They are called, collectively, “the platforms” for therapists — Alma, Headway, Grow and other practice management companies that offer a collection of services for therapists like credentialing with insurance, billing services, client referrals via listings, prompt payment, record-keeping and help for other bothersome business details that some therapists hate. For a therapist, joining a platform holds the promise that they can practice therapy without the other stuff.
The platforms have exploded in growth in the last five years or so, replacing the longer-standing model of private practice, either solo or group. The growth was spurred by the growth of telehealth sparked by the pandemic, the nation’s mental health crisis, the grind of dealing with insurance companies — and a lot of funding from venture capitalists and insurance companies’ venture wings, seeking to make money on the business of mental health.
But along with their explosive growth has come a growing wave of therapists who tried to use a platform and left disenchanted. These are some developments:
- A 40-something licensed professional counselor in Oregon said she left Alma because she realized the hefty percentage of her earnings they were taking — although they told her her costs were just a fixed $125 a month.
- In March of this year, a therapist wrote of why she was abandoning her relationship with Alma, in a Medium post titled “Let’s run away together: I’m a therapist leaving venture capital-backed mental health.” Melissa Flanagan, a licensed clinical social worker, detailed why she joined Alma and why she’s leaving.
- The Psychotherapy Action Network, in a survey of 667 licensed therapists, found “a troubling gap between these companies’ marketing promises and the reality of their business practices.”
- Barbara Griswold, author of the blog “Navigating the Insurance Maze,” and the book of the same name, is a therapist who recently retired as a consultant helping other therapists with the business of a practice. She wrote about the platforms in a two-part series starting in May 2025. “For many therapists, these platforms have been the key to building their practices. They enjoy being relieved of the billing hassles, and are thrilled they were able to join health plans so quickly, get client referrals, and get good income. But many therapists have not had such positive experiences,” she wrote. “Let me say that I’m no expert on these platforms. But after some in-depth research where I interviewed representatives of several of these platforms, read their websites and their provider contracts, and talked to many users, I came away with a number of concerns.”
Platforms surging
The platforms have surged in the past few years, promising to make it easy for therapists to get credentialed with an insurance company, get paid quickly and get help with the business-side burden of billing and other bothersome details.
The platforms contract with insurers to get pay for therapists that they say is usually better than what solo practitioners can get. Therapists can sign up and pay fees or give a cut of their pay to the company, often becoming a 1099 independent contractor and gaining aid in billing and access to assets like credentialing, an electronic health record, a telehealth platform, a scheduler and so on. They have grown quickly because they promise to alleviate the burden of practice management, offer what they describe as higher pay than what a solo therapist can make, and also because they promised answers to telehealth procedural questions that sprang up early in the pandemic. Headway, founded in 2019, says it works with 34,000 providers; Alma, founded in 2018, says it has 21,000 providers in its directory. Grow claims 15,000.
But disenchantment with the platforms has been rising, with some therapists saying that they are concerned about some business practices, and also about clients’ records being put into the hands of venture-funded platforms that have as their paramount goal making money, rather than providing safe, effective, confidential therapy.
When two big digital mental health platforms, Alma and Headway, cut pay rates for therapists using UnitedHealth’s Optum insurance late last year, the action stirred a debate among therapists about the overall value of the platforms. And yet the platforms continued to collect therapists.
(Do you want to talk about this or other things related to therapy? email jeanne@clearhealthcosts.com or Signal 914-450-9499.)
A surprise discovery
But some are choosing to leave. The 40-something Oregon counselor said in a Zoom interview that she started taking insurance through Alma in October 2022, while she was in a solo private practice. Alma credentialed her quickly with three insurances in less than 45 days, she said, while in private practice the same credentialing took seven or eight months. She spoke on condition of anonymity because her contract, like most, prohibits revealing pay rates.
She was paying $125 a month to Alma for this service and for their role in negotiating what she thought were better or comparable rates with insurers, and for billing services. In going solo, she considered hiring a biller, but she said that would cost anywhere from 7 to 11 percent of her income, and she thought Alma sounded like a better deal. She said she questioned the Alma salesperson about how $125 a month could cover all their services, and the salesperson assured her that this was how it was done — with no extra charges, assuring her that Alma did not take a percentage of payments from clients.
