Ditching Insurance & Platforms: How to eliminate (some or all) crappy contracts and take back your practice

By Miranda Palmer, LMFT and Kelly Higdon, LMFT · Updated October 20, 2026

You are exhausted by insurance runarounds and platforms that micromanage and underpay.

Requirements buried in hundreds of pages of manuals. Denials. Pre-approvals. Rules that change without notice. Reimbursements going down while every cost of doing business goes up.

Platforms were supposed to be the way out. Some were bad from the start. Others were genuinely good for a while; easier billing, some protection from clawbacks, a break from being micromanaged by an agency. Now the reimbursements are getting cut, the new requirements are rolling out, the clawback protection is quietly disappearing, and the privacy protections went out the window. And at tax time, the math isn't mathing.

In 2025, the seven largest for-profit health insurance companies booked more than $54 billion in operating profits on nearly $1.7 trillion in revenue. That's seven companies. Meanwhile the platforms are valued in the billions and positioned for a payout that goes to investors and executives, built on the labor of therapists who are working paycheck to paycheck with little or no retirement.

Source: Wendell Potter, 2025: Big Insurance's $1.7 Trillion Year, HEALTH CARE un-covered, February 2026.

The frame that changes how you read your own contracts

When you accept insurance, you invite a third party into the therapeutic relationship. You may not see them on the couch, but they are in the room, deciding medical necessity, authorizing services, requesting your files, setting what counts as usual and customary, and reserving the right to ask for the money back years later.

Accepting insurance through a platform invites a fourth.

And it isn't only an insurance problem. Even on fully private pay, platforms are increasingly making direct recommendations about your notes, your treatment, and which psychological measures your clients have to complete. Many of them are funded by the same insurance companies they claim to protect you from.

What we cover

1. How to run an unbiased assessment of every insurance and platform contract you hold, so the decision comes from your numbers instead of your fear.

2. The fee floor math: what you need to gross, divided by the weeks you actually work, divided by the sessions you can sustain without burning out. That number tells you which contracts are costing you money to keep.

3. How platform contracts are actually structured, and what to look for. Many are built to avoid a business associate agreement, employment obligations, and corporate practice of medicine restrictions, while leaving you responsible for compliance in an environment you don't control. We walk through the three things to examine in any agreement: operational control, system control, and who owns the client relationship.

   For a deeper look at the platform model itself, watch our free training on platforms.

4. How to build a termination plan before you give notice. Read your termination clause, then plan as though you'll be cut off the same day, because we are seeing that happen more and more. People give two weeks and immediately lose access to their clients, their data, and any chance at a termination session. That means getting HIPAA-compliant storage of client contact information in place first, and having somewhere of your own for clients to follow you to.

   We lay out the full step-by-step process in How to Get Off Insurance Panels (and Credentialing Platforms) Without Losing Your Practice.

5. Which contract to drop first, and why the answer is sometimes the worst-paying one and sometimes the one with almost nobody on it.

6. How to stay, ethically, if that's your decision. Asking for a raise with outcome data behind it, redlining a contract, documenting PHI concerns, and who to actually contact when something is wrong: your insurance commissioner, your state board, your professional association, your labor board.

What this training is not

It is not a pitch to drop everything. Plenty of people finish this and decide to stay on a panel, keep a hybrid practice, or renegotiate instead of leaving. That is a good outcome. Every plan, every state, and every license is different, and we are not going to pretend we know your numbers better than you do.

You are sovereign in this decision. We just want you to make it on purpose, with the math in front of you.

Because dropping a contract that doesn't work is not the same as reducing access. Insurance companies are required to maintain access to providers. We are not required to take insurance.

Accessibility to a burned-out therapist is not accessibility.

You don't pay McDonald's for a cheeseburger and then not get one; you are the cheeseburger, and it is their responsibility to provide it. Companies are being fined millions of dollars over ghost networks because of the lies they are already telling.

What happens when people run the numbers

Gary started on insurance panels and was genuinely scared to leave, convinced he'd lose all of his clients. His breaking point was spending forty minutes composing a single message to justify three sessions for a severely depressed client, knowing he'd never be paid for that time. Within eighteen months of leaving, his practice had exploded and he had his first waitlist.

Heather kept running the numbers and kept getting stuck, juggling so many different reimbursement rates. Looking at her lowest-paying contracts, she could see she was losing money by keeping them, on top of working for free on audits and phone tag. A health crisis finally forced the issue and made something plain: the pay was never going to cover a health problem, a retirement, or a vacation.

Jennifer put it most directly. Asked what she'd say to someone wondering whether they could do this: "Absolutely, you can and please do. In my states especially, because I need people to send potential clients to."

Keep going

• How to get off insurance panels, step by step
• What You Must Know About Insurance as an Out-of-Network Therapist (helping clients use their out-of-network benefits)
• Our free training on platforms

Who's teaching this

Miranda Palmer and Kelly Higdon, both LMFTs, both of whom built cash-pay practices the hard way. Miranda built hers during the Great Recession in a city with double-digit unemployment that was ranked among the ten worst places to live in the country. Kelly built theirs in Orange County at the tail end of that same recession, in a market already saturated with therapists. zynnyme has been helping therapists build practices that work since 2010.

zynnyme is committed to providing universal access to all of our trainings. Closed captioning is provided whenever possible. Please contact help@zynnyme.com to request the video transcript and/or discuss additional disability accommodations.

Most people need more than an hour.

An hour can make the decision clear. It can't sit with you through the fears, the contract-by-contract decisions, the marketing you have to build so the phone rings without a panel feeding it, and the hundred small implementation steps between knowing what you want and actually having it.

If you want this done with you rather than explained at you, that's what Business School for Therapists is. We've been running it since 2014, and it has helped thousands of therapists build practices that hold up without burning them down. The reviews and case studies are there to read; we didn't write them.

See the full syllabus

Not sure what's next for you?

Not sure yet, or not sure what you can spend? Start here instead. Answer a few questions about your practice and we'll point you toward what actually fits, free trainings included if that's the right call for you right now.

Get started

Frequently asked questions

Is the Ditching Insurance & Platforms training really free?

Yes. It's a free, on-demand video training. Closed captioning is provided whenever possible, and you can email help@zynnyme.com to request a transcript or other accommodations.

Do I have to leave all my insurance panels?

No. Plenty of therapists finish this training and decide to stay on a panel, keep a hybrid practice, or renegotiate instead of leaving. The goal is to make the decision on purpose, with your numbers in front of you.

Does the training cover Alma, Headway, and other platforms?

Yes. We walk through how platform contracts are structured and the three things to examine in any agreement: operational control, system control, and who owns the client relationship. We also cover how to plan a termination so you don't lose access to your clients and data the day you give notice.

Doesn't dropping insurance reduce access to care?

Dropping a contract that doesn't work is not the same as reducing access. Insurance companies are required to maintain access to providers; therapists are not required to take insurance. A burned-out therapist isn't truly accessible to anyone, and a sustainable practice is how you stay in the field and keep serving clients.