Can Therapists Use ChatGPT? What HIPAA Actually Allows in 2026

Not with client information, on the plans most therapists actually use. As of September 2026, ChatGPT Free, Plus, Pro and Business, Claude Free, Pro, Max and Team, and Gemini on a personal Google account do not come with a Business Associate Agreement (BAA), so pasting a client's information into them is generally a disclosure HIPAA does not permit. OpenAI, Anthropic and Google each now offer BAA-covered versions, but they come with conditions, and a signed BAA is where your obligations start, not where they end.

What a BAA Is, and When HIPAA Requires One

Under HIPAA, a business associate is a person or company that creates, receives, maintains, or transmits protected health information (PHI) on behalf of a covered entity.¹ A covered entity must have a written business associate contract in place before a vendor handles PHI for it. That contract spells out what the vendor may do with the information and commits it to protecting it.²

A chatbot company that receives your prompt, stores it in your chat history and runs it through its servers fits that description. HHS has said the same about cloud services in general: a cloud provider that maintains electronic PHI is a business associate even if it only stores encrypted data it cannot read.³ Whether the vendor ever looks at your data is not the test. Handling it is.

Two points trip people up. First, turning off model training or chat history is a privacy setting, not a BAA. Second, HIPAA covers health care providers who transmit health information electronically in connection with standard transactions, such as billing insurance electronically.² A strictly private-pay practice may fall outside that definition, but state confidentiality law, your licensing board and your profession's ethics code still apply. If you are not sure which side of the line you are on, treat yourself as covered and ask.

Where Each Vendor Stands (as of September 2026)

These offerings changed several times during 2025 and 2026. Everything below comes from the vendors' own help pages or news coverage of their announcements. Check the current page before you sign anything.

OpenAI (ChatGPT)

• ChatGPT Free, Plus, Pro and Business: no BAA. OpenAI's help center says only ChatGPT Enterprise or Edu customers with a sales-managed account are eligible for a BAA for ChatGPT.⁴
• HIPAA-eligible products. OpenAI lists ChatGPT for Healthcare, ChatGPT for Enterprise with Regulated Workspace, ChatGPT for Clinicians and the API with Modified Retention (plus FedRAMP versions) as available with a BAA.⁵
• ChatGPT for Healthcare launched in January 2026 as an enterprise workspace, rolled out first at health systems such as Cedars-Sinai, Boston Children's Hospital and UCSF.⁶ It is not a plan a solo practice signs up for the way it would for Plus.
• ChatGPT for Clinicians launched in spring 2026.⁸ It is free for verified U.S. clinicians, verified through your NPI, and an individual clinician can sign a BAA within the product.⁷ But as of September 2026, OpenAI lists the eligible clinicians as physicians (MD/DO), nurse practitioners, physician assistants and pharmacists.⁷ Psychologists, counselors, social workers and MFTs are not on that list. If that changes, the help page will say so.
• The API can be covered by a BAA, with conditions on which endpoints and data-retention settings apply.⁴ This matters mostly if you use software built on OpenAI's models: your BAA would be with that vendor, and theirs with OpenAI.
• ChatGPT Health is a consumer feature, launched in January 2026, for people connecting their own medical records.⁹ It is not a BAA product.¹⁰ “Health” in the name does not mean your clients' information is covered.

Anthropic (Claude)

• Claude Free, Pro and Max: not covered. Anthropic's BAA covers HIPAA-ready services such as the first-party API and Enterprise plans.¹¹ Team and individual plans cannot enable HIPAA.¹²
• Claude Enterprise has a HIPAA-ready configuration. The organization's Primary Owner turns it on in settings and accepts the BAA as a click-through, and Anthropic says the choice cannot be reversed.¹²
• Exclusions. The BAA excludes Claude Console, Claude Cowork and beta features such as Claude in Office. Several API features, including the Batch and Files APIs, are also outside it.¹¹

Google (Gemini)

• Personal Google accounts: not covered. Google's HIPAA Business Associate Amendment requires an existing Google Workspace services agreement and does not apply to products outside its covered services.¹³ Google also says chats in Gemini on a personal account may be reviewed by human reviewers.¹⁴
• Google Workspace customers accept the BAA from a super administrator account in the Admin console, then must configure the services appropriately.¹⁵ Google's list of covered functionality, effective August 31, 2026, includes the Gemini app (excluding Gemini in Chrome), the Gemini Mac app, Gemini in Workspace, Gmail and Drive. NotebookLM was not on the version we read.¹⁶

Why “I Removed the Name” Usually Isn't De-identification

HIPAA recognizes two ways to de-identify health information: Safe Harbor and Expert Determination.¹⁸ Information that meets neither standard is still PHI, whatever you deleted.

