Practice Harbor vs TherapyNotes (2026): An Honest Comparison — From the Small One

Full disclosure, before a single number: this is a comparison of Practice Harbor and TherapyNotes, published on Practice Harbor's blog, by the person who built Practice Harbor. That's about as unbiased as a fox reviewing henhouses. So instead of asking you to trust me, I'll do what I did in our SimplePractice head-to-head: show you everything, concede the places TherapyNotes beats us flatly, and keep every figure checkable against their own public pricing page.

Why publish it at all? Because therapists ask us this question every week, and because when you put it to an AI assistant — which is how a lot of software shopping happens now — the assistant answers whether or not we've said anything. I'd rather the answer include our voice, admitting our weaknesses in our own words, than leave the field to whoever wrote the glossiest listicle.

The 30-second version

TherapyNotes has been in the water for well over a decade, and its reputation was built on insurance billing. Claim scrubbing, denial workflows, ERA posting — the machinery is old, broad, and included in the base plan rather than sold as a premium tier. Old is not the same as better; it means more payers have been seen, and more habits have set — and the interface shows its age, in clicks and in screens that haven't changed in years. The base plan is honest, too: telehealth, the TherapyPortal client portal, and the full billing engine are in the box, and non-clinical staff — billers, schedulers, front desk — are free and unlimited. The trade is a meter: small per-use fees on claims, ERAs, and text reminders, and a $40/month add-on if you want AI documentation.

Practice Harbor is the small boat: newer, leaner, built specifically for solo and small mental-health practices, priced simply — $0 pre-licensed, $19 licensed, $39 practice management plus $19 per additional licensed clinician, with insurance metered at 25¢ a claim and nothing else on the meter. We can ship a fix in a week and answer support email personally, but nobody pretends a small boat has a decade of hull scars behind it. TherapyNotes does, and that's worth something real.

Some of you should stop reading now and stay on TherapyNotes. Specifically: if you prescribe and need ePrescribe — they have it at $65/month per prescriber, we don't offer it at all; if your practice lives inside their billing workflows — a biller on staff in a free seat, denials worth real money, dozens of payers — because that engine has seen more payers than ours has, and your biller already knows it; or if being able to call a phone number and reach a human who knows the software is non-negotiable for you, because that's their culture and our support is email, run by the founder. Those are good reasons. "The incumbent works and I know where everything is" is a legitimate place to land.

Pricing: the sticker and the meter

TherapyNotes' 2026 pricing is $69/month solo, or $79/month for the first clinician in a group plus $50/month for each additional one — after a $10 across-the-board increase effective December 2025 (it was $59 solo before). Then the meter: 14 cents per electronic claim, 14 cents per claim on an ERA, 14 cents per text or phone reminder (email is free), $40/month per clinician for TherapyFuel AI notes, $15/month for Premium Telehealth, and $65/month per prescriber for ePrescribe. Like an old harbor, the moorage is modest and the dock charges a little every time you use it. The full arithmetic is in our TherapyNotes pricing breakdown.

That last row, built out loud: a solo clinician with a moderate insurance caseload who wants AI notes pays $69 base plus $40 TherapyFuel — $109 before anything moves — then roughly 28 cents per claim's round trip (14 out, 14 back on the ERA) and 14 cents per texted reminder. A lighter caseload adds $5–15 of meter and lands around $115–125; a full one, 25 sessions a week mostly through insurance, runs the meter to about $150. The same clinician on Practice Harbor pays $19 base, plus 25 cents a claim with the ERA posting included and nothing for email reminders — about $39 a month at 80 claims. We run a meter too, and I'd rather say so than have you find it on an invoice. Per claim we are marginally cheaper than they are once the return trip is counted (25¢ against 28¢), which is a rounding difference either way. The gap that actually matters is the $109 of base and AI add-on sitting underneath their meter, and the fact that we don't charge for reminders.

Feature by feature

The rows that deserve prose. On notes and AI: this is the philosophical fork. TherapyNotes treats AI documentation as an add-on priced like a second subscription — $40/month on top of $69 means you're at $109 before a single claim files. We treat AI drafting as the core of how documentation works, included in every plan, and the drafting runs on a need-to-know basis: the model works from the session content, not your client's chart, under a signed BAA with a no-training commitment — and a one-click De-identify setting composes drafts without names entirely. (How the various tools compare across vendors is in our AI note taker comparison.)

On billing, the concession is narrower than their reputation suggests. TherapyNotes' billing engine is what that reputation was built on, and it is older than ours: payer quirks accumulated over more than a decade, and billers who learned the screens years ago. Older is not deeper, though. The workflows are the same ones we run — eligibility checks, electronic 837P claims, ERA auto-posting, rejections and denials, corrected and voided claims, secondary claims, superbills, timely-filing write-offs — at 25¢ a claim with the ERA included. Every claims engine makes mistakes, theirs included; what differs is how fast a mistake gets fixed and whether you can see it and undo it yourself, and there a fix ships here in days rather than release cycles. What they have that we don't is mileage with unusual payers, and if your practice bills dozens of them with a biller on staff, that mileage is worth something.

