Alma, Headway, and the big question: is this still the answer in 2026?

Burnout & SustainabilityTech & IndustryFees & InsuranceGrowing A Private Practice

Jun 3

Written By zynnyme

last updated 6/3/26

For therapists looking to launch or expand a private practice, platforms like Alma and Headway have offered a tempting solution. These startups promise to simplify the headaches of taking insurance while expanding access to care. They handle billing, credentialing, and the logistical mess, so you can focus on what you do best: providing therapy.

BUT... the last few weeks have given therapists some very hard questions to ask about the long-term sustainability of these platforms. 🧐

Two specific things happened in two weeks, both documented. We'll get to those. First, the setup.

The allure of Alma and Headway

At first glance, Alma and Headway seem like the ideal compromise:

You get to accept insurance without navigating the maze of billing and clawbacks.
They offer an easy way to fill your caseload and reach clients who need affordable care.
They even help new therapists dip a toe into private practice.

This model has been so appealing that Alma raised $130 million in Series D funding, as reported by PR Newswire. Headway raised $100 million in 2024, reaching a total valuation of $2.3 billion, according to Behavioral Health Business. And in a sign of where all this is heading, Alma was acquired by Spring Health in May 2026, folding it into the largest VC-backed platform in the space.

Clearly there's money in connecting therapists with insured clients. Here's where it gets tricky... 👀

🚩 What just happened in two weeks

This is the part that turned a slow worry into a flashing red light.

May 20: Alma told providers that Aetna is changing what it pays therapists on the platform, effective July 15, 2026. Extended sessions, the kind you need for trauma work or a hard week, get paid the same as shorter ones (90837 paid at the 90834 rate). Doctoral-level psychologists get paid the same as master's-level clinicians. Since Alma has historically paid about $15 to $25 more for a longer session, that's a real cut on every extended session for clinicians who offer them. Alma has said they disagree with the change and would advocate against it.

May 28: Eight days later, Aetna (a CVS Health company) announced "Aetna Mental Health On Demand," planned for self-insured customers starting January 1, 2027. This means real-time access to licensed clinicians by chat, phone, or video, for members thirteen and up, built on a single-session model with AI-powered tools and predictive analytics.

Read those two together. 🤔 This isn't "more sessions" or "better access to a therapist you actually build a relationship with." It's a single-session model, and in the early rollout, Aetna noted clinicians responded to members in about thirteen seconds.

Thirteen seconds. Say what? 😳

Imagine your whole job is responding inside a thirteen-second window. One session per person, AI drafting your notes while you go. That's not a therapy practice; that's a queue.

Now look at the order. Make experienced, relationship-based therapy too expensive to deliver, then offer a faster, cheaper, AI-supported substitute. We're not saying anyone drew this on a whiteboard. We're saying that when you read every rollout through the lens of "more profit for shareholders," the sequence starts to click.

🚩 The harsh reality of insurance rates

None of this is new, it's just the newest example. As outlined in ClearHealthCosts, insurers like UnitedHealth's Optum have been slashing reimbursement rates for digital mental health platforms for a while now.

In some cases, Alma and Headway are reportedly making $0 per session on Optum contracts, while still carrying the liability for potential clawbacks. 😬

Which raises the big questions:

How sustainable is a model where platforms barely break even, or lose money, on sessions?
Will therapists eventually shoulder the cost through lower pay or higher fees? (See: May 20.)

The day-to-day version of this isn't always a headline. Sometimes it's just the grind of having no leverage with the platform. One therapist, who gave us permission to share this, put it plainly:

"Recently, I've been receiving unexplained additional invoices for my clients. Charges appear without explanation, and when I ask Alma for clarification, I'm met with silence or generic responses. Clients are being billed hundreds of dollars for sessions they already paid for, and I'm left canceling appointments to sort out the mess. It's damaging to my practice, my therapeutic relationships, and my faith in Alma as a platform."

