rate per claim |
|---|---|
| First 250 | $0.39 |
| 251 to 600 | $0.37 |
| 601 to 1,000 | $0.35 |
| 1,001 and up | $0.33 |
The tiers are marginal, so a 300-claim month is 250 claims at $0.39 plus 50 at $0.37, which is $116.00. SimplePractice uses this same example in its own support article.
Subscription prices are unchanged: Starter $49, Essential $79, Plus $99 a month.
Two smaller changes land at the same time. Manual insurance status checks (eligibility checks) become $0.15 each on Starter and Essential; they stay free on Plus until 2027, then move to $0.15 as well. And the Starter plan's old $0.25 status-check fee drops to $0.15.
The two insurance products
Insurance Essentials is what every plan gets. It's the existing claims workflow at the new price: electronic primary and secondary claims, ERA enrolment, insurance reports, manual payment posting, the Billing Hub, Claim Rule Automation, the corrected-claim workflow, and Simple Invoicing.
Insurance Navigator is a new paid add-on. It replaces the Essentials rate with $1.79 per submitted claim and adds:
- Claim Assistant, an AI check that flags errors and suggests fixes before you submit
- Automatic verification of benefits with an estimated client responsibility
- EOB upload with autofill for payment posting
- Personalised onboarding
- Priority phone and email access to live insurance specialists
Navigator is generally available from October 1. A 30-day trial with no per-claim cost opens "beginning November 2026"; a waitlist gives earlier access to the same trial. You can switch between Essentials and Navigator freely, and a downgrade takes effect on the next billing cycle.
The honest read on Navigator: for a practice that bills a lot of insurance and has been fighting denials alone, humans on the phone and automated benefits checks are a real service, and $1.79 a claim may be cheaper than the alternatives. One distinction matters, though. Navigator is advisory. A specialist tells you what's wrong with a claim; you still fix it, resubmit it, and chase the payer. It is not a billing service, and nobody at SimplePractice is on the hook for whether you get paid. For a solo therapist submitting 30 claims a month, it's $54 on top of the plan for advice they may use twice.
What it costs, by plan and volume
These are SimplePractice's own before-and-after rates applied to five claim volumes. Old rates: Starter $0.50 per claim; Essential 10 free then $0.35; Plus 35 free then $0.25. New rate: $0.39 tiered, all plans.
| Claims a month | Starter | Essential | Plus |
|---|---|---|---|
| 20 | |||
| 50 | |||
| 100 | |||
| 300 | |||
| 1,000 |
Three things stand out.
Starter gets cheaper at every volume. Roughly 22 percent less. If you're on Starter and bill insurance, this is a price cut.
Essential pays more until very high volume. The new rate beats the old $0.35 only once you're past about 2,000 claims a month, which almost no Essential practice is. At typical solo volumes the increase is 20 to 120 percent, though the dollar amounts are small.
Plus pays more at every volume, and it's the tier that gets hit hardest. The old marginal rate was $0.25 and the 35 free claims were worth $8.75 a month on their own. A Plus practice at 100 claims goes from $16.25 to $39.00. At 300 claims, from $66.25 to $116.00. Plus is the tier group practices were moved onto for team features, so the practices most affected are the ones billing the most insurance.
The volume tiers don't change that. Even at 10,000 claims a month, the blended rate under the new model is $0.334, still above the old Plus rate of $0.25. At 300 claims it's $0.387; at 1,000, $0.367; at 3,000, $0.342. There is no volume at which a Plus practice pays less than it did.
What it means for your kind of practice
The same numbers, by the kind of practice that tends to be on each plan:
| Practice | Plan | Claims a month | Before | After | Change |
|---|---|---|---|---|---|
| Private-pay solo who files occasionally | Plus | 5 | $0 | $1.95 | |
| Hybrid solo | Essential | 20 | $3.50 | $7.80 | |
| Hybrid solo | Plus | 25 | $0 | $9.75 | |
| Insurance-heavy solo | Plus | 100 | $16.25 | $39.00 | |
| Small group, 3 to 5 clinicians | Plus | 300 | about $66 | $116 | |
| Mid-size group, about 10 clinicians | Plus | 750 | about $179 | $279 | |
| Large group, 20 or more | Plus | 1,500 | about $366 | $532 | |
| Starter user who bills insurance | Starter | 100 | $50.00 | $39.00 |
If you're a solo private-pay therapist who files a handful of claims a year, this is a couple of dollars. If you're a group on Plus, it's a new line item in the hundreds.
How therapists are reacting
The change landed in the r/SimplePractice community within hours of the announcement (thread 1, thread 2). A few themes come up repeatedly:
- The notice period. One month between announcement and effective date, for software that handles regulated clinical and financial data, is the most common complaint. Several people point out that it's not enough time to evaluate alternatives, let alone migrate.
- The free claims were why people chose their plan. Essential's 10 and Plus's 35 free claims were a deciding factor for therapists who bill a little insurance. Removing them without lowering the plan price reads to those users as paying the same for less.
- Plus users asking where the discount went. The recurring question is whether Plus gets cheaper now that its two insurance advantages (free claims, lower rate) are gone. It doesn't.
