FTC's "Click-to-Cancel" Rule: What Therapy Practices Need to Know About Subscription Compliance in 2026
Is Your Therapy Practice Prepared for FTC Subscription Rules in 2026?
The Federal Trade Commission has drawn a line in the sand regarding subscription cancellations, and mental health practices offering recurring billing services need to pay attention—immediately. As of this week, the FTC's "Click-to-Cancel" rule is in full enforcement, bringing with it significant compliance requirements and steep penalties for violations.
If your therapy practice offers any form of recurring subscription—whether it's group therapy memberships, paid newsletters, monthly wellness retainers, or ongoing coaching packages—this rule fundamentally changes how you must handle cancellations. The stakes are high: fines can reach up to $51,744 per violation, meaning non-compliance could be financially devastating for small practices.
Understanding the Click-to-Cancel Rule
The FTC's Click-to-Cancel rule, formally part of the agency's broader "Negative Option Rule," represents a significant shift in consumer protection enforcement. At its core, the rule establishes a simple principle: if a consumer can sign up for a recurring subscription online, they must be able to cancel that subscription online with equal or fewer steps.
This sounds straightforward, but the implications are far-reaching for therapy practices that have traditionally handled cancellations through phone calls, emails, or face-to-face conversations. Many practitioners have preferred these personal approaches, viewing them as opportunities to address client concerns, offer alternatives, or ensure clients aren't canceling due to a misunderstanding about services or billing.
However, from the FTC's perspective, these "retention conversations" can cross the line into making cancellation unnecessarily difficult—a practice the agency has identified as harmful to consumers across multiple industries.
The rule specifically targets what the FTC calls "negative option features"—any arrangement where a consumer's silence or failure to take affirmative action is interpreted as acceptance of charges. This includes:
Automatic renewal of subscriptions
Continuity plans where products or services continue until canceled
Free-to-pay conversions where free trials automatically convert to paid subscriptions
Pre-notification negative options where consumers receive advance notice of upcoming charges
All of these models are common in therapy and wellness practices, making compliance with the new rule essential.
Why the FTC Created This Rule
The FTC didn't develop these requirements in a vacuum. The agency has documented widespread consumer frustration with subscription cancellation processes across industries. From streaming services to gym memberships to software subscriptions, consumers have reported being trapped in unwanted subscriptions because cancellation was made deliberately difficult.
Common problematic practices the FTC identified include:
The Phone Maze: Requiring consumers to call a phone number during limited business hours, then subjecting them to long hold times and retention scripts designed to dissuade cancellation.
The Email Black Hole: Forcing consumers to send cancellation requests via email, then delaying responses, claiming emails weren't received, or requiring multiple rounds of back-and-forth communication.
The Chat Shuffle: Directing consumers to chat support where representatives are incentivized to retain subscriptions through confusion, offers, or simply making the process time-consuming.
The Hidden Cancellation Option: Burying cancellation procedures deep within account settings, using confusing language, or requiring consumers to navigate through multiple pages and confirmations.
The "We Need to Talk" Approach: Insisting on a conversation with a manager or retention specialist before processing any cancellation request.
While therapy practices generally don't engage in the most egregious versions of these tactics, many have inadvertently created cancellation processes that are more difficult than signup—precisely what the rule prohibits.
How This Impacts Therapy Practices
Mental health professionals have increasingly embraced subscription and membership models for good reasons. These models can provide:
Predictable Revenue: Recurring billing creates stable cash flow, making practice finances more predictable and sustainable.
Continuity of Care: Memberships encourage ongoing engagement with mental health services, which can lead to better outcomes.
Accessibility: Group memberships and wellness retainers can make mental health services more affordable and accessible than traditional fee-for-service models.
Community Building: Membership models often include access to peer support communities, which can enhance therapeutic outcomes.
Diversified Services: Subscriptions allow practices to offer educational content, resources, and lower-intensity support alongside traditional therapy.
Common subscription models in therapy practices include:
Group Therapy Memberships: Monthly access to ongoing therapy groups, often with different groups for different issues or populations
Wellness Retainers: Monthly fees covering a set number of check-ins, email support, or resource access
Content Subscriptions: Paid newsletters, educational video libraries, or exclusive podcast content
Coaching Programs: Ongoing coaching relationships billed monthly rather than per-session
Platform Access Fees: Monthly fees for access to client portals with worksheets, progress tracking, or secure messaging
Hybrid Models: Combinations of live sessions, digital resources, and community access for a flat monthly fee
All of these models are affected by the Click-to-Cancel rule if they involve recurring charges and online signup.
