Are Third-Party Credentialing Platforms a Lifeline or a Trap? A Deeper Look at the Ethics and Sustainability of Alma, Headway, and Grow Therapy
Barbara Griswold is one of the most respected voices in the therapy community when it comes to insurance and ethical business practices. Her latest newsletter (you should definitely subscribe here) raised an interesting and important question: Can therapists be in-network with a third-party platform like Alma or Headway but out-of-network in their private practice?
The answer? It depends—but the bigger question is should therapists be participating in these platforms at all if the financial model doesn’t actually work for them? Let’s dive in and unpack the question, her answer, and the bigger issues at play for therapists.
The Ethical Dilemma of Selective Credentialing
A therapist recently asked Barbara if they could bill as an in-network provider through Alma (which holds the insurance contract) while remaining out-of-network in their private practice for the same insurer. The concern? If they tell private clients they don’t take insurance, but then those clients discover they could have used their insurance had they gone through Alma, is that unethical?
Barbara, as always, provided a nuanced and thoughtful response. Technically, this situation may not be illegal or a violation of an insurance contract- but of course you have to dive in to your contract). But ethically, withholding an option that could significantly lower a client’s costs creates an ethical gray area. She specifically ends with: "My rule of thumb? “Always operate as a therapist the way you would like to be treated if you were the client.” In this kind of situation, if I were the client, I would want my therapist to offer me the chance to use my insurance, if possible. Wouldn't you?"
Ethical Bigger Picture: There’s More to This Story
At ZynnyMe, we want to zoom out even further- to dive into the ethical scenario that we think is driving this question in the first place. Many therapists are joining these platforms while also creating a separate private pay practice. Why? Because many therapists know these contracts aren’t sustainable long-term. Therapists often use Grow, Alma, and Headway, Sondermind, and a whole host of other online tech companies as a temporary bridge while building a private practice that is sustainable.
Some therapists join these platforms because they can’t afford to be in-network independently due to poor reimbursement rates. Others might technically afford the rates but find the administrative burden so overwhelming that they need an intermediary service just to function.
If therapists can only stay in-network by outsourcing billing and credentialing—while accepting unsustainable fees that require overworking—this points to a much deeper problem. The system is fundamentally broken. Instead of making these unsustainable contracts work through third-party platforms or seeing more clients than you could do great work with- what if a more ethical choice might be to step away from contracts, and from companies, that don’t fully fit the needs of therapists or their clients. This shift would put pressure back on insurance companies to create fair reimbursement structures and reduce administrative headaches.
Worried that not taking insurance is going to decrease accessibility? Read this and learn how saying no to unsustainable contracts with insurance companies can actually IMPROVE accessibility to care and reimbursement rates for our profession.
The Hidden Costs of Third-Party Credentialing Services
At first glance, Alma, Headway, Sondermind, Grow Therapy and the dozen other companies that have popped up seem to offer a win-win for therapists and clients. They handle credentialing, billing, and claims processing, removing some of the biggest administrative burdens from therapists’ plates. Some of them handle the marketing too- and will fill you up with clients lickety split. But at what cost?
1. The Sustainability Problem
Many therapists sign up with these platforms because the reimbursement rates they would get independently are too low to sustain their practice. However, the reality is that these platforms regardless of whether they can negotiate higher reimbursement rates- they still need to take a significant cut in order to remain profitable and create profits for the investors who invested tens of millions of dollars to create these third parties to get paid by third parties.
Ok- let’s unpack that for a second. Insurance companies are third party payors. Now these companies are third parties helping us get paid by third parties. These are NOT employers providing w-2 reimbursement for all hours worked. These are companies hiring companies (the therapist who holds a 1099 contract) to provide services to the insurance companies. So what is happening?
Therapists often still don’t receive fair pay for their work.
In some cases, insurance companies are declining to allow therapists to get credentialed independently and forcing them to go through these companies.
Therapists often have to choose all or nothing- meaning they can’t just choose some insurance contracts that work for them- they have to choose ALL the contracts negotiated by the company.
These platforms normalize low rates, making it harder for therapists to negotiate better reimbursement on their own.
If therapists can’t survive on standard insurance rates, they may also struggle with these platforms’ rates, especially if they need to see an unsustainable number of clients just to make ends meet.
Real-life scenario: A therapist had a hybrid private practice. About 70% of their clients were using insurance through Grow, and 30% were private pay. The therapist LOVED making insurance accessible. The therapist was a 1099 contractor- meaning their business was contracted with Grow.
They had zero medicare patients, and knew that they could not afford the reimbursement rates of Medicare. As an LCSW they had to opt-out of Medicare globally to make sure they weren’t legally required to see clients for free or an unsustainable reimbursement rate- you can learn more about that here. They took this step to protect their private practice.
