It's Not Just You with picture of Kristen looking at computer

Why Your Insurance Referrals Are Drying Up (And What's Really Going On)

Jun 24, 2026

Like many of you, I have been hearing a lot of discussions in therapist forums, substack, and on social media about changes in the industry.

The first I heard was Alma notified providers that, effective July 15, 2026, Aetna would reimburse 90834 and 90837 at the same rate and stop distinguishing between master's and doctoral level clinicians. The notice went out May 20.

The second was CAQH has transitioned to a for-profit structure and rebranded itself as DataSpring with major health insurers now governing strategy and priorities.

The third was Aetna announced Mental Health On Demand which is an AI-powered single-session intervention platform launching in January 2027. Clinicians are trained on a single-session model with AI-powered tools embedded in the platform to streamline note-taking and administrative tasks.

As a trauma therapist in private practice who is entirely private pay, I thought...these don't really apply to me. But as a business coach for trauma therapists, they do apply to my coaching clients so I decided to do a deeper dive.

And what I discovered is this...it will significantly impact our industry, whether you are private pay or insurance-based.

So I'd encourage you to read this article, or watch the YouTube video because it's critical to understand the workings of our industry and to have an idea where we are headed. I promise to deliver the facts with as little drama as possible.

First things first...

I have to admit I didn't have much of an idea of who Headway or Alma or any of these platforms were so I did a deeper dive. And here's what I've found:

There are primarily 2 ways to start an insurance-based private practice:

The "OG" way (which is what I did) - Independently panel with the insurance companies. You deal with the initial headaches of credentialing, get your NPI, complete the application process for whatever panels you want to be on. And then once paneled, you submit claims for reimbursement based upon the contracted rate.
The platform way - Sign up with a platform (such as Headway or Alma...there are others) and they handle the hassle of credentialing and some provide other support. It's important to note providers are not credentialed with the insurance company directly, they are credentialed through the platform. The platform receives some form of compensation from the therapist. Two popular structures are a percentage of the reimbursement or a monthly membership fee.

Developing Hypotheses

If you have ever done any clinical consultation with me you know I am always encouraging us to use current data, contextual information (historical and present day) and our own knowledge to develop clinical hypotheses that help guide treatment.

I'm going to use that same approach here as we look at potential hypotheses of where our industry is headed.

Platforms & "Big Tech"

For purposes of this discussion, let's focus on 2 platforms: Headway and Alma. (There are more platforms and insurers are building their own as well which I'll touch on briefly.)

Both platforms are backed by venture capitalists or "VCs". When I hear therapists talk about the platforms there's usually some disdain toward these VC firms. And I get it, but if we vilify them, we may miss important information.

What is a venture capitalist? Venture capitalists provide capital (funding) for businesses in early stages of growth.

It's important to note that venture capitalists do not own the companies, they are investors. As investors they provide funding and management consultation to the owners of the company.

They typically look for companies in the early stages of business with high growth potential.

What does this tell us about Headway, Alma and similar companies? It tells us that these business models of consolidating therapists onto platforms to deliver care are considered to have high growth potential by VCs.

It's also important to note that venture capitalists are not long-term business partners. They begin with the end in mind which means they are looking at the exit strategy because this is how they make their money.

There are 3 typical exit strategies for venture capitalists:

Merger or acquisition
Initial Public Offering (IPO, "going public")
Company fails (which happens with many of these investments)

Once the company achieves the next level of growth, typically the VC exits with their profit but may maintain an equity position or seat on the board (if the company goes public).

Note: This is a very simplified version of the process for educational purposes.

What that tells us is these platforms are in the growth phase of their business with the goal of being absorbed into a larger company, becoming a larger company themselves by acquiring other companies and/or going public.

For example in January 2026, it was announced that Spring Health would acquire Alma. (The acquisition was finalized in May 2026.) Headway is still operating independently and has not been acquired or filed for an IPO.

Insurance Company Involvement

The next important point is that there is insurance company involvement in these two companies. There are 2 primary ways the insurance companies are involved. The first is through direct investment:

Alma's investors include Cigna Ventures and Optum Ventures among others.

Headway's investors include Health Care Service Corporation (which is the insurer for many Blue Cross Blue Shield Plans) among others.