The Specific Requirements You Must Meet
The FTC's rule establishes several specific requirements that therapy practices must follow:
1. Cancellation Method Parity
If a client can sign up through an online form, website, or app, they must be able to cancel through the same medium. This is non-negotiable. You cannot require a phone call, email, or in-person visit to cancel a subscription that was initiated online.
The rule specifically requires that cancellation be "through the same medium" as enrollment and involve "the same or fewer steps." This means if signup requires filling out a form with basic information and clicking "Subscribe," cancellation should require no more complexity than navigating to account settings and clicking "Cancel Subscription."
2. Clear Disclosure Requirements
Before obtaining billing information, you must clearly and conspicuously disclose:
That the consumer is enrolling in a recurring subscription
The exact cost and frequency of charges
The duration of any commitment period
How to cancel the subscription
Any material terms that could affect the consumer's decision
These disclosures can't be buried in lengthy terms of service documents. They must be prominent, easily readable, and presented before the consumer commits.
3. Express Informed Consent
You must obtain express informed consent before charging consumers. This means consumers must actively agree to the terms after being presented with clear information. Pre-checked boxes don't satisfy this requirement—consumers must take affirmative action.
4. Simple Cancellation Process
The cancellation mechanism must be:
Easy to find (not hidden in account settings or behind multiple menu layers)
Simple to use (no unnecessary steps or information requirements)
Immediate in effect (you can't delay cancellation processing)
Confirmation-based (consumers must receive clear confirmation that cancellation is complete)
5. No Retention Tactics During Cancellation
You cannot require consumers to engage with customer service, listen to retention offers, or explain why they're canceling as a condition of processing the cancellation. While you can offer to help or present alternatives, these must be optional and easily bypassed.
Auditing Your Current Systems
If you're reading this and feeling uncertain about your compliance status, you're not alone. Many therapy practices need to immediately audit their current subscription and cancellation processes. Here's how to do it:
Step 1: Identify All Recurring Billing Arrangements
Make a comprehensive list of every service or product you offer that involves recurring charges. Don't forget:
Ongoing group therapy memberships
Monthly payment plans for packages of individual sessions
Content subscriptions or paid newsletters
Platform or portal access fees
Wellness or coaching retainers
Sliding scale programs with recurring monthly billing
Professional consultation services for other therapists
Even arrangements you don't think of as "subscriptions" may fall under this rule if they involve recurring charges.
Step 2: Map the Customer Journey
For each recurring billing arrangement, document:
How do clients initially sign up? (Website form? In-person enrollment? Phone call? Email agreement?)
What information do they provide during signup?
How many steps does signup require?
How are they currently able to cancel?
How many steps does cancellation require?
Do they need to contact a human to cancel?
Be honest in this assessment. If cancellation is objectively more difficult than signup, you have a compliance issue.
Step 3: Review Your Payment Platform Capabilities
Most therapy practices use one of several common payment processing platforms:
Simple Practice: Check whether your subscription offerings include client-accessible cancellation options in the client portal. Simple Practice has been updating its features to support compliance, but implementation varies by how you've configured your services.
Stripe: If you've built custom subscription flows using Stripe, review whether you've implemented the customer portal feature that allows subscribers to manage their own subscriptions. This functionality exists but must be deliberately enabled.
Therapy Appointment/Thrizer: These platforms have varying levels of self-service cancellation capabilities. Review your specific configuration and available features.
Square: Square's subscription features include customer management options, but you need to ensure they're properly configured and accessible.
Other Platforms: If you use practice management software with built-in billing (TheraNest, ICANotes, etc.), check their documentation on subscription management and cancellation features.
Step 4: Test the Cancellation Process
Don't assume your cancellation process works as you think it does. Create a test subscription and actually go through the cancellation process from a client's perspective:
Can you find the cancellation option within 30 seconds?
Is it clearly labeled as "Cancel Subscription" or similar unambiguous language?
How many clicks does it take?
Are you required to contact support or provide a reason?
Do you receive immediate confirmation of cancellation?
Is the confirmation clear about when charges will stop?
If any part of this process feels complicated or confusing to you, it definitely will to your clients.
Step 5: Review Your Terms of Service and Disclosures
Examine the language you use when clients sign up for subscriptions:
Do you clearly state that this is a recurring charge?
Is the amount and frequency obvious?
Are cancellation instructions provided upfront?
Is the language clear and jargon-free?
