Telehealth therapy practices have no branches, no checks, no in-person touchpoints — but still pay big-bank fees. Here's the banking stack built for how they actually operate.
Telehealth therapy practices have a banking problem the rest of healthcare does not, one that the behavioral health banking playbook (opens in a new tab) has to account for on its own. There is no lobby, no front-desk lockbox, no paper checks to deposit. Every dollar is electronic. Every expense is electronic. Most providers are 1099 contractors paid by ACH. The platform fee runs by ACH. The EHR runs by ACH. And yet most of these practices still bank with the same regional or national bank that served their first solo office, paying for branches they never visit and locked into a fee schedule built for a very different business model.
Look at a typical telehealth therapy group's banking activity for a month:
A traditional bank charges per ACH, per wire, and sometimes per transaction over a monthly threshold, the kind of fee structure broken down in why ACH beats other payment rails for high-volume payouts (opens in a new tab). Branch fees and physical-product fees are baked in and unavoidable. None of those services apply to a telehealth practice. The bank still charges for them, and the cost compounds as the practice grows.
Strip the requirements down to the things that matter for a fully remote therapy group:
A bank built around branches does not optimize for any of this. A bank built for digital-first practices does.
The structure most telehealth groups land on once they switch:
ACH is $0 in both directions, so paying a large contractor network every week (opens in a new tab) costs nothing on the banking side. Wires are a flat $15 if you ever need one. Operating cash earns 1.75% APY across the structure. FDIC coverage runs up to $10M per entity through the IntraFi sweep network, well past FDIC coverage limits most practices don't realize they're exceeding (opens in a new tab), which matters when a quarterly payer settlement lands and the operating account briefly holds seven figures.
A telehealth practice has fewer banking touchpoints than a brick-and-mortar one, which makes the switch faster than most owners expect:
Most groups report cleaner books and noticeably lower banking fees within the first full quarter, and many use the saved time to launch a new program or expand into a new state.
If you are a solo therapist with two payer contracts and you are happy paying $20 a month for online banking, this is overkill. If you have more than three clinicians, more than three payers, or a contractor pool above a dozen people, the math usually closes itself in the first quarter after migration.