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The best EHR for cash-pay practices: what to demand before you pay
Most EHRs are built to bill insurance companies, and cash-pay practices end up paying for machinery they never use. This guide scores what a direct-pay practice should actually demand, with prices verified on the vendors' own sites in August 2026. We publish DrinCloud, we score DrinCloud, and we also show you exactly where an insurance-first EHR is the right buy.
Insurance-first EHRs, the category SimplePractice and Jane App lead, price per clinician, sell AI notes per seat, and carry the claims machinery that defines them. DrinCloud drops the claims engine entirely and prices by practice size, from $49 a month with the record, AI on your own OpenAI key, unlimited telehealth, the portal, surveys and campaigns in every plan.
The math that matters: a ten-clinician practice with AI for everyone pays DrinCloud $249 a month, while the leading per-seat platforms run from Jane's roughly $544 to SimplePractice's $1,115 at published August 2026 rates. The category still wins its home block: insurance, claims and prescribing goes 4.5 to DrinCloud's 1.0, so if you bill payers, buy insurance-first and do not look back.
Pricing: what cash-pay practices actually pay (August 2026)
| Pricing | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| Sticker for one provider | $49/moannual billing; $59 month to month | $49 to $99/moSimplePractice publishes $49 to $99, Jane App $54 to $99, checked August 20, 2026 |
| The bill at 10 providers | $249/moMedical Center covers 4 to 15 providers at one flat rate | $544 to $1,115/moJane about $544 and SimplePractice $1,115 with AI for everyone; the math is under the scenarios table |
| AI included, not sold per seat | ✓ Yesruns on your own OpenAI key, every user | Usually extraSimplePractice charges $35/mo per clinician, Jane $15/mo per practitioner for unlimited notes |
| A flat price as you hire | ✓ Yesbands: 1 provider, 2 to 3, and 4 to 15 | ✗ Rareper-clinician pricing is the industry norm |
| A real trial with no credit card | ✓ 15 dayssample data preloaded, no sales call | VariesSimplePractice offers 30 days; Jane offers guided demos |
| No setup fee, month to month | ✓ Yes | ✓ Commonmost leading platforms sell month to month |
| Unlimited patients on every plan | ✓ Yes | Variessome entry plans cap usage; Jane's Balance caps at 20 appointments a month |
| Block score · Pricing and transparency (20%) | 5.0 | 2.5 |
Sources: simplepractice.com/pricing, jane.app/pricing and drincloud.com/pricing, checked August 20, 2026.
Read any EHR price as three numbers, not one: the sticker, the cost of the next hire, and the cost of AI for everyone. The sticker clusters between $49 and $99 across the market. The other two numbers spread wildly: a tenth provider costs $0 at DrinCloud, about $35 at Jane and $74 at SimplePractice every month, and AI multiplies by headcount everywhere except where it runs on your own key.
The real math: three scenarios
| Scenario | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| Solo clinician with AI notes | $49/moSolo Practice, annual billing; OpenAI usage billed by OpenAI at cost | $94 to $114/moJane: Practice $79 + $15 AI Scribe = $94. SimplePractice: Essential $79 + $35 Note Taker = $114 |
| 3 clinicians, AI for everyone | $119/moGroup Practice, flat for 2 to 3 providers | $194 to $352/moJane: $79 + 2 x $35 + 3 x $15 = $194. SimplePractice: $99 + 2 x $74 + 3 x $35 = $352 |
| 10 clinicians, AI for everyone | $249/moMedical Center, flat from 4 to 15 providers | $544 to $1,115/moJane: $79 + 9 x $35 + 10 x $15 = $544. SimplePractice: $99 + 9 x $74 + 10 x $35 = $1,115 |
Arithmetic with rates published on simplepractice.com/pricing and jane.app/pricing (per-practitioner fees from Jane's own pricing calculator), checked August 20, 2026, assuming every clinician uses AI notes. DrinCloud figures are annual billing; monthly runs $59, $145 and $299. Whatever you choose, redo this table with your own headcount before signing.