The 2022 claims were processed correctly, she said, but then in January 2023, UnitedHealthcare claims started to be processed incorrectly, as out of network. United acknowledged the problem immediately, but Alma billed her clients as if they were out of network. The result: One client’s Health Savings Account card was maxed out, and another was charged nearly $650 on a credit card. She lost two clients. “Right away my clients didn’t want to see me,” she said. “They knew something was wrong. But they didn’t want to risk seeing me. They said, ‘I can’t see you until this is fixed.'”
She asked Alma to address this known problem, she said, but they refused to do so until United fixed it. “Back and forth,” she said. “It was a nightmare, three months for them to get the revised and to refund the money” — with multiple emails, no direct live person to speak with at Alma despite repeated entreaties, and endless frustration.
Taking a cut
With no help from Alma, the therapist volunteered to help one distraught client by going directly to United.
“I said, ‘Give me your E.O.B. and i am going to contact United directly,'” she said. “One gave me all the E.O.B.’s, and that’s when I saw that the contracted rate that Alma was getting was significantly higher than what i was getting.
“United was paying $142.80, and my income was $121.80.”
She then winkled out the parallel numbers from Cigna: For a session coded at Current Procedural Terminology code 90837, 53 minutes or more individual therapy, her income from a Cigna patient was $95, while Alma took in $151.74 and pocketed the difference. For a 90834, 38 minutes or more, Alma paid her $79 but received $125 from Cigna — this after the Alma representative assured her they were not taking a cut.
So she decided to leave Alma. She got credentialed individually with the three insurers that Alma had her credentialed for — United, Cigna and Aetna — as an independent solo private practice. Confirming that this had been done and that she was billing under her own National Provider Identifier number, she painstakingly removed herself from Alma’s panel.
Then she downloaded all records from each client with Alma. “It took many hours as I went through each client and downloaded their invoices,” she wrote in an email. “Luckily, I didn’t have progress notes, treatment plans, or any other documents held with Alma. If I did, it would have been a significant time investment. Given that I am supposed to keep records of documents for years after treatment, I did not have an option. I had to download documents one-by-one.”
We asked Alma for comment but they did not respond by deadline; if and when they do, we will update this post.
Broad experience
A Latina licensed marital and family therapist who practices in California wrote by email: “I joined Betterhelp right around the pandemic and found their lack of structure to support therapist’s record keeping to be concerning.
“I only saw a few clients there and then joined Headway which I have had a good experience with (although there’s always someone posting on the facebook group of Headway therapists about some scary insurance claim story where Headway has dropped the ball so that doesn’t feel great).
“I also joined Rula and did not like that there was no way for me to export the client notes for me to keep in my own EHR — so when the client I was seeing stopped engaging with treatment I canceled my contract with them. I am also still technically a part of Grow but I have not seen any clients through there.
“It feels like with Rula and Grow they use my name and the fact that I’m a latina as a big bonus for them to advertise, and I don’t like that because they will use my name and face even though I am not actively taking any clients at the time so that feels gross to me.”
‘No leverage’
There is a lot of conversation about this on Reddit, particularly in the r/therapists Subreddit.
“I’ve had a solo private practice and have been individually credentialed with insurance for 7 years, and I’ve also been working with Headway for a small number of my clients for about 2 years. I think we’re stuck between a rock and a hard place in our relationship to insurance,” one poster wrote. He identified himself by followup chat on Reddit as who Jeffrey, a licensed clinical professional counselor.
He is individually credentialed with insurance, after the annoying credentialing process, he wrote, but he pointed out that with insurers “we have no leverage when things go wrong…. I’ve desperately wanted a service that can negotiate better rates for me and who can handle problems when the insurance companies screw up. I haven’t found a billing service that can do this for me.
“I was so fed up with the insurance system last year that I nearly dropped out of my insurance networks. Most of my colleagues don’t accept insurance, and they make more money than me with less headaches. The problem is that this is terrible for clients. Most of my clients (including myself) can’t afford to pay $600 a month for therapy. I don’t think that mental health care should only be accessible to the wealthy, and in this current political climate I feel compelled to prioritize accessibility over personal profit.