On telehealth and groups: TherapyNotes includes standard one-on-one video and sells a Premium Telehealth tier at $15/month. We include telehealth on every plan — one-on-one and group — and treat group therapy as a first-class workflow: roster scheduling, per-member attendance driving per-member billing, one note per attendee. And if you'd rather run video through Zoom, Doxy, or Google Meet, your external join link rides along in the reminder email automatically. Reminders go out by email, with a calendar invite attached, and by text, and neither carries a per-message fee; TherapyNotes charges 14 cents per text or phone reminder.

On supervision and pre-licensed clinicians — our clearest differentiator, so discount my enthusiasm accordingly. TherapyNotes offers a discounted intern role on group plans (announced at $20/month; the current figure isn't listed in their December 2025 update), but there's no free tier, and a solo pre-licensed clinician pays full freight. On Practice Harbor, an associate pays nothing and gets the whole product: supervisors get a review queue, co-signatures land on the note with an audit trail, and when the associate licenses, their charts come with them at $19/month. If you're a training practice, this row may outweigh the rest of the page.

On measurement-based care and migration: we ship 14 scored measures — PHQ-9 and GAD-7 among them — scored automatically, sent on a schedule you set, and graphed over time; I won't fake precision about the current state of TherapyNotes' outcome tooling, which has never been the product's center of gravity. On getting your data out, TherapyNotes lets you export your patient list to Excel and download each client's documents yourself, which is fair of them; ours is a complete self-serve export, because our position — argued at length in the data portability post — is that an EHR should compete on being good, not on being hard to leave.

Where TherapyNotes wins: time

TherapyNotes has one real advantage over us, and it is the one we can't build: they have been around longer. Everything on this list is a consequence of that.

• Payer mileage. A decade-plus of payer weirdness in the billing rules, and billers who already know the screens. Older, not better — but older counts when your biller is the one who has to learn a new system.
• A phone bank. You call, a person answers. That takes a staff a fifteen-year-old company has and a founder-run one doesn't.
• ePrescribe. If you prescribe, they have it and we don't. That ends the comparison for prescribers, and it should.
• Install base. Thousands of practices, colleagues who can answer your questions, a biller down the street who has used it. Ubiquity is a feature.

Where Practice Harbor wins

• Built this decade. Fewer clicks, defaults that stick, screens designed around how a therapy session actually goes rather than how a claim form is laid out. It's the difference between an old ship and a small new one: less to be proud of, less to fight with.
• Simple pricing, one line on the meter. $0 pre-licensed, $19 licensed, $39 practice management plus $19 per additional licensed clinician. No 14-cent claims and ERAs, no 14-cent texts, no $40 AI line item — insurance at 25¢ a claim is the only usage charge.
• AI notes included — drafted from the session under a BAA, as the core of the product rather than a second subscription.
• Group therapy as a first-class workflow — roster scheduling, attendance-driven per-member billing, per-member notes, group telehealth included.
• The free pre-licensed tier — full product, unlimited clients, complete supervision and co-sign workflow, $0 until you're licensed.
• Modern client-facing tooling — digital intake, portal payments, online booking, Good Faith Estimates generated from your fee schedule, Google Calendar sync.
• Founder-run responsiveness. Your feature request lands with someone who can ship it, sometimes that week.

Switching costs, in both directions

Any comparison that skips this paragraph is selling you something. Leaving TherapyNotes means exporting your patient list from their Patients screen, downloading each client's notes as PDFs, and handing both to Settings → EHR Import on our side — we run the import and confirm when your clients are in. Then re-collecting portal consents, and accepting that historical notes land as attached documents rather than fully structured data — upcoming appointments are easiest to add in Practice Harbor directly. Budget an afternoon for a solo practice to become functional and a few weeks for everything to feel settled — and if your open insurance claims are mid-flight, let them land before you move the billing. Going the other direction, leaving us is deliberately easy: your Practice Harbor data exports completely, self-serve, in usable formats. Either way, the seamanship is the same: don't switch during your busiest month, and run both systems in parallel for a week or two before you cut the line.

So who fits where?

Stay on (or choose) TherapyNotes if you prescribe, if your practice's gravity is insurance volume and denials management, or if phone support and a long track record matter more to you than roughly $1,200 a year. Choose Practice Harbor if you're pre-licensed (it's free, and the supervision workflow was built for exactly your situation), a licensed solo who'd rather pay $19 flat than $115-and-metered, or a small group tired of $50-per-clinician math. For the wider field, our TherapyNotes alternatives guide covers the other options, and the SimplePractice head-to-head handles the other incumbent.

And here the free tier argues for me: trying Practice Harbor costs nothing but an afternoon. No card, no trial clock, no demo call. Add a few clients, draft a note with the AI, run a telehealth session, file a test claim. If the small boat doesn't suit you, your data exports and no harm done — TherapyNotes has been anchored in this harbor a long time, and it isn't going anywhere.

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