BetterHelp Spends Twice as Much Selling Therapy as Delivering It

Teladoc Health, the company that owns BetterHelp, files an annual report with the Securities and Exchange Commission (SEC) like every public company. The report for 2025 shows that BetterHelp brought in $950.4 million in revenue, down 9% from the year before. In the same year, BetterHelp spent $518.5 million on advertising and marketing, while its total cost of revenue, which includes what it pays the therapists who deliver care, came to $253.2 million.¹

BetterHelp spent about twice as much finding customers as it spent on the care those customers came for.

The filing: lower therapist costs protected the margin

The same report explains why BetterHelp's cost of revenue went down. In the company's words, the decline was "primarily driven by lower therapist costs."¹ Over the year, paying users fell 5%, to about 390,000.

The first quarter of 2026 continued the trend. BetterHelp revenue fell 9% from a year earlier to $218.4 million, and paying users fell 9% to 361,000. The segment's adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) dropped 75%, to $1.9 million.²

I read those numbers as a business that has to keep buying new customers because too many of them leave, and that protects its margin by holding down what it pays clinicians. Neither of those habits is good for the people in therapy or for the people providing it.

Client data: regulators have been here before

In 2023, the Federal Trade Commission (FTC) charged that BetterHelp had shared consumers' sensitive health information with Facebook, Snapchat, Criteo and Pinterest for advertising after promising to keep it private. To settle those charges, BetterHelp agreed to pay $7.8 million to consumers and to an order banning it from sharing consumers' health data for advertising.³

People who come to a therapy site are often at the hardest point of their lives. What they type into an intake form belongs to them, and it should never become raw material for an ad campaign.

The pattern: growth first, care second

Venture-funded mental health companies have a familiar playbook. They raise money, spend heavily on advertising to sign up users, and then work on the clinical side until the numbers satisfy investors.

At the far end of that playbook is Done Global, a telehealth startup that prescribed stimulants for attention deficit hyperactivity disorder (ADHD). On July 7, a federal judge sentenced its founder, Ruthia He, to 72 months in prison, a $1 million fine and $91 million in forfeiture. Its clinical president, David Brody, received 24 months.⁴ Prosecutors said Medicare, Medicaid and private insurers paid more than $14 million tied to the scheme.

Done's case is extreme, and most companies in this market are not breaking the law. Even so, the model underneath it is common, and the people who pay for it are clients who churn through clinicians and therapists who are paid less to carry more.

What we built instead

StartHere.care takes nothing from a session. Clients find a therapist who fits, contact that therapist directly, and pay the therapist at whatever rate the therapist sets or their insurance pays. We charge therapists nothing to be listed and clients nothing to search. We have no investors waiting on a return, so we have no margin to protect by paying clinicians less.

We also do not sell what clients tell us in intake, and we do not send it to advertising platforms. That information is used to find people a good fit.

I built StartHere.care because I got tired of watching the wrong people profit from a mental health crisis. If the way we operate ever changes in a meaningful way, I will say so here first.

Questions about how the platform works? Reach out directly at Jeff@StartHere.care.

Sources

1. Teladoc Health, Form 10-K for fiscal year 2025, filed with the SEC, 2026.
2. Teladoc Health, first quarter 2026 earnings release, filed with the SEC, April 29, 2026.
3. Federal Trade Commission, press release on BetterHelp, March 2, 2023.
4. U.S. Department of Justice, United States v. Ruthia He and David Brody, 2026.