They loved Alma at first. They believed the promise. The billing chaos isn't the exception that proves the platform works; it's what it looks like when the platform answers to investors and you answer to your clients. When something goes wrong, you're the one canceling appointments and rebuilding trust. 💔

Who's really profiting?

While these platforms simplify some of the insurance hassle, the bigger problem stays put: insurance companies are squeezing therapists.

Consider this: the top 5 health insurance companies made $44 billion in profit in 2023. Meanwhile, therapists are covering basic living expenses, paying off student loans, and trying not to burn out. 🙄

And now the platforms are caught in the same cycle. Despite raising hundreds of millions, Alma and Headway are still at the mercy of insurers lowering rates. Which begs the question: are these platforms just a middleman propping up a broken system?

🔒 "But HIPAA protects this stuff." Not necessarily.

Here's a newer wrinkle worth sitting with. In April, Proof News reported on Jennifer Kamrass, who used Talkspace through her employer's benefits. She typed to her therapist about her marriage, her finances, her self-esteem. Two years later, a transcript of every word she'd typed was produced in court by her former employer and used against her. Her therapist had no idea the transcript even existed. 😨

The part to sit with: this case had nothing to do with AI. No algorithm collected it or analyzed it. One platform simply stored what was typed, and it ended up in a courtroom. A chat platform doesn't produce a clinical note; it produces a complete, searchable, permanent record. Once that record exists, you don't get to choose who reaches it.

And the record isn't a byproduct. Per the same reporting, Talkspace's CEO has told investors the company built "one of the largest mental health data banks in the world," 140 million messages and 8 billion words, with the goal of training an AI therapy bot. The data IS the product.

This is the same thread we pulled in our piece on the SimplePractice lawsuit. The question every therapist should be asking right now: do you actually know what's in the terms of service and privacy policy you agreed to? Not the marketing language; the actual legal terms. Not what they say they'll do, but what the terms allow them to do.

Free training

Do you actually know what your platform contract allows?

Most therapists have never read the fine print on the contracts and privacy policies they signed. This free training walks you through the red flags, the questions to ask before signing anything, and what your alternatives are if you decide to leave.

Watch the free platform contracts training

What does this mean for therapists in 2026?

If you're considering Alma or Headway to grow your income, a few things to think through:

Do the math. How much will you actually earn per session after platform fees, and after the July 15 rate change? Compare that to a cash-pay practice or out-of-network clients.

What happens if rates drop further? These platforms depend on reimbursement rates they don't control. Aetna just proved how fast that can change. If insurers cut more, is your pay sustainable?

Are you gaining true autonomy? Private practice is about building a business that works for YOU. If you're tied to insurance contracts through a platform that can change the terms on the 20th and announce your replacement on the 28th, are you really building something that's yours?

The bigger picture

Therapists have long relied on insurance to expand access to care. But as the system gets more extractive, it's worth asking whether participating in it, even through a middleman platform, is feeding the very beast we're trying to escape.

And here's the thing about the rescue most of us picture. The comments on every post about this fill up with the same three: "Why don't we unionize?" "Where's APA? Where's AAMFT?" "Someone should sue." We get it. But you're not Aetna's employee; there's no bargaining unit. A room of independent practice owners agreeing to set the same rate isn't a union, it's price-fixing. And the associations advocate on timelines measured in years. Aetna moved in eight days. ⏱️

No one is coming to do this for us. Which means we get to do it ourselves. 💪

The only real leverage we have is building something they can't extract from: a practice that isn't dependent on a system that can rewrite the terms whenever it suits shareholders. We've watched over 2,000 therapists do exactly that. Some left panels entirely. Some kept one or two and dropped the rest. Some left platforms they thought they couldn't live without and found their practice actually grew.

We're the people who sit with someone through the hard thing. We know healing happens in a relationship, over time, with someone who's accountable to the client. That's worth building around, and it's worth protecting. 💛

What's next for you?

If you're a therapist thinking through your next steps, let's talk. Explore sustainable practice options, learn how to build a cash-pay model that works for you and your clients, and join the conversation about how we push for change together.

It's time to stop feeding the beast and start reclaiming our profession.