Running a Solo Therapy Practice Single-Handed: The Software Stack

Yes, one therapist can run a practice alone when software covers the four jobs a staffed practice splits: the phone, the schedule, the note and the money. On Ona that is one practitioner seat at $130 a month, with the scribe, telehealth and screening forms included in the seat. Phones and claims cost extra.

Quick answer:

• The real monthly cost for one clinician on Ona is $130 cash-pay, $230 with the phone answered, and $299 with the phone answered and insurance billing running.
• The seat includes scheduling, intake, consents, self-scoring screening forms, charting, the ambient scribe, telehealth, the patient portal, messaging, invoicing and reports. There is no higher tier to buy.
• Sign-off, appeals, credentialing, no-show follow-up and any call that needs a person are still yours. Nothing here removes them.

The four jobs a solo therapist absorbs

A group practice splits the week between a clinician, a front desk and a biller. Alone, you are all three, plus the person who remembers to renew the consent that expired.

Break it into four jobs and the question stops being philosophical. Who picks up when the phone rings mid-session. Who keeps the calendar honest. Who writes the note. And who turns a finished session into money that arrives. Software can take the first, the third and most of the fourth, but not the judgment inside the third.

Ona is a general ambulatory EHR that scales from solo clinicians to multi-location groups and enterprise systems. A one-person therapy practice is one of the setups it serves, not the category it belongs to. Everything below is what the platform publishes, gaps named.

Who answers the phone

This is the job solo therapists underestimate, because the cost is invisible. A call that hits voicemail during a session is often a first appointment you never hear about again.

Ona's AI receptionist is an add-on, not part of the seat. It picks up 24/7, works out what the caller wants, books against real availability while honoring session duration and buffers, and writes the transcript, recording and structured intake onto the patient record. First-time callers become leads with the right person notified, which in a solo practice is you.

The part that matters most here is the part that does not automate. Ona's own page states that urgent symptoms and sensitive flows, including mental-health distress or medication safety concerns, bypass the agent entirely and ring a human. Read that literally: the agent is not standing between you and the hardest call of the week. It filters the twenty routine ones so you can take that call.

The agent can take a call in Spanish while writing the note in English, and Ona says most clinics are answering live calls within about a week. If you only want ordinary calling instead, the separate Calls add-on is $25 a month and puts placing and receiving calls inside Ona, every call transcribed and recorded onto the record.

Who writes the note

Documentation is the single largest non-clinical load in a therapy week, and the one job that needs your license on the end of it.

The ambient scribe records the session in the room or on a telehealth call with per-visit consent the client can pause, or takes uploaded audio afterwards in MP3, M4A or WAV up to 100MB. It diarises the transcript into timestamped speaker turns and drafts a structured note against your template: SOAP, DAP, BIRP, freeform, or one you build. Placeholder fields pull medications, allergies and history into the right slots.

Two things are worth stating plainly. Every draft lands in a review state and nothing enters the record until you sign it, and Ona states it does not train models on your recordings.

Telehealth sits in the same seat and the same record. It runs in any modern browser on desktop or mobile, with no client account and nothing to install, a waiting room with a live preview, and a Join button that unlocks at the scheduled start. Consent-gated audio recording feeds the same scribe. Visits are one clinician, one client today.

Who scores the screener

Screening instruments are the quiet admin tax in a therapy practice: print, score by hand, transcribe into the note, file the paper.

Ona's screening forms carry the canonical 0-27 PHQ-9 scoring and the 0-21 GAD-7 scoring with their standard severity bands, and the PHQ-9 ships with item 9 preconfigured so an answer above "Not at all" raises a suicidality risk flag. Scores are visible to clinicians only; the client sees the questions without scoring labels.

The limits are on the same page. Each result lives on the form it came from, there is no reporting across patients today, and the page is blunt about the flag itself: a flag is information, not a diagnosis, and what happens next follows your clinical protocol.

Intake runs ahead of it. The client completes a conversational questionnaire on their phone in the patient portal, and you get a structured assessment before the first session. Consents are versioned, capture a timestamp, the signer and the template version, and can be set per visit or evergreen, which is how an annual HIPAA privacy notice stops being a thing you forget.

Who gets you paid

Split this by how you get paid; the cost differs completely.

Cash-pay. Billing generates the invoice from the signed note, payments run on Stripe at pass-through rates with Ona taking no cut, and clients pay from the portal, at the desk, or by text-to-pay. Superbills cover client self-submission, and session packages cover prepaid blocks. No clearinghouse plan is needed at all.