What we can hypothesize about these direct investments based on the knowledge we have about how venture capitalists' business models are structured is that the insurance companies expect these platforms will eventually provide some return on investment through mergers, acquisitions or going public.

Which leads us to the second way insurance companies are involved - through strategic partnerships. If the insurance company wants their investment to succeed, they develop partnerships with the platforms to help them grow.

Alma's strategic partnership includes an Evernorth/Cigna network partnership and Optum distribution partnership.

Headway's strategic partnership includes Anthem BCBS of CA and Cigna portal placement.

What is a strategic partnership?

Insurer partnerships provide these platforms with privileged distribution, easier member access, or preferred placement in care-navigation pathways.

Let's take Cigna insurance, if you access their patient portal and navigate the process of finding a therapist, you will see multiple options (all of their strategic partnerships). You can click a link to Alma, Headway and other similar platforms. At the very bottom of the page, you can click a link to a list of all of their credentialed providers (which is the only place the OG independently contracted therapists are listed).

The navigation encourages their members to utilize one of these platforms. If you are an independently contracted clinician and have noticed your referrals dropping off (as I've heard anecdotally from many) this is most likely why.

The Platform Business Model

Understanding the business model is key to us understanding where the industry is headed.

In a nutshell:

Platform credentials with the insurance companies, NOT the clinician.
They negotiate rates with the insurance companies
They charge a fee to the therapist (multiple different methods/strategies but same outcome)
Platform provides referrals

Benefits to Therapists

It's not hard to see the benefit to a therapist wanting to launch into private practice. There is ease in credentialing and referral sources. You can fill your caseload quite easily over a short period of time with limited administrative work.

Benefits to Insurance Companies

Why would insurance companies want to invest in this model?

They negotiate one contract per platform
Reduces the administrative burden of contracting with individual therapists
Ease of making changes to rates and reimbursement policies

An example is Aetna's recent announcement that they will be collapsing reimbursement rates for 90834 and 90837s and paying doctoral level clinicians the same as masters level clinicians but only for Alma providers.

They updated one contract, not thousands. Alma (and now their parent company Spring Health) are the ones who have to manage the backlash from providers, not Aetna.

The question on many clinicians minds is valid...will Aetna be instituting this across the board?

It's hard to answer because the dynamics are much more complicated than they may appear at face value. At first, I thought this is probably a test of whether they can get away with it. But after more research I realize the acquisition by Spring Health creates more complexity and the story becomes more multifaceted.

I'm not going to go into further details about the acquisition here, for the purposes of this blog post, but if people are interested and want to hear more, let me know and I'd be happy to do another post about it.

While I'm not sure the entire motivation of that change is a test, I do see it giving Aetna important feedback that will shape decision-making about rate changes in the future.

The most important piece of information it could provide them would be to see what kind of impact that has on provider network access. Does Aetna lose a significant number of providers with this move?

Network Access Requirements

How does losing providers impact Aetna? All health insurers have to maintain network accessibility which means they have to demonstrate their provider networks have enough providers of the right types, within reasonable travel time and wait times, so that members can access care.

Insurers demonstrate compliance using time-and-distance standards, provider-to-enrollee ratios, and wait-time metrics, and regulators use this to decide whether a plan can operate in a state.

If you've ever tried to panel with an insurance company and they have denied entry saying they have sufficient providers in your region, this is the regulation they are using to substantiate that decision.

And this is why the announcement about CAQH matters.

CAQH/DataSpring

If you've gotten this far in the post, I'm sure you've said to yourself, why join Alma or Headway...why not just independently credential? Yes a headache in the beginning but it seems safer to me. Right? The answer is possibly...but this new development warrants consideration.

In January 2026, CAQH went from a non-profit (similar to a utility) to a for-profit entity owned by 12 shareholder companies affiliated with major health insurers including: UnitedHealth Group (board chair), Centene Corporation, Aetna (CVS Health), The Cigna Group, Elevance Health, Humana, Inc. and a coalition of Blue Cross Blue Shield plans.

On June 8, 2026, CAQH announced a rebranding of CAQH to DataSpring.

Which means insurance companies now own the data of all providers who are independently contracted with insurers (the OGs).

In the past, when you were credentialing with an insurance company, you would allow access to that insurer and they could review your information to determine whether they will contract with you to be on their panel.

