Updated 11/6/25 and 11/17/25, see updates in red below

PART 1 OF 2

If you’ve dreamed about having someone handle all the hassles of insurance credentialing and billing, or billing for your private-pay clients, perhaps you have thought about hiring a biller.

But you may have also heard of multi-state therapist billing organizations such as Headway, Alma, Grow Therapy, Rula (formerly PATH), and Talkspace.  These organizations (I’ll call them “platforms” in this article) promise to quickly credential you with insurance plans, help you grow your practice with client referrals, and rescue you from all future billing headaches.  Is it too good to be true?

What we aren’t talking about

Just to be clear: We are not talking here about Electronic Health Record (EHR) programs like TherapyNotes, TherapyPartner, or SimplePractice.  This article focuses on organizations that will credential therapists with insurance plans under the platform’s Tax ID, and handle all aspects of working with the insurance clients, including health plan billing and payment and client collections.

Mixed reviews

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.

My research

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.

Let’s start with some of the benefits:  

• These platforms provide administrative support with all aspects of insurance billing and filing of claims.  
• They will likely be able to credential you much more quickly than you would be able to on your own (it may only take a few days or weeks instead of many months). 
• They will typically be able to negotiate a higher reimbursement rate than you could have gotten if you had credentialed on your own, due to their size and the fact that they are multi-state entities.
• They often can help you build your practice, with client referrals via their external marketing and online therapist directory.  
• The platforms I interviewed stated they paid therapists within 1-2 weeks of a session, which is often quicker than the usual network insurance reimbursement.
• Some have built-in templates for notes and treatment plans.
• Several platforms told us they offered some level of audit “clawback” protection to their providers.  
• Several platforms told us they offer online user communities where users could ask questions, get training, get clinical support, and network.
• Several platforms said they offered objective client tests such as GAD-7 and PHQ-9 for clients
• At least one platform said they would pay even if a client no-shows.

My areas of concern

While the platforms certainly sound like great aids to the overburdened therapist, I have many areas of concern:

• Transparency: 
  • Many of these platforms seem to want to quickly sign you up, without giving a lot of information, or making it easy to ask questions first.  This means therapists may join without fully understanding the terms of their agreement.
  • Some platforms do not have therapist directories, and do not assist with client referrals, something many users had expected.
• Calendar requirement: Some platforms require you to use their online calendar so clients can schedule initial appointments.  While this speeds referrals and shortens wait times for clients, you may not be able to screen new clients for appropriateness.  
• EHR requirement: Some platforms require you to keep your notes in their program so they have access to them. This may not allow you to customize notes to your needs, and might give the platform more access to your charts than you would like.
• Artificial Intelligence (AI):  Alma already offers the use of their AI program Note Assist for your notes.  However, recent articles have documented serious problems with this program.  Click here to read my article on my concerns about AI and documentation, and click here to read an article specifically about the problems reported with Alma’s AI Note Assist.
• Access to records: 
  • Different platforms reported varied ability to access your confidential client records.  In fact, one platform stated they will release records for Risk Adjustment (RA) audits to insurance plans without contacting the provider. If not giving the platform access to your records is important to you, you may prefer to work with a platform that will notify you when your records are released, or you might consider keeping your notes in an external EHR. 
  • At least two platforms stated that they do their own INTERNAL audits on provider files progress notes and treatment plans, to find weaknesses and make suggestions for improvement.  This is not something all their users were aware of.   If this is something you would welcome — or hate — this might be something to ask about.
• Medicare requirement: Some platforms will not accept therapists who have opted-out of Medicare.  Since there are some real benefits to opting-out of Medicare, and there can be consequences if you don’t, this can block your ability to see older and disabled cash-pay clients in your private practice.  Read more about opting-out of Medicare here
• Dependence on platform: 
  • If you credential through one of these plans, you are only credentialed under their Tax ID number.  You won’t get a copy of any provider contract of any insurance plan they credential you with.  The contract is between the platform and the health plan.  This means you have no document outlining what you are agreeing to, and your responsibilities as an insurance provider.  If there is an insurance problem, you must rely on the platform to troubleshoot with the health plan – you can’t contact the insurance plan yourself.  You must also rely on the platform to submit your resignation to a health plan.
  • A big complaint from users was that many of these platforms don’t offer phone support, and also didn’t respond quickly or knowledgeably to emails, making it difficult to resolve more complex issues.
  • The platform may handle financial issues differently than you would.  For example, if the insurance plan does not pay as expected, the platform could send your client a large bill for the balance, when you might have tried to negotiate something with the client.  I have also heard of a case where the platform did not inform the therapist when the client wasn’t paying their copayments.
  • Two clinicians told me that due to mistakes made by the platform, they were kicked off the platform without warning, leaving them unable to access their client information, and leading to a loss of clients and income.
  • One therapist told me her clients abruptly lost their coverage to see her because the platform did not let her know that the insurance plan needed an updated copy of her license and malpractice.
  • Because you do not hold the contract with the health plan, you do not have the ability to ask for a higher reimbursement rate.  You also can’t fight it if the rate drops, which recently happened with all therapists on one of these platforms who were contracted with United HealthCare / OPTUM.
• Fee issues: 
  • While the presumption exists that you can get a higher reimbursement rate from going with one of these online panels, this may not always be the case, particularly with Headway.  Several therapists reported they were paid significantly more when contracted directly with a health plan than they would be paid by Headway.  For example, Jessica Wong of The Hawaii Therapist Hub points out that in Hawaii, HMSA pays therapists who contract individually $17 more than Headway pays for a 90837 session, which can add up.
  • Several therapists told me they did not know the exact amount the platform was billing the health plan for their services.  This became a problem when, during the deductible period, the client was handed a bill for each session for an amount that was higher than the therapist’s full fee.
• Practicing in other states:  If you are a member of PsyPact or another interstate compact, the platform may not accept this.  Just because these platforms operate in other states doesn’t mean you can do so legally.  Remember, to see a client in another state, you must be licensed (or permitted by the licensing board) in the state where your client is located at the time of the session.
• Note that. many of these billing platforms are now partially owned by insurance plans.  This might make you wonder about the future of these organizations and your relationship with them.