“Headway and similar venture capital companies offer solutions to some of these problems, but they also introduce a whole new set of issues. Rather than improving the root issues in the insurance industry, we’re now seeing a host of tech companies inserting themselves as profit-seeking middlemen. If they’re following the playbook of tech companies in other industries, they will offer valuable services at a loss until they’ve captured enough of the mental health industry that they’ve become indispensable, at which point they’ll squeeze their providers for more profit.
“My compromise is that I’ve decided to use Headway as a billing service for insurance, but I am keeping as much of my private practice separate from the Headway ecosystem as possible. I get 20-30% better pay from my Headway clients, and Headway handles the back-end problems with insurance that has exhausted me so thoroughly over the past few years. They haven’t placed any restrictions on how I practice, so I’m still totally independent. … I’m totally fine with them skimming some profit off the top as long as they continue offering a legitimately good service. I am keeping my own EHR, website, referral sources, and I’ve even kept my own individual credentials with insurance companies. I’m not dependent on Headway, and I will be able to leave their network with minimal disruption if the need arises.”
Bottom line, he said, is that systemic reform is needed.
Other Redditors write of their experience with Headway, Alma, Grow Therapy, Sondermind and others. (As a general rule, of course, online commenters are upset about something; happy customers do not write in as much.)
‘Better rate’?
Are the rates really better through the platforms? Well, it depends.
Griswold wrote: “Well, sometimes, sometimes not. But ‘better rate’ is something you have to flesh out. It depends on where the therapist is located, what insurance plan we are talking about. Usually, though, therapists don’t even know what the platform is charging for their services. I would say in many cases you can get a higher rate by using a platform, especially if you take into account that you don’t have to hire a biller. But the lack of control, the number of problems that can occur, and the lack of ability to get in touch with someone at the platform or insurance plan who can help you resolve the problem are major drawbacks people don’t know about when they join.”
But isn’t it easy to compare rates? No, she said, only the Medicare pay rate is publicly available: “A clinician typically has to apply and go through the entire contract process before they will tell you what the rate is — [insurers] don’t want that information made public.”
Also, she pointed out, since the therapist doesn’t hold the contract — the platform does — the therapist is unable to negotiate the fee, or any part of the contract. Some therapists might want to negotiate higher rates, or higher rates just for services they specialize in, and they can’t do it.
“Sometimes platforms are charging more than the therapist’s normal full fee, which actually could be considered insurance fraud,” she added. “And remember the other issue that is a big one — that the therapist doesn’t own the contract, so if they leave the platform, their insurance clients will not continue to be covered unless the therapist can negotiate an individual contract with the plan, which isn’t guaranteed.
“Also, there is speculation that these insurance plans are giving these large platforms higher rates now, but will drop them later. We have already seen this happen with United and one of the platforms.”
Aren’t there protections for client data and record privacy under the Health Insurance Portability and Accountability Act (HIPAA)? Well, it depends. A contract and a business associate agreement (BAA) for covered entities should protect a client and a therapist — but does it really? Truly, it depends. And the therapist doesn’t always know who the platform is doing business with, or what commitments are made.
What are the names of the platforms? Headway, Alma, Rula, Grow and Talkspace, as well as Betterhealth. There are also others: Springhealth, Sondermind, Maven, Lyra, NOCD, Klarity, Telemynd, Brightside and a number of others. Each has its own way of managing the business, its own contracting practices, and its own way of employing therapists — commonly as 1099 independent contractors, though not always.
Insurers’ investing role
The platforms often benefit from investments from venture capital firms that are seeking profits in order to make fast money.
The platforms also have investment from insurance companies. Alma, for example, has investments from Cigna Ventures and Optum Ventures. Headway has investment from Health Care Service Corporation, the country’s largest customer-owned health insurer, with millions of members in its health plans in several states; H.C.S.C. is an independent licensee of the Blue Cross and Blue Shield Association. Rula has investment from the Blue Venture Fund, which invests on behalf of the Blue Cross and Blue Shield Plans, a federation of 33 US health plans.
The concern among some is that the venture firms’ goal is making money fast. The idea of turning over patient records to for-profit venture-backed startups also raises concerns that patient records can be used for other purposes than assuring good treatment.
Several of the platforms also offer record-keeping on their platforms, and the ability to make session notes using AI as well as making transcripts of sessions between therapists and clients, raising concerns about privacy and use of patient records. The growth of wannabe AI therapists is a great concern among therapists; some will say they believe that despite privacy assurances, any records or transcripts or session notes or treatment plans that the platforms have access to might be used in development of such AI tools, or in other ways to maximize the platforms’ profits on data.
