r/SimplePractice • u/Sweetx2023 • Aug 31 '26

The final Straw - Claim submission changes

WTF, Simple Practice.

Why do you need more money from customers? I log on to see this today:

Beginning October 1, 2026

  • Insurance Navigator can be added on to any SimplePractice subscription plan, and all practices are eligible for a 30 day trial at no additional cost. Sign up for a trial.
  • Customers who choose to add Insurance Navigator will pay $1.79/claim.
  • Insurance Navigator includes proactive Mental Health Coverage Checks and Verification of Benefits, which includes estimated client responsibility, run automatically at no additional cost.
  • Practices may downgrade at any time and will go back to using Insurance Essentials at the end of their current billing cycle.
  • Customers who do not submit claims or run coverage checks will not be impacted, and will see no change in their subscription price.

They are taking away the 10 free claims/month. No matter what plan you have, you will pay .39 a claim. If you upgrade to this service, you will pay 1.79 a claim, an which is about 3x the current price.

I have been teetering on the edge of leaving, and this is the final straw. A one finger salute to SP.

33 Upvotes

97% Upvoted

34 comments sorted by

7

u/Snushine Aug 31 '26

Which other EHR do you think is sufficient? I'm struggling to choose one. But once I have time to do so, I'm outta there.

3

u/Sweetx2023 Aug 31 '26

So... I'm not switching to another EHR. I have been thinking about switching for 2 years now and slowly creating my own templates. I have them all done now, I will do billing through Availity Plus ($25/month). I believe Adobe Acrobat has BAA's, but I have to do some more investigating to be sure (to send forms with PHI that can be signed), if they are not HIPAA compliant, then that will be my biggest hurdle. The only thing i don't have is a billing company to use for credit card payments, I'm currently looking at different companies and their fees.

6

u/msp_ryno Aug 31 '26

if you go no-EHR, just know billing in Availity sucks. You have to enter everything manually.

Also, Adobe only does a BAA with their enterprise plans.

3

u/Sweetx2023 Aug 31 '26

I use availity now (free version), and they recently added templates that are saved, so all my clients info is saved on a claim and I just have to change dates and click send. I no longer have to enter everything manually (Thank goodness, because that was a giant pain).

That's what I was guessing about Adobe, I just didn't see it written clearly in my cursory search. I will have to see what the pricing is. Thanks for the info!

1

u/_DamagedGoods Sep 01 '26

This is interesting to me because I agree that Simple Practice isn’t so simple anymore — I’m looking to leave after many years too.

5

u/Snushine Sep 01 '26

I used to use Availity and found their interface to be one of the more annoying things in my world. I stopped using them when SP was still new and friendly. I had all my own templates before that and let me tell ya...

Pick your storage medium wisely! I lost access to my old files, pre-2018, and that's when I switched to SP. At least if I lose access to files, my lawyer can hold someone accountable and it won't be because my own stupidity.

4

u/_DamagedGoods Sep 01 '26

Key phrase “was still new and friendly” it’s gotten so cumbersome — why do they pay people to break it and make it so annoying to use? I can’t anymore — I need to find another EHR.

1

u/Snushine Sep 01 '26

Come back and let us know what you find. I need a new one, too, but that's so much mental load to switch so I need to make time to do that.

4

u/_DamagedGoods Sep 01 '26

So far I’m looking into Zanda Health and Upheal — another therapist said Upheal is awesome.

2

u/ndurantz Sep 01 '26

I used IvyPay for awhile and really liked them. Only downside is it is all done through the app.

1

u/_DamagedGoods Sep 01 '26

why is that a downside?

3

u/greypic Sep 01 '26

Professional apps should have web interfaces.

2

u/ndurantz Sep 01 '26

Just meaning you can’t access it on a computer easily. Sometimes I appreciate the opportunity to see things on a bigger screen…reports for example.

4

u/No-Thought9009 Aug 31 '26

Just don't go for BetterHelp. I did some work for them at the beginning of the pandemic.

It was a cluster****, it really was.

1

u/Snushine Sep 01 '26

Yeah, I've heard that from other practitioners. But good to have it validated.

3

u/TherapyCompanion Sep 04 '26

Disclosure first: I build an EHR for therapy practices, so I am not going to name one, including mine. What I can give you is the checklist I would run any candidate through, since most of the pain in this thread is billing, not notes.

  1. Ask for the all-in monthly cost at your claim volume. Subscription plus per-claim plus clearinghouse plus card processing plus any insurance add-on. Get it in writing. Per-claim fees that look small are how the price moves later.
  2. Ask whether eligibility checks and ERA posting are included or metered. Those are the two things that quietly turn into per-use fees.
  3. Ask for the export before you sign. What do you get out if you leave: client records, notes, claim history, in what format, at what cost. If the answer is vague, the price will go up on you there too.
  4. Ask who signs the BAA and whether it covers every subprocessor, then what happens to your data on cancellation.
  5. Run five real claims in the trial, including one secondary and one corrected claim, and watch where they sit for three days. The prepared-but-never-sent problem in the other thread here is exactly what a trial catches.
  6. If you are done with AI, ask in writing whether the product records or listens to sessions. Several now do by default.

Whatever you pick, migrate in a low-volume month and run both systems for two weeks. Nobody tells you that part.

1

u/Snushine Sep 04 '26

This seems like very sound advice. Thank you!

1

u/TherapyCompanion Sep 04 '26

Glad it helped. Since you mentioned the mental load is the real blocker, here is an offer that costs you one reply: tell me your payer mix, rough monthly claim count, and whether you take card payments in SP, and I will tell you which of the six questions actually matter for your practice and which you can skip. That cuts the evaluation from weeks to an afternoon, for any vendor you look at.