Issues when you leave

• Several platforms acknowledged that if the therapist leaves their platform, the clinician will no longer have access to the notes entered in the platform’s EHR.  This concerns me since notes are sometimes needed at a later date, such as to defend yourself in a complaint, or to support a client’s disability claim.  One platform’s provider contract stated, “any patient files and health records created by…Provider into the Company’s EHR system or telehealth platform … are and shall remain the sole property of the Company, and the Provider shall have no right or interest in such patient files or records.”  Again, this is a fact that the users I spoke with were often not aware of.   While you might be able to individually download each note as a PDF before leaving, this could be cumbersome if you work with a large number of clients.   If this is a concern, you might consider keeping your session notes (or a copy) in an external EHR. 
• It’s important to note that if you decide to leave any of these platforms, your health plan in-network status will end.  You would have to apply to the health plan for an individual contract, which can take months, and there is no guarantee you will be accepted.  This may leave your insurance clients high and dry if you leave unless you plan in advance.
•  

And then there are some ethical dilemmas…  

• The private-pay bind: Let’s say you are contracted with Aetna through Platform XYX, when an Aetna client comes to you in your private practice ready to pay you your full fee, out of pocket.  Is it unethical to charge them your full fee, and not tell them that you could bill for them through the platform, so they could use their insurance?
• Remember interstate therapy rules: Just because these platforms operate in other states doesn’t mean you can do so legally.  Remember, to see a client in another state, you must be licensed (or permitted by the licensing board) in the state where your client is located at the time of the session.
• Insurance plans are now investing in these platforms.  For example, United Healthcare / Optum and Cigna have invested in Alma and Headway.  This may lead to decreased provider reimbursement rates.
• Something to ponder: By participating in a trend where therapists are joining platforms to get higher pay, might you be making it harder for individual clinicians to get raises, thus forcing clinicians to have to join these platforms?  

The stories of disenchanted therapists

One therapist wrote about her experience of joining, participating with, leaving a platform, her conclusions, and the ethical issues it brought up for her – read her article here.  A second therapist wrote about her experience with a platform, comparing it to being in a relationship with a Narcissistic abuser —  read her article here.

11/6/25 update: Journalist Jeanne Pinder of Clear Health Costs (who often writes about the woes of therapists) interviewed me and many therapists for a very detailed article about the disenchantment many clinicians feel after joining a platform — read her article here.

11/17/25 update: Check out this article from Susan Frager of PsychBillingCoach about how platforms profit off your practice.  Susan can help you decide whether to join one –– read her article here.

The summary

These platforms are growing in popularity, and can really help some therapists to build and grow their practices.  When you feel overwhelmed, what they are offering seems enticing.  But I have concerns on several fronts.  The main one:  Whenever you have a third party between you and your clients, you lose some of your control.  This sometimes leads to financial, administrative, and even ethical complications that can affect the clinical relationship.

My hope is that this article serves to slow you down when joining, helps you analyze with clear vision the pros and cons of this move, and helps you ask good questions to get all the information necessary to make an informed choice.

I also hope you will consider whether hiring a billing person — someone that works directly with you and for you — instead of a nationwide billing platform might be a better option for you.  Read my article on hiring a biller here

In Part Two of this article, I’ll help you analyze things to think about and do before you join a platform, and the questions I recommend you ask before — and after — joining.  Click here to read that article.

Join my e-mail mailing list to receive helpful articles like this in your inbox — click here