Relay sells one idea: 20 sub-accounts so you can run Profit First or any other envelope-style cash management. For service businesses with stable revenue and a culture of reserving cash by category, that's a useful product.

Healthcare practices are not service businesses in the same way. Your revenue does not come in clean payments you can immediately bucket. It comes in ERA 835 files that have to be matched to claims first. The bucketing comes later, if it comes at all.

Where Relay Works

Relay is well built. The dashboard is clean. Sub-accounts are easy to set up and rename. Bill pay works. ACH is free. There are no monthly fees on the standard plan. For a single-entity practice that wants to allocate cash to operating, taxes, payroll reserve, and owner draws, the architecture is appealing.

If you've already adopted Profit First or a similar method and you don't process insurance reimbursements at scale, Relay covers it.

Where Relay Falls Short

Sub-accounts are not the same as separate FDIC-insured legal entities. That distinction matters more than it sounds.

No ERA 835 matching. Relay treats payments like deposits. Reconciliation against the patient ledger happens elsewhere, by hand or by your billing software.

No medical lockbox. Paper EOBs and patient checks need a separate handler. Lemma's Medical Lockbox is $2.50 per check with OCR and ERA matching included.

Sub-accounts are not entities. Relay's 20 sub-accounts share the same legal entity and the same FDIC umbrella. If you operate an MSO with multiple PCs, you cannot represent that structure cleanly in Relay. Each PC needs its own bank, or its own Relay account, which defeats the consolidation.

FDIC coverage. Standard $250K per depositor at the partner bank. No sweep network for higher coverage. Lemma offers up to $10M per entity through IntraFi.

When to Use Each

Relay is a good cash-budgeting layer for a single-entity practice. Lemma is the operating bank for any practice that processes insurance reimbursements, runs an MSO-PC structure, or holds more than $250K in operating cash.

Some practices use both: Relay for the budgeting envelopes, Lemma for the operating account, ERA matching, and FDIC coverage. The accounts interoperate via free ACH.

Open a free account in 5 minutes.