SimplePractice Limitations That Matter for Behavioral Health Practices

UPDATED ON: Feb 10,2026

SimplePractice does a lot of things well. Clean interface. Solid scheduling. Easy onboarding for solo practitioners. Nobody’s arguing that.

But running a behavioral health practice with prescribers, group therapy, or IOP/PHP programs? You’ve probably bumped into SimplePractice limitations that go beyond minor annoyances. After a 63% price increase in 2025¹ and continued feature gaps for behavioral health workflows, more practice owners are weighing whether it’s time to look elsewhere.

Here’s an honest look at where SimplePractice falls short for behavioral health, and what actually matters when you’re comparing alternatives.

No Group Notes, and That’s a Problem

Group therapy sessions need documentation. DBT skills groups, process groups, IOP programming: all of it. SimplePractice has no native function for creating group notes with 3 or more clients.²

Users on SimplePractice’s own support forums describe the workarounds as “jerry rigged.”² You’re creating individual notes for each group member and cross-referencing them manually. For a 10-person DBT group, that’s 10 separate notes instead of one group note with individual progress entries.

That’s not just an inconvenience. Group documentation tracks individual progress within a group modality, coordinates between co-facilitators, and demonstrates treatment effectiveness to payers. Without it, you’re spending hours on workarounds that a purpose-built EHR for behavioral health handles in minutes.

Think about what that looks like at scale. A clinical director at a 15-clinician substance use treatment center in Charlotte runs 6 groups per day. Her team creates dozens of individual notes to approximate what should be a single group note per session. Multiply that across a week and you’re burning clinical hours on data entry.

PIMSY includes native group notes with multi-facilitator documentation. One group session, one note, individual progress tracked per client. Two clinicians co-facilitating? Both document in the same place. It works the way group therapy actually works.

No UB-04 Billing Means No IOP, PHP, or Residential Revenue

SimplePractice only supports CMS-1500 professional claims. Practices billing for IOP, PHP, or residential services need UB-04 institutional claims. SimplePractice can’t generate them.² No workaround. No timeline for adding it.

This isn’t a nice-to-have. UB-04 is required for facility-level billing. Without it, you’re either running a second billing system alongside SimplePractice or you’re simply not offering those services. Either way, it’s revenue you can’t capture, or extra overhead eating into your margins.

A practice in Raleigh recently added an IOP program to meet growing demand. They had to bolt on a separate billing platform just to submit institutional claims, while keeping SimplePractice for outpatient. Two systems, double the reconciliation headaches.

Growing behavioral health practices are increasingly expanding into IOP and PHP programming. A practice management system that can’t bill for those programs puts a ceiling on your growth.

PIMSY handles both CMS-1500 and UB-04 billing, with support for residential and institutional claims. One system, both claim types.

The Pricing Squeeze: 63% Increases and Add-On Costs

In early 2025, SimplePractice restructured pricing with minimal notice. Plans jumped from $29 to $49+ overnight, a 63% increase.¹ Some users reported seeing their bills climb from $49 to $99 with features they didn’t ask for bundled into mandatory upgrades.³

The sticker price is only part of it.

ePrescribe runs $49/month per prescriber, plus an $89 one-time setup fee per clinician.⁴ A behavioral health practice with 3 prescribers pays $147/month extra just for medication management. That adds up to over $1,700 a year on top of base subscription costs.

Only the Plus plan supports group practices, so per-clinician costs compound fast. A 10-clinician practice isn’t paying $99/month. The real number climbs significantly once you factor in plan tiers, add-ons, and feature gates.

Telehealth Reliability Has Become a Liability

SimplePractice’s telehealth has gone from selling point to friction point. Users report clients getting kicked from sessions, audio quality described as “horrible grinding background noise,” and connection failures where both parties are on the call but can’t see or hear each other.⁵

Among SimplePractice limitations, this one hurts most. A dropped video call isn’t just an IT inconvenience. When you’re mid-session with a client processing trauma or reviewing a medication change, a telehealth failure is a clinical disruption. Your clients notice. Some reportedly joke about how unreliable the feature is.³ That’s not the kind of word-of-mouth you want.

PIMSY includes HIPAA-compliant telehealth at every plan level: waiting rooms, breakout groups, chat, and whiteboarding. You choose between Jitsi/8×8 (affordable) and SecureVideo (premium). No add-on fees at any tier.

When Your Practice Outgrows the Platform

SimplePractice works for a solo LCSW doing private pay in a single office. But behavioral health practices don’t stay small. You hire a prescriber. You launch an IOP program. You open a second location.

Each growth milestone exposes a new SimplePractice limitation.

No multi-organization toolkit for practices managing multiple entities. No authorization management with auto-decrementing units, which matters when you’re tracking Medicaid authorizations across dozens of clients. No ONC certification, which payers and interoperability requirements increasingly demand.

No credential tracking, no HR or payroll modules, no inpatient features like bed management or eMAR. Need any of these? You’re stitching together separate systems. And that’s where errors, inefficiencies, and compliance risks start to multiply.

Consider a practice owner in Raleigh who started with 3 therapists on SimplePractice. Five years later, she has 20 clinicians across two locations, prescribers on staff, and an IOP program. She didn’t switch because SimplePractice was bad. She switched because her practice outgrew what it could do. Sound familiar?

Authorization tracking, credentialing, HR, payroll, bed management, eMAR, medication inventory: it’s there when you need it. You don’t outgrow the system.

What to Look for in a Behavioral Health EHR

Weighing SimplePractice alternatives? Here’s what actually matters:

Native group therapy documentation (not workarounds)
Both UB-04 and CMS-1500 billing support
Prescriber-therapist coordination in one system
Authorization tracking with unit management
ONC certification for interoperability
Telehealth that’s built in, not bolted on

Here’s the distinction that matters most: “built for behavioral health” versus “adapted for behavioral health.” SimplePractice was designed for solo wellness practitioners and expanded from there. PIMSY was built specifically for behavioral health from day one, since 2007. Treatment plans, group documentation, prescriber coordination, substance use workflows… these are core architecture, not afterthoughts.

That design difference shows up in the details. It shows up in group notes that actually work, in billing that covers both claim types, in features that match how behavioral health practices actually operate.

The Right Tool for the Job

SimplePractice isn’t a bad product. It’s a good tool for solo therapists doing private pay. But these SimplePractice limitations add up fast when behavioral health is your specialty. Your EHR should match the complexity of the care you deliver.

Practices with group therapy, prescribers, IOP/PHP programs, or Medicaid billing need a system built for that work from the ground up.

PIMSY was built for behavioral health practices like yours. See the difference for yourself: start a free 30-day trial or request a demo.

Already thinking about making the switch? We’ve been through it with thousands of practices. You’re busy, we get it.

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