Insurance. The insurance module runs real-time eligibility before the session, showing coverage, co-pay, deductible and out-of-pocket max on the record, generates a pre-filled CMS-1500 from the note you signed, submits it, and tracks status through to payment, with denials in their own queue carrying the payer's reason.

Claim submission sits on a separate line: Ona Clearing House, which runs on Stedi with no separate Stedi account to open, contract or pay for. Starter is $69 a month for 100 claims, 100 ERAs and 200 eligibility checks, with unlimited providers and payer enrollments on every plan. A solo therapist billing around 25 sessions a week files roughly 100 claims a month, right on that Starter ceiling; a fuller book moves you to Core at $149 for 250.

What it actually costs for one clinician

Every feature is on every plan, so there is no tier to upgrade into for claims or for AI. Published figures, one practitioner, no staff seat:

• Cash-pay, phone not covered: $130 a month. One practitioner seat: scheduling, intake, consents, screening forms, charting, the ambient scribe, telehealth, the portal, messaging, tasks, reports and invoicing. Omnichannel messaging is free at two practitioners or fewer, so its $150 does not apply.
• Cash-pay, phone answered: $230 a month. The AI receptionist at $100 for 400 minutes, about 19 minutes of calls on a typical working day.
• Insurance, phone not covered: $130 plus $69. The seat plus an Ona Clearing House Starter plan.
• Insurance, phone answered: $299 a month. All three lines together.
• If you prescribe: e-prescribing adds $45 per prescribing practitioner and EPCS adds $25 on top of it, which is the psychiatric rather than the therapy-only setup.
• A part-time front desk later: +$45 a month for a staff seat.

Annual billing takes 10% off everything, which takes the cash-pay solo to about $117 and the fully loaded insurance setup to about $269. There are no setup fees and no long-term contract, migration from any EHR is free, and the trial is 14 days with no credit card. Current numbers live on the pricing page.

One honest detail on the receptionist: overage is $0.20 a minute, while an included minute on the entry tier costs $0.25. Busy weeks therefore do not force you up a tier, and 500 minutes on the 400-minute tier comes to $120.

Ranked: solo therapy stacks compared

Ranked on one narrow axis: how much of a one-person therapy practice each stack covers before you add a second vendor or a second person. It is not a quality ranking and not a price ranking. Ona is not the cheapest row here. Figures come from each vendor's own pricing page, checked in September 2026.

Rank	Stack	Who answers the phone	Notes and screeners	Claims and payments	Published cost, one clinician
1	Ona	AI receptionist add-on: 24/7, books the live calendar, sensitive calls bypass the agent and ring a human, transcript and intake onto the record	Ambient scribe and templated charting in the seat; self-scoring PHQ-9 and GAD-7 with bands and an item 9 flag	In the seat: invoice from the signed note, the eligibility and claims workflow, CMS-1500, denial queue; Stripe at pass-through rates. Eligibility checks, claims and ERAs are metered by the Clearing House plan	$130 seat; receptionist from $100 for 400 min, $0.20/min over; Clearing House from $69; e-prescribing +$45, EPCS +$25
2	TherapyNotes	Not covered for patient calls, but 24/7 phone and email support for you on every plan	TherapyFuel +$40/mo per clinician; unlimited notes	Electronic Billing $0.14 per claim, ERA and eligibility request; payments 3.1% plus $0.30	Solo $69/mo; Premium Telehealth +$15; ePrescribe +$65 per prescriber; 30-day trial
3	SimplePractice	Not covered	Note Taker $35/mo list, or included in the Care Aide suite at $59/mo	Insurance Navigator filed at $1.79 per claim, listed as coming soon	Starter $49, Essential $79, Plus $99; ePrescribe $49/mo plus an $89 setup fee; 50% off for 3 months today
4	ICANotes	Not covered	AI Scribe $49/mo per user; part-time Notes Only and Non-Prescribing cap at 60 notes a month, part-time Prescribing at 100	Text reminders, claims and statements quoted by sales	Notes Only $55, Non-Prescribing $75, Prescribing $213 full-time; $99 activation on Prescribing plans; 3-month commitment; Telehealth $20/mo
5	Healthie	Not covered	AI charting carries additional fees, not published	ClaimMD from $30/mo; inbound fax $10/mo	Core $19 (10 clients), Essentials $49 (250), Plus $129 (unlimited); DoseSpot $40 per clinician/mo

Read it by what breaks your week. If the phone is the problem, only the first row addresses it inside the product. If budget is the problem, TherapyNotes at $69 with 24/7 phone support and unlimited notes is the cheapest credible way for a solo therapist to be properly covered, and on its published rate a hundred claims, ERAs and eligibility checks each add about $42. If you are cash-pay with a small caseload, Healthie's Core plan has the lowest entry price here, with a 10-client cap to check against your panel.

