How to Choose an Online Therapy Service

Online therapy is sold on convenience, and convenience is genuinely the point: you get matched with a licensed therapist in days rather than months, and you talk from your own home. What the marketing tends to skip is the shape of what you are buying. The weekly price is a subscription, not a per-session fee, the session length is shorter than a traditional appointment, and there are several things these platforms cannot legally do at all.

Here are the seven questions worth settling before you subscribe.

1. What does the weekly price actually include?

Prices in this category are quoted per week but billed weekly or monthly as a subscription. BetterHelp, the largest platform, advertises a range of $70 to $100 per week, and states that a subscription covers one live session a week of 30 or 45 minutes, plus unlimited messaging with your therapist between sessions (BetterHelp, what your subscription includes).

Two things follow from that. First, a 30-minute session is half the length of the 50-minute hour most in-person therapists work to, so compare on minutes rather than on sessions. Second, if you skip a week, you are usually still billed, because the subscription runs on the calendar rather than on attendance. Ask how unused sessions are handled before you commit to a month.

2. Is the therapist licensed, and licensed where you live?

Reputable platforms use licensed clinicians (LPC, LMFT, LCSW, PhD or PsyD) and match you to someone licensed in your state, because that is a legal requirement rather than a courtesy. Confirm two details on the platform's own site: that every therapist holds a current state licence, and that matching is restricted to your state. If you travel or move, ask what happens to your care, since a licence does not follow you across state lines.

3. Can the service prescribe, diagnose, or produce paperwork?

This is the limit that catches people out. Talk-therapy platforms are not psychiatry services. They do not prescribe medication, and they generally do not provide a formal diagnosis. BetterHelp states plainly that its therapists do not diagnose and that it is not the right service if you need a diagnosis for an insurance claim, a court, an employer or a school (BetterHelp on diagnosis).

If you need medication management, look for a service that employs prescribers, or plan to pair a therapy subscription with a psychiatrist. If you need documentation for any formal purpose, ask about it in writing before you pay, not after.

4. Will insurance help, and what happens if it will not?

Some platforms now take insurance directly. BetterHelp says it works with more than 125 insurance plans and that members using accepted coverage pay an average copay of about $23, while noting that it does not accept Medicaid, Medicare or TRICARE (BetterHelp insurance page). Others in the category take no insurance at all.

If a platform is out of network, the usual fallback is a superbill, an itemised receipt you submit to your insurer for partial reimbursement. Superbills normally require a diagnosis code, so a service that does not diagnose usually cannot issue one. Check both facts together: no insurance and no superbill means the full price is yours. Our guide to insurance coverage in this category goes through the checks in order.

5. How does matching and switching work?

The first therapist you are matched with may not be the right one, and that is normal rather than a failure. What matters is the cost of changing your mind. Ask whether switching is free, whether it is unlimited, how long a new match takes, and whether your message history moves with you. On the better platforms switching is free and immediate. Treat a service that charges for it, or makes you restart intake, as a worse deal at the same price.

6. What happens to your data?

Mental health data is about as sensitive as personal data gets, and this category has a real enforcement record. In 2023 the Federal Trade Commission finalised an order banning BetterHelp from sharing consumers' health data for advertising, alongside a $7.8 million payment for consumer refunds (FTC press release). Refund notices went out to about 800,000 people in 2024 (FTC, May 2024).

The practical takeaway is not that one brand is uniquely careless. It is that you should read the privacy policy for two specific things: whether intake answers can be used for advertising or shared with advertising platforms, and whether you can delete your data on request. Both should be answerable in a couple of minutes of reading.

7. How do you cancel?

Find the cancellation path before you subscribe. You want to know whether you can cancel yourself in the account settings, whether cancelling ends billing at the end of the current period, and whether refunds are possible mid-period. A service that requires an email to support in order to stop billing is a service that expects you to give up.

A shortlist of red flags

• The therapist's licence type and state are not stated anywhere.
• The price is only visible after you finish a long intake questionnaire.
• Session length is never specified, only "sessions".
• The privacy policy permits sharing intake or usage data with advertising partners.
• Cancellation is not self-service.
• Marketing implies medication or a diagnosis that the service cannot actually provide.

If you need help now

Subscription therapy is not crisis care, and no platform in this category is a substitute for emergency help. In the United States, the 988 Suicide and Crisis Lifeline is free, confidential and available 24 hours a day by call or text (988lifeline.org). If someone is in immediate danger, call emergency services.

Where to go next

Our online therapy comparison applies these questions to each platform we have scored, with the prices we verified and the source we verified them against. Prices in this category change often, so check the date next to any figure and confirm on the provider's own checkout before you buy.