Safe Harbor means removing 18 categories of identifiers. The rule applies to identifiers of the client and also of the client's relatives, employers and household members.¹⁹ The list includes:

• Names
• Every geographic unit smaller than a state, including street, city, county and ZIP code. There is a narrow exception for the first three ZIP digits.
• Every part of a date except the year, for dates tied to the person, such as birth, admission or discharge. Ages over 89 are also removed.
• Phone and fax numbers, email addresses, Social Security numbers, medical record numbers, health plan and account numbers, and license numbers
• Vehicle and device identifiers, URLs, IP addresses, biometric identifiers and full-face photos
• “Any other unique identifying number, characteristic, or code”¹⁹

On top of that, you must not actually know that what remains could identify the person.¹⁹ Expert Determination is the alternative: a qualified expert applies statistical or scientific methods, concludes the risk of re-identification is very small, and documents how.¹⁹ Few private practices will do that for a chatbot prompt.

Therapy material is dense with identifiers. Picture an intake note with the name removed: a 34-year-old ER nurse at the county hospital, recently separated, whose brother died in March. That still contains an employer, a relative and a date element. In a small town it may be enough for a stranger to recognize the client. A practical rule: if you could recognize the client from the text, assume someone else could.

What a Consumer Chatbot Is Fine For

Plenty of practice work involves no client information at all. With no PHI in the prompt, there is no BAA question:

• Website copy, a directory profile, or a newsletter, as long as it contains no client stories, including “composite” ones built from real cases
• First drafts of policy templates, such as a cancellation policy or social media policy, for you or your attorney to review
• Summarizing public articles and research for CE reading
• Understanding a payer's published policy or a billing concept in general terms
• Explaining a therapeutic concept in plain language for a handout, written generically
• Emails to your landlord, accountant or website designer

A Decision Checklist

Run through this before you paste anything into an AI tool:

1. Is there anything about a client in it? Consider names, dates, places, employers, family members, diagnoses, or details unusual enough to recognize someone. If there is none, a consumer tool is fine.
2. Am I a HIPAA covered entity? If you bill insurance electronically, almost certainly. If unsure, assume yes. Either way, state law and your ethics code apply.
3. Does the text leave my device? If a vendor receives it, is there a signed BAA with that vendor, for this plan and this specific feature?
4. Am I sending only what is needed? Rewrite the question without client details whenever the task allows it.
5. Have I covered the rest? Record the tool in your risk analysis, decide what clients should be told, and review every output yourself.
6. Still unsure? Ask your compliance adviser, licensing board or attorney before you paste, not after.

Where On-Device AI Fits

If an AI model runs entirely on your own computer and nothing is sent to an outside company, no vendor creates, receives, maintains or transmits PHI on your behalf for that task. There is no business associate, so there is no BAA to sign.

That does not make the problem disappear. It moves it to your desk. The Mac now holds the PHI, so it becomes part of your safeguards. That means full-disk encryption with FileVault,²⁰ a strong login password, current software updates, no shared user accounts, and knowing what the app keeps on disk. On-device AI is also still AI: it can misread a document, and it is not a clinical decision-making tool.

How Hey Eduardo Handles This

Hey Eduardo is a Mac menu-bar app built around that approach. Local mode is the default: the AI model runs on your Mac, and nothing you capture is sent to Hey Eduardo or any AI company. In local mode there is no vendor receiving PHI, so there is no BAA with us. That does not make your practice HIPAA compliant; it removes one vendor from the picture.

In practice, you highlight text anywhere and press a shortcut. On a denial letter from an insurer, ⌥⇧S summarizes it, or ⌥⇧A lets you ask what they need from you and by when. The “How do I respond?” preset drafts a reply for you to edit and writes [...] wherever it needs a fact it does not have. For a scanned PDF with no text layer, ⌥⇧C reads the text with Apple's on-device text recognition. It is not an AI scribe, never records sessions, and does not connect to your EHR.

Two settings matter for clinical work. Recent history is on by default and keeps your last 25 results, with up to 4,000 characters of source text, on the Mac. Turn it off in Settings → Reading → Recent and clear it, and turn on FileVault. Cloud mode is opt-in, uses your own Anthropic, OpenAI or OpenRouter API key, and sends captured text to that provider. It is meant for research with no client data, and a Local/Cloud badge is always visible. Hey Eduardo requires an Apple Silicon Mac on macOS 15 or later. There is more on clinical use on the therapists and psychologists pages.

Related: For specific ways to use AI in a practice without sending client data anywhere, see AI workflows for therapists in 2026. For setup, see the Hey Eduardo guide, and for profession-specific details, the therapists and psychologists pages.