In another potential area of concern, the platforms can make business decisions the therapists might not like. Rula, for example, is partnering with Amazon Health. Alma contracted with a Czech startup, Upheal, to create a clinical documentation system for Alma; the clinical documentation was found to create false narratives. Upheal raised its Series A round of funding in late 2024.
Flanagan, author of the piece on leaving Alma, wrote: “Many therapists who join big mental health platforms have no idea that the same insurance plans we’re fighting with for better rates, clearer communication, and transparency around audits and payments are also investors in those platforms via venture capital funding that helped bring companies like Alma to its estimated valuation of at least $500 million as of 2022, after its big fundraising windfall that year (Some reports estimate the valuation much higher, but since Alma is not a publicly traded company, these numbers are speculative). The investment arms of United Health Group-Optum (Optum Ventures) and Cigna (Cigna Ventures) helped build Alma as a way to get richer in ways that have not yet been revealed to us beyond speculation. Some presume that it’s simply more cost effective for insurance plans to streamline claims processing under one, enormous group practice, but the darker theories involve investor interest in the massive amounts of easily accessible — and lucrative — consumer data that will drive American healthcare deeper into sadism and mediocrity.”
Alma offers to keep records in its own Electronic Health Record, she wrote, but “I have never trusted that the insurance partners who are also Alma’s venture capital investors would be denied access to the data they want — whether it’s aggregated or de-identified — so I have chosen to use an outside EHR that costs a lot but remains safely separate from Alma’s benefactors.”
Privacy, ownership
The new study by Psychotherapy Action Network (PsiAN) found significant concerns among mental health professionals about these practice management companies (P.M.C.’s).
“Privacy Concerns are Paramount: 96% of therapists rate client privacy as extremely important, yet 81% of those using P.M.C.’s believe these companies don’t adequately protect patient information. This is particularly concerning given that Headway is currently being sued for allegedly sharing patient data with Google,” the study found.
“Hidden Insurance Company Ownership: 85% of therapists said they wouldn’t use a PMC if they knew it was owned by an insurance company, yet 70% are unaware of who actually owns these platforms. In reality, major P.M.C.’s are owned by the same insurance companies therapists struggle with daily — Headway by Blue Cross Blue Shield, Alma and Grow Therapy by Cigna and Optum.
“Mixed Satisfaction and Financial Results: While P.M.C.’s promise higher pay, 50% of users report earning the same or less than independent practice, and 84% weren’t informed about fee-splitting arrangements before joining.”
In conclusion, the report says: “The study suggests that rather than solving systemic problems in mental health care delivery, P.M.C.’s may be creating new challenges while benefiting the same insurance companies that created the original problems. As one researcher noted, ‘Insurers have manufactured the therapist shortage, which is advantageous to them — the fewer therapists and sessions they pay for, the more profitable they are.'”
What you can do
Many therapists who joined these platforms are now reconsidering, while many still find value. There’s a lot of conversation about plusses and minuses on forums like Reddit and a number of professional listservs and Facebook groups. It’s worth reading up on others’ experiences.
Zynnyme, a private practice consulting group, held a webinar on Nov. 4 about how the platforms work, with concrete advice on what therapists can do to judge whether they are in the right place — questions like “are you a 1099 or W2 employee?” and “what is the platform’s policy on record-keeping?” and “how do you know what you are contractually obligated to do?” (The answer to the last: Read the contract.) There are also some very practical specifics about topics like the platforms encouraging cross-state credentialing, and the pitfalls a therapist might encounter. You can access their trainings here.
Griswold’s two-part blog series about the platforms starts here.
Other resources also focus on practice management, to help therapists alleviate the challenges the platforms seek to address: PsychBillingCoach, headed by Susan Frager, and QA Prep, headed by Maelisa McCaffrey. Griswold’s blog is also a good source of related information, while she is formally retired. Trade organizations may also be a resource.
The Psychotherapy Action Network’s study of 660-some therapists is here.
(Do you want to talk about this or other things related to therapy? email jeanne@clearhealthcosts.com or Signal 914-450-9499.)
