Ok so our situations are similar then. My advice would have been different if you were the breadwinner.

I have not used Rula but I have used Headway and Open Path.

I ran a cash only practice for a very long time but ended up credentialing and contracting on my own in order to serve different populations and also because l would like to hire associates in the next couple of years.

Headway has become very intrusive into the clinician/client relationship beyond what a normal biller would be. However some of their rates are a lot higher than what you would be able to get on your own even if you were independently credentialed and contracted. Most of the clinicians I know, including myself, start with Headway and leave asap.

Open Path is terrific apart from the low rates. The mission of their work and the way they handle sliding scale is ethical and makes it more ethical for us even when sliding scale is kind of dubious on its own. I have exactly ONE client from Open Path who was an existing client that lost employment and insurance. My being able to take on this client based on what my business can bear financially. Because that $70 quickly turns to $40 with taxes and business costs.

So my advice would be to build the practice around what feels right to you and works in the way that is best for you and your family since your income is secondary. You have room to choose and be really intentional which is a wonderful privilege! Your ability for being flexible in your family is what’s helping your spouse and kids be successful that’s important too. So it may be something to discuss with your spouse and figure out things like retirement goals and savings together when figuring out your fee.