Are disclosures in a readable font size and color?
Could a reasonable person miss important information?
Your legal documents may be technically compliant while your actual presentation fails the "clear and conspicuous" standard.
Implementing Compliant Cancellation Systems
Once you've identified gaps in your current approach, here's how to fix them:
For SimplePractice Users
SimplePractice offers client portal access where clients can view appointments and documents. To ensure compliance:
Enable the client portal for all clients with recurring billing
Configure subscription management features to allow client-initiated cancellation
Provide clear instructions in your subscription confirmation emails about how to access cancellation features
Test the client portal experience regularly to ensure cancellation options are functional and prominent
If SimplePractice's current features don't support fully self-service cancellation for your specific setup, contact their support team about compliance-friendly alternatives or consider supplementing with additional tools.
For Stripe Users
Stripe provides robust subscription management capabilities, but they must be implemented:
Enable Stripe's Customer Portal in your dashboard settings
Configure the portal to allow subscription cancellation
Add a link to the customer portal in your subscription confirmation emails and member dashboards
Customize the portal to match your branding while maintaining clarity
Set up email notifications to alert you when clients cancel (for your records, not to intervene)
Stripe's customer portal is specifically designed to help businesses comply with regulations like the Click-to-Cancel rule, making it an excellent solution for practices with technical capacity.
For Other Platforms
If your practice management software doesn't natively support compliant self-service cancellation:
Option 1: Request Feature Updates - Contact your software provider about adding these features. With the rule now in enforcement, many vendors are prioritizing compliance features.
Option 2: Hybrid Approach - Use your practice management software for scheduling and notes but handle subscriptions through a compliant payment platform like Stripe.
Option 3: Manual Compliance System - If neither option is immediately feasible, create a clearly documented email-based cancellation system where clients can cancel by sending an email to a dedicated address (like [email protected]) and receive immediate automated confirmation, with no human gatekeeping required.
While Option 3 is less ideal than true self-service cancellation, it can provide temporary compliance if the process is genuinely streamlined and immediate.
What About Legitimate Concerns?
Many therapists have understandable concerns about instant, friction-free cancellation. Let's address them:
"But I need to ensure continuity of care"
Continuity of care is indeed important, but subscription cancellation isn't the same as terminating therapy. A client can cancel a group membership subscription while still being your individual therapy client. A client can stop paying for a wellness retainer while still scheduling regular sessions.
If you're concerned about clients leaving treatment entirely without appropriate termination, address this through your informed consent process, not your billing practices. Explain the importance of discussing ending treatment when they first become clients, and encourage them to schedule a termination session if they're considering leaving therapy.
"I want to understand why they're canceling to improve my services"
This is a legitimate business interest, but it can't be a requirement for cancellation. Instead:
Make feedback optional during the cancellation process
Send a brief post-cancellation survey (with no expectation or requirement of completion)
Invite (don't require) a feedback conversation
Use other methods to gather service quality data from current and satisfied members
"What if they're canceling due to a billing error or misunderstanding?"
Build prevention into your frontend:
Provide exceptionally clear information about what the subscription includes and costs
Send advance notice before renewals
Make it easy for clients to contact you with billing questions before they decide to cancel
Offer a "pause subscription" option if you suspect temporary issues
If someone cancels due to a misunderstanding, you can reach out afterward to clarify and offer to reinstate their membership—but the cancellation itself must be processed immediately and without barriers.
"I'm worried about impulsive cancellations during difficult moments"
This is perhaps the most nuanced concern. In mental health services, we know that clients sometimes make reactive decisions when they're struggling. However:
Trapping people in subscriptions they want to leave is never therapeutic
If your services are valuable, most clients who cancel impulsively will return
You can offer a "pause" option as an alternative to outright cancellation
Clear communication about what they're losing by canceling can help inform their decision without blocking it
Trust your clients' autonomy, even when you suspect they're making decisions you wouldn't recommend. This is consistent with therapeutic ethics around client self-determination.
The Penalties for Non-Compliance
The FTC isn't making idle threats with this rule. Violations can result in:
Civil Penalties: Up to $51,744 per violation. Importantly, each improperly canceled subscription could constitute a separate violation. If you have 50 active subscriptions with non-compliant cancellation processes, your exposure could theoretically exceed $2.5 million.
Corrective Actions: The FTC can require you to:
Refund improperly charged consumers
Notify affected consumers of their rights
Implement compliance systems
Submit to monitoring
Injunctive Relief: The FTC can obtain court orders preventing you from continuing non-compliant practices.