The pattern to demand in writing from any vendor: a quote at your current size, a quote at your size plus three hires, and a quote with AI for the whole team. If the three numbers climb a steep line, you are funding the vendor's growth with yours. DrinCloud's line is flat inside each band; the leading per-seat platforms roughly double between three and ten clinicians.
The record and the AI: what to demand
| What to look for | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| Forms per specialty you can edit yourself | ✓ Yesform builder, no support ticket needed | ✓ Commontemplate editors are standard |
| A template library on day one | ✗ Noyou adapt our specialty forms; there is no community catalog | ✓ OftenSimplePractice and Jane both ship large libraries |
| Fields that carry history forward | ✓ Yesmemory fields pull allergies, history and medication into the next visit | Varies |
| AI that drafts the note from the recorded visit | ✓ Yeson your own OpenAI key, no markup | Usually an add-on$15 to $35 per clinician per month at the leaders |
| AI clinical assistant | ✓ Yesdifferential diagnosis, drug interactions, guidelines | ✗ Rare |
| AI patient chatbot on your own information | ✓ Yes | ✗ Rare |
| Pre-visit forms from the portal | ✓ Yes | ✓ Common |
| Informed consents with remote e-signature | ✓ Yesthe patient signs on their own phone | ✓ Common |
| Before and after photos on the chart | ✓ Yes | Varies |
| Block score · Clinical record and AI (25%) | 4.4 | 3.1 |
Sources: simplepractice.com, jane.app and drincloud.com product pages, checked August 20, 2026. 'Common', 'Varies' and 'Rare' describe the pattern across leading US platforms on that date, with named examples where a number exists.
Two demands sort the market fast. First: can the AI do more than transcribe? Scribes are everywhere now; a clinical assistant and a patient-facing chatbot are not. Second: who pays for the AI as you grow? Per-seat AI fees at $15 to $35 per clinician quietly become the biggest line on a ten-provider invoice. The trade DrinCloud asks in exchange is honest: no ready-made template library, so budget an afternoon to adapt the specialty forms.
Scheduling and patient communication: what to demand
| What to look for | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| Multi-provider, multi-room calendar on every plan | ✓ Yesrooms included from the $49 plan | Partlyrooms sometimes arrive in the top plan, as in Jane's Thrive |
| Booking that embeds in your own website | ✓ Yesreal-time availability by provider and specialty | ✓ Common |
| A waitlist that fills cancelled slots itself | ✓ Yes | Variesoften plan-gated |
| Email reminders | ✓ Yes | ✓ Standard |
| Text reminders | Paid pack$36 per 300 SMS; TCPA consent captured at intake | ✓ Usually included |
| Telehealth without metering | ✓ Unlimitedevery plan | Variesper-plan limits or per-practitioner fees appear |
| Patient portal with no app to download | ✓ Yes | ✓ Common |
| Self check-in kiosk | ✓ Yestablet check-in and check-out, with a visit rating on the way out | ✗ Rare |
| Waiting room call screen | ✓ Yes | ✗ Rare |
| Block score · Scheduling and patient communication (15%) | 4.7 | 3.1 |
Sources: simplepractice.com, jane.app and drincloud.com product pages, checked August 20, 2026.
The trap here is the plan ladder: booking, waitlists and rooms exist almost everywhere, but read which plan they live in. The two rows that separate a busy walk-in clinic from a laptop practice, the check-in kiosk and the waiting room screen, are rare in the category; the row DrinCloud loses, included SMS, is standard in it. Ask for the reminder pricing in writing either way: 'included' often means a monthly cap.