What still needs a human

This is where the automation story should stop, and most articles do not.

Signing the note. Every draft lands in review. You read it, you edit it, you sign it. The scribe shortens the writing, not the thinking.

Deciding what a flagged screener means. The flag is a prompt to look, nothing more.

The calls that matter. Sensitive calls ring a human by design, and in a solo practice there is exactly one human. An AI receptionist reduces interruptions; it does not give you an on-call partner, and you should not buy it as though it does.

No-show follow-up. Ona sends booking confirmations by email and the receptionist confirms the bookings it makes on the phone. There are no automated SMS or push reminder cadences today. If no-shows are your biggest revenue leak, weigh that hard and ask about it on the demo.

Appeals, denials and credentialing. A denial queue with payer reasons makes the work visible. Deciding what is worth appealing is a person reading a policy, and credentialing is months of forms that no EHR shortens.

Setup. Your note templates, your screening forms with their point values and bands, your services and buffers, your payer list. Guided onboarding and workflow tuning are included in every plan and migration is free, but full cutover typically runs one to three weeks for smaller practices, and those are your hours.

Support hours. Ona's human support is in-app chat and email from a primarily business-hours team, aiming for a same-day answer. TherapyNotes advertises 24/7 phone and email support on every plan. If you work evenings and want a person on the line at 9pm, that difference is real: Ona's 24/7 is the receptionist answering your clients, not a person answering you.

Two more limits before you commit: there are no native mobile apps, so the workspace and the portal are mobile-friendly web, and Ona does not read message content looking for emergencies, which its messaging page states.

For the cross-specialty version, see how to run an entire practice by yourself, and for the documentation angle, the best AI scribe for behavioral health and the behavioral health page.

Frequently asked questions

Can one therapist run a practice alone?

Yes, if software takes the four staffed jobs: the phone, the schedule, the note and the money. An ambient scribe drafts the session note for you to sign, screening forms score themselves, telehealth and the patient portal sit inside the record, and billing runs off the signed note. What stays yours is clinical judgment, sign-off, appeals and credentialing.

What does a solo therapy practice cost per month on Ona?

One practitioner seat is $130 a month with every feature included, so a cash-pay solo practice starts there. Add the AI receptionist from $100 a month for 400 minutes, and Ona Clearing House from $69 a month if you bill insurance. A cash-pay solo with the phone answered is $230 a month; an insurance solo with the phone answered is $299. Annual billing takes 10% off everything.

Do I need an AI receptionist if I work alone?

Not on day one. It earns its place when the calls you cannot take during sessions are costing you bookings. Ona's answers 24/7, books against real availability, and writes the transcript and structured intake onto the record. Calls that sound like mental-health distress or a medication safety concern bypass the agent entirely and ring a human, which in a solo practice means you.

Can I score PHQ-9 and GAD-7 inside the chart?

Yes. Ona's screening forms carry the canonical 0-27 PHQ-9 scoring and the 0-21 GAD-7 scoring with their standard severity bands, and item 9 answered above 'Not at all' raises a suicidality risk flag. Scores are visible to clinicians only, and patients see the questions without scoring labels. Each result lives on its own form, and there is no reporting across patients today.

Does a solo therapist need a clearinghouse plan?

Only if you bill insurance. Cash-pay practices do not need one. Ona Clearing House starts at $69 a month for 100 claims, 100 ERAs and 200 eligibility checks, runs on Stedi with no separate Stedi account to open, contract or pay for, and includes unlimited providers and payer enrollments on every plan. A fuller caseload moves you to Core at $149 for 250 claims.

What does the software still not do for a solo therapist?

It does not sign your notes, decide what a flagged screener means, appeal a denial, or get you credentialed with a payer. Ona sends booking confirmations by email and has no automated SMS or push reminder cadences, so no-show follow-up is yours. Human support is in-app chat and email from a business-hours team, while TherapyNotes advertises 24/7 phone and email support.

Next step

Test it against one real week, not a feature list: your call volume, your note format, your screeners, your payers. Book a 15-minute walkthrough, no obligation, then run the setup yourself on the 14-day free trial, full access, no credit card. If you stay, your data comes across from any EHR free, usually within one business day.