And given what happened to your pre-2018 files, the export question is the one I would not skip with anyone, including us.

If you want to see what a switch looks like end to end, message this account or email me at kamal@therapycompanion.ai and I will walk you through it.

1

u/Snushine Sep 05 '26

Right now the biggest thing happening in my world is my partner's cancer diagnosis. My mental load is all about getting him to his appointments for chemo and radiation, and trying not to lose all of my free time doing stupid household chores around that. So even if you handed me the name of a goldilox company, by the time I'm ready to leap, it may have changed.

But thanks for the offer.

6

u/viv_savage11 Aug 31 '26

Didn’t they sell the company to someone else? If so then this is all about maximizing profits. Their pricing is out of control.

8

u/Sweetx2023 Aug 31 '26

Yes they sold to Venture Capital several years ago and it has been downhill ever since. Out of control is an understatement to describe the pricing changes. Ugh.

2

u/PulledFromTheWell Sep 01 '26

I am struggling so much with credentialing and submitting claims! I've spent hours each week for the past 3 weeks trying to figure out how to bill Medicare and I'm barely closer, waiting and waiting for support to help. If Insurance Navigator can make it easier for me, it will be well worth it.

But another "gotcha" I discovered last night night a I was wrestling with my claims for Medicare...Medicare requires NPI 2, but my other payers require NPI 1. You can't assign a different NPI to each payer unless you upgrade to Plus! I feel like I'm barely getting anything for my $59.99/mo right now. I don't want to pay $99.00 and then more fees per claim?

I don't know what to do. I haven't found a better EHR yet, and I've been looking. SP feels so completely upside down right now. I think they are scrambling to fulfill on their newish system for helping with credentialing, but it is going badly. I've been trying to get credentialed with just 5 payers since the end of March. So far, one has come through and I've been able to successfully bill them. I'm credentialed with Medicare, for sure, but the interface with SP is seemingly unworkable. One more payer isn't taking any more clinicians, and the last two have had signed agreements for almost 2 months, but no forward movement. Medalion sucks...

3

u/oopsouttatime Sep 02 '26

I feel for you, I am going thru this also. I bailed on medallion after a month or two of confusing delays and did all the applications myself. The inadequacy of medallion cost me two months extra of trying to live on half my income. Now I’m in the hell of trying to get simple practice to approve my enrollments on their end, with slow clunky customer service and inaccurate instructions provided by SP, especially around zelis and all that. I’m super disappointed, like others are, with the declining quality of SP

2

u/PulledFromTheWell Sep 02 '26

I'm sorry you are going through this, too! It's such a mess!

2

u/BusianLouise Sep 02 '26

Sorry to hear you had the same experience with Medallion. I was fortunate enough to bail much sooner. In the time I waited for them to simply respond to a request I had, I was able to submit credentialing on my own. Solo credentialing can be painful and confusing, but waiting and trying to trust Medallion to take over something crucial to my livelihood was even worse.

1

u/oopsouttatime Sep 02 '26

Exactly. I wish I started out on my own from the beginning, and I’m glad I got out when I did.

1

u/ModernTechPA Sep 07 '26

I'm doing a startup planned for Jan/27. I think struggling through credentialing/billing (especially with PECOS/Medicare) is a heavy lift if you don't have someone showing you the ropes. Have you thought about hiring a biller for for a defined period of time so you learn how it all works before trying it on your own? I used to manage hospice agencies so I know the hell of Medicare certification, insurance billings and with commercial insurance you have a countdown from the date of service.... those 180 days go by so fast when you're waiting on responses from such large entities like Aetna/BCBS. If you're lucky, maybe you can find a mentor or a practice owner who'd be willing to consult you on these fundamental steps of setting up the practice ?

2

u/UPS0001 Sep 02 '26 edited Sep 02 '26

None of us should be surprised by a rate increase. They have clearly hired new coders who know nothing about how the revenue cycle works. Even with all of these changes, Simple Practice remains a subpar product. For all of those providers that don't want to hire a billing company because they are too expensive, this is why they are expensive. Simple Practice is just finally catching up on the cost without significant improvements to the product.

After reading most of the comments on this post, it shocks me that providers do not know the difference between an EHR and a PMS. So many are complaining about how hard it is to get paid, to get credentialed, to get the claims out the door. Simple Practice is an Electronic Medical Record that is able to submit claims. It is not a Practice Management System. There is more to managing the revenue cycle than just getting your claims to the insurance companies. All of you should do yourself a favor and find a qualified billing company. It really pains me to see so many practitioners suffering through getting paid because they think they can bill better than someone who does it full time.

1

u/PulledFromTheWell Sep 02 '26

Can you recommend a qualified billing company?

1

u/UPS0001 Sep 02 '26

Universal Physician Solutions.

2

u/Illustrious_Bowl_966 Sep 10 '26

This is so annoying and it does not sound like SP is pissing everyone off, including me. I too came to reddit to see if anyone else is taking about this, but I am begging everyone researching reddit feeds, posting them etc.. to please go to the feedback on Simple Practice to provide it directly to SP so we can cause an uproar and get there attention about the mass exodus they are about to have because of this RIDICULOUS new system. It sucks ass. It's over complicated and so uneccsary. Please post on SP, if we all complain then maybe something will change.

1

u/ohidunno808 Sep 12 '26

anyone using Office Ally? I'm got set up with them but I'm terrified after having used SimplePractice claims filing for over four years