Getting paid: what a cash-pay practice should demand
| What to look for | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| Desk, online and payment-link charges | ✓ Yesall three included | ✓ Commoncard processing is usually built in |
| Deposits at booking | ✓ Yescharge the visit or a deposit when the patient books | Varies |
| Superbills with NPI, EIN, CPT and ICD-10 | ✓ Yesyou enter your own CPT codes | ✓ Common |
| Sliding scale fees per patient | ✓ Yes | Varies |
| Product sales with inventory | ✓ Yesstock falls as you invoice, with separate numbering | ✗ Rare |
| Quotes and treatment plans | ✓ Yes | Varies |
| Prices per service, specialty and provider | ✓ Yes | ✓ Common |
| Packages, memberships and gift cards | ✗ Noquotes and treatment plans, yes; memberships and gift cards, no | VariesJane's Thrive plan sells packages, memberships and gift cards |
| Block score · Getting paid (15%) | 4.4 | 3.1 |
Sources: simplepractice.com, jane.app and drincloud.com product pages, checked August 20, 2026.
Insurance-first platforms treat patient payments as a side door; cash-pay is the front door, so demand the tools that live there: deposits at booking to kill no-shows, sliding scale per patient, retail with real inventory, and quotes that become treatment plans. One gap on our side, said plainly: if memberships and gift cards fund your model, DrinCloud does not sell them and Jane's Thrive does.
Languages and patient experience: what to demand
| What to look for | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| Interface in each staff member's language | ✓ YesEnglish, Spanish, Portuguese and more, per user | ✗ RareEnglish-only interfaces are the norm |
| Communication language per patient | ✓ YesEnglish, Spanish, Portuguese or German; reminders, portal and documents follow it | ✗ Rare |
| Portal with no app to download | ✓ Yes | ✓ Common |
| Post-visit surveys with statistics | ✓ Yesanonymous or named, after each visit | Varies |
| Campaigns triggered by patient events | ✓ Yesif X happened, send Y after Z days, by email or SMS | Varies |
| Birthday and recall messages | ✓ Yesautomatic, in the patient's language | Varies |
| Block score · Languages and patient experience (10%) | 5.0 | 2.1 |
Sources: simplepractice.com, jane.app and drincloud.com product pages, checked August 20, 2026.
If your city speaks two languages, this block outweighs its 10%. A reminder the patient does not read is a no-show, and 'the receptionist translates' is not a system. Demand the language as a field: on the user, so staff work in their own language, and on the patient, so every reminder, portal page and document goes out in theirs. The US market barely offers it, which is exactly why we lead with it.
Insurance, claims and prescribing: when you need the other side
| What to look for | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| Claims and clearinghouse | ✗ NoDrinCloud does not file claims, on purpose; it is why the product is simpler and cheaper | ✓ Yesthe defining feature of the category |
| Eligibility checks | ✗ No | ✓ Common |
| e-Prescribing with EPCS | ✗ Noprescriptions print or go out as PDF; mandate states like CA, FL, NY, MI, MN and DE need a separate e-Rx platform | ✓ Oftenusually a paid add-on |
| ONC certification for Medicare and MIPS | ✗ Noit only matters if you bill Medicare | Varies |
| Superbills for out-of-network patients | ✓ Yes | ✓ Common |
| Block score · Insurance, claims and prescribing (10%) | 1.0 | 4.5 |
Sources: simplepractice.com, jane.app, healthit.gov (ONC certification context) and drincloud.com, checked August 20, 2026.
The category wins this block 4.5 to DrinCloud's 1.0, and that is the whole point of this guide: if claims, eligibility and e-prescribing are your daily bread, buy an insurance-first EHR and pay its per-clinician price with a clear conscience. A cash-pay practice funds all that machinery and uses none of it, except the superbill, the one insurance artifact your patients actually ask for.