After their opt-out of Medicare went through, Grow Therapy contacted them and ended their contract with less than 2 weeks notice. Even though they were seeing zero medicare clients, they decided that all of their 1099 contractors MUST stay eligible to see Medicare patients. So, even though technically Grow is calling themselves a service provider in California (if they called themselves an employer in Califronia they’d need to pay therapists as w-2), they are actually treating this business like an employee- without any of the benefits of employment.
2. The Risk of Over-Reliance
Many therapists rely heavily on these platforms to fill their caseloads. But what happens if these venture-backed companies decide to change the rules, like in the example above—or shut down entirely?
Alma, Headway, and Grow Therapy are relatively new players in the mental health field, and their business models are still evolving. If they fail or pivot away from insurance-based services, thousands of therapists could be left scrambling.
They can cut reimbursement rates at any time (which has already happened). In late 2024, Alma and Headway announced lower rates due to renegotiated contracts with UnitedHealth’s Optum.
If a therapist builds their entire practice around these platforms and they disappear, will they have the infrastructure to continue attracting clients?
3. Competing Against Your Own Private Practice
Most therapists who use these services also have a private practice. But by participating in these platforms, they are actively competing against themselves in the following ways:
These companies spend millions of dollars a month on marketing, outranking individual therapists on Google and pushing potential clients toward their platforms instead.
Therapists who have worked hard to build referral networks are essentially sending clients away to companies that take a portion of their earnings if they refer every client to these platforms who finds them in their private practice.
If a therapist drops out of these platforms later, they risk losing clients who only found them through Alma or Headway in the first place.
Are These Platforms Helping or Hurting the Profession?
Let’s take a look at the numbers. These platforms have attracted massive investment, but are they truly designed to benefit therapists—or are they just another corporate structure profiting off of therapists' labor?
Financial Overview of Alma, Headway, and Grow Therapy
Alma: Raised $90.5 million in funding. Estimated annual revenue: $222 million.
Headway: Secured $225 million in total funding. Estimated annual revenue: $279.9 million. Valued at $2.3 billion.
Grow Therapy: Raised $90 million. Revenue figures not publicly available.
While these companies have grown rapidly, their long-term profitability is unclear. And unlike traditional private practices, they very likely do not have plans for continuity of care if they were to fail. If these companies disappeared tomorrow, thousands of therapists and clients would be left in the lurch.
So, What’s the Ethical Choice?
If a therapist can’t financially sustain being in-network independently, but can through one of these platforms as a bridge to a private pay practice, what does that really mean?
It means the insurance rates are unsustainable—period.
It means that therapists are only able to accept insurance under an unsustainable business model because of temporary external support.
And it means that, in the long run, therapists may be harming themselves and their colleagues by propping up a system that is already failing.
So rather than trying to navigate the ethical gray areas of being in-network here but out-of-network there, perhaps the real ethical choice is to leave insurance plans entirely if they aren’t sustainable for your individual business.
Feeling angry right now at the idea of therapists leaving insurance contracts and reducing accessibility to insurance based care, we invite you to read this. Remember, insurance contracts and reimbursements vary wildly across the United States in particular, as does the cost of living. A Blue Cross Blue Shield contract that easily helps you create a sustainable business with a great reimbursement rate, may be providing poverty-level reimbursement rates in another city. Yes, we said poverty-level reimbursement rates.
Can we have some compassion for our colleagues who have to say no to insurance contracts?
We haven’t met a therapist to date since starting this work in 2005 that doesn’t want therapy to be accessible to clients. In fact, many of them would do healing work for free if they could. And, the way our country si setup, they need to be able to keep their doors open.
The reason that someone may decide not to take insurance isn’t because they are privileged- it might actually be because they DO NOT have the privilege to accept those reimbursement rates. Reasons why a therapist may not be able to accept low reimbursement rates:
They did not have family to subsidize their education costs and they have tremendous student loans to pay off.
They can’t afford to not pay their student loans as it will create barriers to housing- whether renting or owning.
They don’t have a partner or spouse whose income is subsidizing their ability to live.
They are a caregiver for children, parents, partners or extended family who need support.
They have medical conditions that don’t allow them to sustain overworking.
The Dangers of Putting All Your Eggs in One Basket
If therapists are relying solely on Alma, Headway, or Grow Therapy to fill their practice, they need to consider the risks:
These companies control the client flow. If they decide to lower rates, increase fees, or change their business model, therapists have little recourse.
Insurance companies have already cut reimbursement rates through these platforms once—and they can do it again.
The platforms are still for-profit companies. Their primary goal is not therapist sustainability—it’s investor return.
The Bottom Line: Take Back Control of Your Practice
The ethical dilemma around third-party credentialing services highlights a much bigger issue: The insurance system is deeply flawed, and therapists are often left navigating impossible choices. But instead of making temporary workarounds, perhaps the most ethical—and sustainable—option is to say no to contracts that don’t work for us. And that is an individual decision for each therapist.
If you’re struggling to decide whether to drop one or all of your insurance plans, we can help.
Take our free training on making an informed decision about insurance participation.
It’s time to build a practice that works for you—not for a system that undervalues your work.