Reputational Damage: FTC enforcement actions are public. Being named in an FTC complaint could seriously damage your practice's reputation and referral relationships.
State-Level Actions: Many states have their own consumer protection laws with similar provisions and enforcement mechanisms, potentially compounding your exposure.
While the FTC typically targets the most egregious violators and larger companies, the agency has been clear that this rule applies to businesses of all sizes. Don't assume you're too small to attract attention, especially if a dissatisfied client files a complaint.
Special Considerations for Therapy Practices
Mental health billing services occupy a unique space where business practices intersect with healthcare and ethical obligations. Here are some specific considerations:
HIPAA and Subscription Management
When implementing self-service cancellation, ensure your systems remain HIPAA-compliant:
Client portal access must be properly secured
Cancellation confirmations shouldn't include PHI in subject lines or unsecured email
System logs must maintain appropriate audit trails
Any third-party subscription management tools must have BAAs in place
State Licensing Board Requirements
Some state licensing boards have rules about terminating therapeutic relationships. Understand that:
Subscription cancellation is not the same as terminating therapy
You may still have obligations to provide appropriate termination even if someone cancels a subscription
Document your process for distinguishing subscription management from clinical termination
Consult your state licensing board if you're uncertain about any requirements
Insurance and Credentialing Implications
If you participate with insurance panels:
Ensure your subscription offerings don't violate credentialing agreements
Some panels prohibit membership or retainer models
Be clear in marketing that subscriptions are for non-covered services
Don't use subscription models in ways that could be considered balance billing for covered services
Ethical Obligations
The ACA, APA, NASW, and other professional codes of ethics address business practices. Ensure your subscription models:
Don't create multiple relationships that could be harmful to clients
Maintain appropriate boundaries around financial arrangements
Provide clear information about costs and services
Don't exploit clients' vulnerabilities
Support clients' autonomy and right to discontinue services
Beyond Compliance: Making Cancellation Easy as Good Business
While this article has focused on regulatory compliance, it's worth noting that easy cancellation is actually good for business:
Increased Trust: When clients know they can easily leave, they're more likely to join. Subscription services with transparent cancellation policies often have higher signup rates than those with complicated cancellation requirements.
Better Member Quality: Clients who stay because they want to, not because cancellation is difficult, are more engaged and satisfied members.
Positive Word-of-Mouth: Clients appreciate businesses that respect their autonomy. Easy cancellation becomes a selling point, not a liability.
Reduced Payment Disputes: When cancellation is easy, fewer people resort to credit card chargebacks or payment disputes, which can cost you more than losing the subscription.
Regulatory Future-Proofing: Consumer protection enforcement is trending toward more stringent requirements, not less. Building compliance into your systems now prepares you for future changes.
Creating Your Compliance Action Plan
Here's your step-by-step plan to achieve compliance:
This Week:
Audit all recurring billing arrangements in your practice
Document current signup and cancellation processes
Identify gaps between signup ease and cancellation ease
Contact your payment platform provider about compliance features
By End of Month:
Implement technical solutions for self-service cancellation
Update your terms of service and subscription disclosures
Test cancellation processes thoroughly from a client perspective
Train any staff who handle billing or client support on new procedures
Ongoing:
Monitor for any clients experiencing cancellation difficulties
Review cancellation data to improve retention through service quality, not barriers
Stay informed about FTC guidance and enforcement actions
Audit compliance quarterly to ensure systems remain functional
The Bottom Line
The FTC's Click-to-Cancel rule represents a significant shift in how therapy practices must handle subscription billing. While the immediate requirement is compliance to avoid substantial penalties, the deeper opportunity is to build business practices that genuinely respect client autonomy and build trust.
For mental health professionals, this shouldn't feel like a burden—our entire field is built on principles of client self-determination and empowerment. Extending these values to our billing practices is simply consistent with our professional ethics.
The practices that will thrive in this new regulatory environment are those that view easy cancellation not as a threat but as a competitive advantage. When clients know they can leave at any time, their choice to stay becomes more meaningful. When cancellation is straightforward, disputes disappear and trust increases. When business practices align with therapeutic values, everyone benefits.
Take the time this week to audit your systems, implement necessary changes, and ensure your practice is fully compliant. The penalties for non-compliance are severe, but more importantly, your clients deserve subscription management practices that respect their time, autonomy, and dignity.
The Click-to-Cancel rule is now in full enforcement. Make sure your practice is ready.