Data ownership: what to demand before you sign
| What to look for | DrinCloud | Typical insurance-first EHR |
|---|---|---|
| AI on your own OpenAI account | ✓ Yesno markup; you own the key and the data relationship | ✗ RareAI is usually resold per seat |
| Full export, free, in writing | ✓ YesCSV and PDF, no retention, no exit fee | Variesask before you sign, not after |
| Free import from Excel or CSV | ✓ Yesassisted migration from $600 if we do the whole job | Varies |
| Tablet signature in the clinic | ✓ YesVidSigner add-on from $19/mo; remote signature on the patient's phone is free | Varies |
| HIPAA BAA on every plan, no surcharge | ✓ Yesincluded, with encryption in transit and at rest | Partlysome vendors reserve the BAA or its terms for higher tiers; read the fine print |
| Block score · Integrations and data (5%) | 5.0 | 2.0 |
Sources: simplepractice.com, jane.app and drincloud.com public security and help pages, checked August 20, 2026.
One test outranks every feature list: email the vendor and ask for their data export policy in writing before you pay. The answer you want has three parts: full export, free, whenever. Then ask who bills the AI. If the answer is 'we do, per seat', the AI line on your invoice will grow with every hire, whether or not anyone uses it.
Which one fits you?
An insurance-first EHR is the better fit if...
- Insurance claims are your main revenue: clearinghouse, eligibility checks and denial workflows are exactly what that category is for.
- You bill Medicare or chase MIPS incentives, where ONC-certified software matters.
- You prescribe electronically, especially controlled substances: EPCS needs a real e-Rx platform, and in mandate states like CA, FL, NY, MI, MN and DE it is not optional.
- You want patient flow from a vendor directory, like SimplePractice's Monarch.
- You want a huge peer community and hires who already know the tool.
- Memberships, packages and gift cards fund your model: Jane's Thrive sells all three.
DrinCloud is the better fit if...
- Patients pay you directly, in full, at the visit: concierge, direct primary care, aesthetics, therapy without panels, med spas, functional medicine.
- You are growing: flat bands ($49 solo, $119 for 2 to 3, $249 for 4 to 15) instead of a per-clinician meter.
- You want AI for the whole team without per-seat fees: drafting, a clinical assistant and a patient chatbot on your own OpenAI key.
- Your patients speak Spanish or Portuguese: language is a field on the user and on the patient, not a browser plugin.
- Your front desk is physical: tablet check-in kiosk, waiting room call screen, one-click excuse notes.
- You sell products or run retail alongside care: inventory deducts from the invoice itself.
- You do procedures: quotes, treatment plans, before and after photos, surgery scheduling and hospitalization for surgical centers.
- Repeat visits are your economics: post-visit surveys, event campaigns, birthday messages and referral tracking, included.
- Your patients still want reimbursement paperwork: superbills with NPI, EIN, CPT and ICD-10 without a claims engine.
- You refuse lock-in: 15-day trial without a card, free CSV import, and free full export the day you leave.
Questions about this comparison
What counts as a cash-pay practice?
Do I need ONC-certified software?
Can my patients still get reimbursed by their insurer?
What about e-prescribing mandates in my state?
Who wrote this guide, and how is it scored?
How often is this guide updated?
See it yourself: 15 days free, everything included
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SimplePractice and Jane App are trademarks of their owners. This page is an informational buyer's guide published by DrinCloud (Massive Bionics LLC), not affiliated with or endorsed by any vendor named. Named figures were verified on simplepractice.com/pricing and jane.app/pricing (per-practitioner fees from Jane's own pricing calculator) on August 20, 2026. The 'Typical insurance-first EHR' column describes common patterns across leading US platforms on that date: 'Common', 'Varies' and 'Rare' are category descriptions, not claims about any single vendor, and vendor-specific facts appear only in the notes with their source. Price scenarios are arithmetic with the official published rates and the assumptions stated under each table. Scores are computed only from the table cells with the published formula. If you represent a vendor named here and find an inaccuracy, write to info@drincloud.com and we will correct the data and the score immediately.
Correction history: first published August 20, 2026.