The Headway mental health therapy practice management company suddenly announced recently that it would charge a new $9.99 per-session fee for client referrals to therapists via the “marketplace” directory it provides on its site.
The fee charged to therapists would apply to any client referred to a therapist on the Headway Marketplace site directory. It would apply to the first and all later visits for any client referred from the marketplace listing, Headway said.
A number of therapists and industry groups immediately expressed concern and even anger, describing this as yet another pay cut. Industry sources and Reddit’s r/therapists subreddit emphatically pointed to the surprise charge as yet another example of how practice management companies that have flooded the marketplace are adding extra charges, taking extra pay percentages, and reducing the independence and income of individual therapists.
Along with the surcharge, Headway announced that it would start requiring extra documentation from therapists — a new condition of employment, which adds to their work load with no compensation. Neither one of these things has been present in the agreements therapists signed with Headway before, therapists and industry sources said, meaning that there is little warning and no apparent recourse.
This takes place against the backdrop of change in the mental health industry. Individual or small-practice therapists have increasingly chosen to give large practice management companies like Headway, Rula, Grow and Alma the power to manage billing and insurance credentialing, and to control certain other aspects of a practice, including record-keeping, rate-setting and possession of personal health information. This changed dramatically around the time of the Covid lockdown, when practices suddenly had to be able to conduct therapy online along with all of the paperwork, insurance, complications, record-keeping, online platform presence and other similar matters. This development gave fuel to the upstart practice management companies like those named above — which are often funded by private equity, venture capital and insurance industry investment funds — as they made it easier for small practices to conduct therapy online.
Despite the pushback, a Headway spokesperson said this is a good deal for providers, and noted that they don’t have to take part in the marketplace listings if they don’t want to. The spokesperson wrote in an email statement: “Far too many people don’t get the mental health care they need because it’s too hard to find the right provider who’s covered by their insurance. That’s why we’re building a patient marketplace that matches people with providers who are the right fit for them and gets them into care faster.”
5 states for starters
Headway announced that it would improve its marketplace, adding: “To support this, we are introducing a $9.99 fee on every appointment with a client who finds you through Headway’s marketplace. The fee applies for as long as you see that client, not just their first session. It does not apply to clients you bring yourself, who book with you through your direct link, or who found you on Headway before these updates.”
The fee kicked in Oct. 8 for Virginia, Washington, Georgia, Ohio and Illinois. For other states “the fee starts later in 2026” and therapists will learn at least seven days before it takes effect by seeing a banner in their Headway accounts. Therapists may choose not to appear in Headway’s marketplace directory listings to avoid the charge; would-be clients will then not see their profiles in the Headway listing.
Headway also announced the new documentation requirement: “Starting October 12, talk therapists on Headway will be asked to have every adult client complete a baseline assessment, like the PHQ-9 or GAD-7, at the start of care, where clinically appropriate. We’ll ask for one completed follow-up assessment per client each year. We’ll bring this to psychiatric care providers and group practices next.”
This is not the first new condition from Headway. In June, Headway began requiring online facial scans from clients of prescribing clinicians, and said it is planning to expand the practice, raising objections from clients and clinicians about the use of biometric data. The company said the policy would expand to encompass all clients and all “providers,” seeming to encompass all therapists and psychiatrists, who prescribe medications. Providers widely objected.
In another example of surprise conditions imposed on providers, Alma introduced a pay cut for all Aetna-insured sessions in May, without notice. At the same time it said said it would launch an Aetna service for insured people to get “Mental Health On Demand” in a single-session model, setting off an uproar among therapists and psychiatrists. (The pay cuts were later modified slightly.)
(If you have information to contribute on this or other topics, email jeanne@clearhealthcosts.com or call Signal 914-450-9499.)
‘Looking at leaving’
Reddit’s r/therapists subreddit is in flames over the Headway charge. Here’s a sampling of comments:
“This was bound to happen sooner or later. Those platforms are not interested in patient care or provider stability. I can almost guarantee the CEO is not cutting his salary to offset any of these ‘costs’.”
“Headway has benefited me so far but this decision has me looking at leaving for good. I sent my feedback and won’t be using their directory for referrals.”
“This is actually a severe violation of the ACA code of ethics. ACA Code of Ethics (Standard A.10.b) regarding fee splitting. There is a massive ethical difference between a flat monthly software subscription (like Alma or SimplePractice) and a per-session referral fee. Flat fees are ethical because they don’t change based on your client volume. Charging $10 per session means a third party is taking a direct, recurring cut of clinical revenue specifically from a client they steered to you.”
“This sounds like a kickback which is illegal to have. We should let them know this is a crime”
“It was always my belief in my State and ethical code it was illegal to accept payment for clients or referrals. This is distinct from paying for marketing. However, this statement from Headway makes this very unclear and the process of the fee and its application is more important regardless of what they call it. Also, what’s the point of the provider agreement if Headway continues to change this at any moment?”
“This is easily a violation of APA, ACA, NASW and AAMFT ethics codes that prohibit paying for referrals, and fee splitting is illegal in some states. It could also violate the anti-kickback statute for medicare and medicaid. Headway already takes 15-20% off the top and now an additional $10 per session ends up being more than having your own EHR, and other services with fees. There are petitions on change.org for it.”
“As a note, make sure your Psychology Today profile is not managed or ‘optimized’ by Headway – people that find you through Psychology Today may still get routed through Headway as a referral from Headway and the fee would apply.”
“Please jump ship and let this company burn to the ground.”