- Navigator as an upsell. Users who have tried it describe the Claim Assistant as AI rather than a person, and question the $1.79 rate for it. The specialists are human; the claim checking is not.
- People are naming alternatives. Some are pricing a no-EHR setup with Availity and their own templates, and finding the manual work heavier than expected. Others are naming specific platforms they're evaluating, including Zanda and Upheal.
None of this changes the arithmetic above. It does suggest that a lot of practices will be reviewing their software in October, which is worth knowing whether you're one of them or not.
What to do if you're on Plus
You have four options, and the right one depends on your claim volume and how much you rely on the Plus-only features.
Stay and absorb it. If you submit under 50 claims a month, the increase is under $16. Not nothing, but not worth a migration.
Check whether you still need Plus. Plus includes team members, group telehealth, automatic status checks, and calendar color-coding. If you're a solo therapist on Plus for the free claims, those claims are gone, and Essential at $79 now has the same claim pricing. The $20 a month difference buys features you may not use.
Price Navigator honestly. At $1.79 a claim, Navigator is $1.40 more per claim than Essentials. For 100 claims that's $140 a month for the AI claim check, benefits verification, and specialist access. If you currently pay a biller, compare against that. If you don't, it's a new cost.
Look at what else the same money buys. October is when a lot of practices review their software, and a claim-fee change is a reasonable trigger to compare total cost across platforms, not just the per-claim line.
How Upheal compares
Upheal charges $0.30 per submitted claim and $0.15 per eligibility check, with no monthly billing fee and no plan tiers. The $0.30 covers the claim and its ERA. That's below SimplePractice's new rate at every volume, including above 1,000 claims where their rate reaches $0.33.
| Upheal | SimplePractice from Oct 1 | |
|---|---|---|
| Per claim | $0.30 | $0.39, stepping to $0.33 above 1,000 |
| Eligibility check | $0.15 | $0.15 (Starter, Essential); free on Plus until 2027 |
| Monthly billing fee | None | None |
| Claim + ERA | One charge | One charge |
| Human billing support | Managed Billing, 5.9 percent of collected revenue: a senior biller runs your account and Upheal takes responsibility for getting you paid. Closed beta, waitlist open | Navigator, $1.79 per claim: specialists advise, you still submit and chase |
The bigger difference is what sits around the claim. Upheal is $1 per session with AI session notes, telehealth, scheduling, and card payments included, so a therapist seeing 50 sessions a month pays $50 for the platform. On SimplePractice, the realistic solo setup is Essential plus Note Taker: $79 plus $35, $114 a month, before any claim. Group practice pricing on Upheal depends on the size of the practice, with discounts for associates; talk to sales for a quote.
On the per-claim line alone, the difference between $0.39 and $0.30 at 100 claims a month is $9. The difference in the stack is $64. If you're reviewing SimplePractice because of this change, review the whole bill.
Upheal is HIPAA compliant, signs a BAA with every practice, and publishes its security control status at trust.upheal.io. If you decide to move, the Assistant recreates your practice from your SimplePractice export: clients, notes, session history, contracts, note templates, and intake and consent forms.
Frequently asked questions
Is my SimplePractice subscription price changing?
No. Starter stays at $49, Essential at $79, and Plus at $99 a month. Only insurance billing fees change.
Does this apply to existing customers, or only new sign-ups?
Everyone. The new rates apply to all SimplePractice subscribers from October 1, 2026, regardless of when they joined.
Is the Plus plan getting cheaper to make up for losing the free claims?
No. Plus stays at $99 a month. The 35 free claims and the $0.25 rate are removed, and nothing replaces them in the plan price. Plus keeps its other features: team members, group telehealth, automatic status checks, and free eligibility checks until 2027.
When does the new pricing start?
October 1, 2026. Claims submitted on or after that date are billed at the new rates. Claims submitted through September 30 are billed at the old plan-based rates.
What happens to my free claims?
They end on October 1. Essential's 10 free claims and Plus's 35 free claims are removed. Every submitted claim is billed from the first one.
Can I switch between Insurance Essentials and Insurance Navigator?
Yes. You can turn Navigator on or off. Upgrades take effect immediately; downgrades take effect on your next billing cycle.
Do I pay for rejected claims?
SimplePractice bills per submitted claim. Check their support article for how corrected and resubmitted claims are counted under the new model, because the corrected-claim workflow is part of Insurance Essentials. On Upheal, a rejected and resubmitted claim is not charged again; the $0.30 covers the claim for that session.
Is Insurance Navigator worth it?
It depends on volume and on whether you currently pay for billing help. At 100 claims a month, Navigator costs $179 in claim fees against $39 on Essentials. If that $140 replaces a biller or prevents denials you're currently eating, it can pay for itself. If you submit clean claims and rarely need support, it's an expensive add-on.
What are SimplePractice's old insurance rates?
Through September 30, 2026: Starter $0.50 per claim; Essential 10 free claims a month, then $0.35; Plus 35 free claims a month, then $0.25. Manual status checks were $0.25 on Starter, $0.15 on Essential, and included on Plus.
Sources: SimplePractice support, "What's changing with insurance pricing?", "Introducing Insurance Navigator", "Subscription plan and pricing FAQs" (updated August 31, 2026), and the Insurance Navigator product page. Rates verified September 4, 2026.
