03/12/2026
I want to share my experience as a therapist using third‑party platforms such as Rula, Alma, and Tava so clients know what to watch for. Over the past year, several of my clients have reported unexpected charges, abrupt changes to their copays, and other billing issues through these platforms.
For example, one client was quoted a $30 copay per session by Rula. Later, without any clear explanation to the client, the platform increased the cost to $ 135 per session and automatically charged the card on file for the difference across multiple past sessions. The client was not proactively informed about the reason for this change; we suspect it may have been related to how the deductible was applied, but this was never clearly explained to them.
Situations like this create financial stress for clients and can damage trust in the therapy process, especially when surprise bills appear after the fact. Research on balance billing and surprise medical costs in behavioral health shows that unexpected charges can increase anxiety, make people consider stopping treatment, and harm the therapeutic relationship.
In my view, platforms and billing agencies should clearly inform clients up front that their quoted copay may change if deductibles or benefits are reprocessed—and they should notify clients before running large, retroactive charges. When this communication does not happen, the burden often falls on the therapist to repair the rupture and explain billing decisions we did not make.
If you are using a therapy platform, I encourage you to:
Ask for written confirmation of your expected copay and how your deductible works.
Review your Explanation of Benefits (EOBs) regularly.
Contact the platform or your insurer immediately if you see a charge you don’t understand.
Therapy should not come with unexpected financial shocks, and greater transparency in billing would help protect both clients and the therapeutic relationship.
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