Considerations Around Joining Alma and Headway

I’ve been talking a lot with therapists recently about trying to decide if they should join one of the credentialing companies like Alma or Headway. I haven’t joined any of these platforms myself nor do I take insurance, but I’ve watched their rise closely. I’ve heard enough from colleagues to feel strongly that we need to be having more honest conversations about them before signing on the dotted line. The pitch is appealing: they handle credentialing, billing, and marketing so you can “just focus on clients.” For someone burned out by the admin side of private practice (which is most of us at some point), it sounds like a dream. But the trade-offs are real, and I worry that many therapists are signing up without fully understanding what they’re giving up.

You don’t actually own your insurance contracts. When you credential through a platform, you’re credentialed under the platform’s NPI, not your own. If you decide to leave, your in-network status with those insurers ends. You’d have to apply individually to each plan, which can take months with no guarantee of acceptance.

The pay isn’t always as good as it sounds. There’s a common assumption that platforms negotiate higher rates than you could get on your own. Sometimes that’s true. But sometimes the platform is collecting significantly more from the insurance company than they’re passing on to you, and you’d never know unless you went digging. It’s worth asking pointed questions about exactly what’s being billed versus what you’re being paid.

The insurance companies own pieces of these platforms. This is the part I find concerning. Major insurance companies have invested in several of the largest platforms. It’s hard to imagine those incentives are aligned with us.

Your client records may not really be yours. Some platforms store your notes in their own EHR, and if you leave, you may lose access to them. Some contracts even state that records created in the platform’s system remain the property of the company. Given that we’re required to keep records for years after treatment ends, that’s a serious concern. There are also growing questions about how client data on these platforms is being used, especially as more of them roll out AI note-writing tools.

They’re crowding out independent therapists in advertising. When a potential client searches “therapist near me,” they’re often seeing these platforms before they ever see you. The more market share these companies grab in advertising, the harder it becomes for independent therapists to be found, which only deepens the cycle of therapists feeling like they have to join a platform just to get clients.

The bigger picture for our profession. When venture capital floods a field, the long-term goal is returns for investors. That’s not inherently evil, but it does mean the incentives often don’t align with what’s best for therapists or clients. The more therapists who route through these platforms, the more leverage these companies have over our entire profession’s pay, working conditions, and clinical autonomy.

I’m not saying never join one and if you already on these platforms, that is absolutely okay! At the end of the day, we need to take care of ourselves. But go in with your eyes open. Read the contract twice. Ask about your NPI. Ask exactly what the platform bills versus what you’d be paid. Ask who owns your records. Ask what happens if you leave. And if at all possible, work toward credentialing on your own so you have options.