‘Like widgets on Amazon’
Linda Michaels, a PsyD and M.B.A. who is the chair and co-founder of the trade association the Psychotherapy Action Network and a psychologist in private practice in Chicago, wrote in an email: “This is awful news, for the field, for therapists to be able to sustain a practice, and for the public who is looking to access therapy.
“The fact that Headway even calls this a ‘marketplace’ shows that they view the practice of psychotherapy as a commodity that can be bought and sold, just like widgets on Amazon. Here we have bait and switch, front and center. We wrote about this in our research study from 2925 on practice management companies. [Link here.] …
“Another announcement is even more concerning: [Link here, on the assessment policy.]
“Insurers are not requiring this at all, at the moment. But I’m sure they will love to get their hands on the data – which they probably will be able to do, since they invest in headway.”
Alma instituted monthly symptom level assessments last year.
“As we all know, whoever has the data has the power,” Michaels wrote. “Clients and therapists are forced to give away their data for free, without choice. Headway and Alma can then use the data to construct capitations payment models that can constrain therapy and prevent people from getting sufficient care.
“As we wrote in our [practice management company] report, we see PMCs as an existential threat to independent practice. It’s policy changes like these that make clear the threat is ongoing and serious. Other therapists are starting to see how grave the threat is.”
(If you have information to contribute on this or other topics, email jeanne@clearhealthcosts.com or call Signal 914-450-9499.)
Changing policies
Barbara Griswold, author of the blog “Navigating the Insurance Maze,” and the book of the same name, is a therapist who helps other therapists with various aspects of the business of a practice, especially insurance. She wrote on her site that another one of the practice management companies, Rula, also had a policy change recently: “As of June 18, Rula changed its policy and no longer credentials or hosts providers who have opted out of Medicare. New-patient matching is paused for current clinicians who have opted out, and providers report that Rula has deactivated profiles and sent notices after identifying their opt-out status. This policy change has left many Rula providers and their clients in limbo. According to Rula, clinicians must formally rescind their Medicare opt-out waiver and notify Rula’s credentialing team to regain eligibility.”
Regarding the Headway decision, she wrote in an email: “Clinicians turn to platforms thinking they are going to ease financial burdens and assist with referrals. And platforms at first seem terrific. But time and again we are seeing that after therapists build a client load, platforms change their policies — they change reimbursement rates, add fees, add requirements that clinicians cannot opt out of Medicare, So often in these cases, therapists face the harsh reality of how much of their financial and clinical control they turned over to these platforms — and may have a tough time getting out.”
Fee-splitting, ethics
Susan Frager, a biller and consultant at PsychBillingCoach since 1997, wrote in an email about the Headway charge: “I can’t understand how this is legal. The federal Anti-Kickback Statute and various state fee-splitting laws, not to mention the codes of ethics for all licenses/disciplines seem pretty clear that paying for referrals is illegal and unethical. (for example, NY: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/2015-11-10_reg_impact_vbp_issue_business.pdf) While Headway may be in a position to impose this, it makes me wonder what legal/professional liability therapists who participate in this are going to encounter.”
Zynnyme, a private practice consulting group, wrote: “And yeah, $9.99 sounds small (it is designed to sound small) but if your rate is $68 that is almost 15% of your pay, and once a client gets tagged as a ‘marketplace’ client that fee follows them for every single session for as long as you work together…
“We have been watching the chats fill up with ‘can’t we just push back?’ and ‘we need a union’ and we get it, we really do. So we wrote the whole thing out: the actual math at different reimbursement rates, who is invested in these platforms (spoiler: the insurance companies), why a nationwide therapist union isn’t legally possible right now, and the steps you can take THIS WEEK to protect yourself, whether you are staying for now or planning your exit. Read it here: Headway is not your friend, your employer, or your business partner“
Company comment
In response to our query, a Headway spokesperson wrote in an email: “Far too many people don’t get the mental health care they need because it’s too hard to find the right provider who’s covered by their insurance. That’s why we’re building a patient marketplace that matches people with providers who are the right fit for them and gets them into care faster. It will also give providers access to more clients, the number one thing they’ve asked us for. To get there, we’re significantly increasing our investment in bringing patients to Headway in 2027, and this fee helps support it and related services.
“Most of our providers run their own practices, and any new cost matters to a small business. We designed this fee to respect their autonomy. It applies only when a provider has an appointment with a client who found them through our marketplace. Providers can opt out of marketplace matches entirely, or by health plan, and keep using Headway for the clients they bring themselves or book directly.”
The spokesperson added, as a paraphrase, that the company thinks a per-appointment fee makes the most sense: providers pay only when they’re actually seeing a client the marketplace brought them. For comparison, a typical directory listing costs much more per month whether anyone books or not. The fee also supports the work we keep doing throughout a client’s care, including benefit checks, scheduling, and patient communications on every appointment. [For comparison, a Psychology Today listing costs $29.95 a month and reaches people outside of Headway’s ecosystem.]
They noted that taking part in the Headway marketplace is optional.
On the assessment requirement, they ascribed this to insurers, saying insurers will pay for more mental health care only if they can see it’s working, and that assessments give patients and providers evidence of progress, evidence that protects provider rates and patient coverage.
A petition asking Headway to stop the new referral charge and replace it with a one-time charge was started on Change.org.
What you can do
Griswold wrote on her site: “Therapists are urged to do the math: subtract the fee from your contracted rates to get the new rate, and see if the Headway rates still make financial sense for you. Please read my articles My Concerns About Platforms, and What To Think About Before Joining Platforms.”
Zynnyme wrote: “Read it here: Headway is not your friend, your employer, or your business partner.”
(If you have information to contribute on this or other topics, email jeanne@clearhealthcosts.com or call Signal 914-450-9499.)