Now, these 12 insurance companies own your data which means the data can be used not just to streamline administration but also to strengthen payer control over network design, directory management and partner (platform) routing.

My hypothesis is that it creates a long-term risk for the OGs. As more of our clients are directed by their insurance companies, to the platforms, the broader the platform networks become and in turn, improves network accessibility for insurance companies.

I believe over time, the insurance companies will opt not to renew independently credentialed clinicians contracts and not allow any new providers to join the panel.

Even if nothing changes overnight for any one therapist, the long-term risk is that independent clinicians lose visibility, leverage, and bargaining power while payer-preferred channels become easier for members to find and use.

Putting It All Together

Here's my hypothesis based on the current data, contextual information (historical and present day) and my knowledge of the industry.

Headway and Alma offer an easy on-ramp to private practice for therapists.

Insurance companies (since they invest and have strategic partnerships with the platforms) then prioritize referrals to these platforms.

Independently credentialed providers start seeing a decrease in referrals because they are buried in thousands of provider listings.

Headway, Alma and similar platforms expand their network of clinicians.

Insurance companies begin to test if they can reduce their rates through the platform and retain network accessibility requirements.

Once they can fulfill their network access requirements through these platforms, they may begin terminating (through non-renewal) independently contracted providers and begin to limit or not offer altogether, new independent contracts.

What's the benefit? Because once all providers are on a platform that has one single agreement with the insurance company, they can reduce rates quite easily and with little pushback.

So if you are independently credentialed with insurance, this impacts you as well, first through decrease in referrals which we know is happening now and second through potentially losing your contracts with insurance (if my hypothesis is correct) and they decide not to renew.

And One More Thing

There's another layer being developed and tested in the industry. Evernorth and Aetna are both experimenting with their own in-house behavioral health offerings.

Evernorth Behavioral Care Group launched in 2024 to deliver outpatient behavioral health to its members. It launched with 1,000 providers in six markets, expanded to more than 5,000 providers across all 50 states as of November 2025, with plans to grow to more than 15,000 providers in 2026.

In May 2026, Aetna announced Mental Health On Demand which is anticipated to launch in January 2027 to self-insured customers providing a single-session intervention platform enabled by AI.

Spring Health, with its acquisition of Alma, is expanding into the insurance arena by offering a behavioral health carve out to large companies such as Microsoft and Target (per their website).

All are experimenting with AI assisted technology which will also change our industry significantly.

What Does It All Mean?

You know I wish I had a crystal ball and could tell you where we would be in 2 years but alas, all I can do is hypothesize...which I'll do for you.

There is so much business activity around mental health solutions right now. We all know (and have known for years) that we have a mental health crisis in this country and now it appears Wall Street has taken notice and realized there is a financial opportunity here.

Here's what I think it means depending on your place in the lifecycle of a trauma therapist.

As a newbie therapist wanting to be in private practice and have more freedom and flexibility with your schedule, Headway, Alma or however these platforms end up shaking out in the end, will be your entry point. You will get clients, experience and a pretty steady referral source.

Direct credentialing will become less strategically valuable over time because insurance companies will increasingly flow member traffic, directory visibility, and operational advantages to payer-preferred platforms and partnerships.

For OG therapists, I believe your referrals will continue to slow as you become buried in the directory listings behind insurance company solutions, platform strategic partnerships and eventually AI solutions.

Kristen, you're depressing me.

I know...I've been struggling with what this all means for our profession and I must admit there are many times I've felt pretty hopeless as I've researched it all.

Here are some positives for you:

Providers on Alma are fighting back about the Aetna changes. If Alma clinicians agree to drop Aetna, that's a pretty significant message to send. And then Spring Health has to renegotiate the contract and they have more leverage than individual providers.

Having easy access to launch into private practice through these platforms is a positive. There's low barrier to entry and if you are just starting off in the field, it can be a great way to build your experience.

If you join the platforms, you are not wedded to one, you can be on multiple, which diversifies your income. You can be on Alma and not take Aetna while being on Headway taking Aetna.

You also can use the platform as a steady income stream while you develop other areas of your business.

The Future of Private Practice

What does it mean for trauma therapists in private practice?

The platforms will continue to make marketing more challenging for us.

But here's a reframe I love to offer therapists...marketing is relationship building and relationship building is your superpower.

The techniques and tools and strategies are all learnable.

And remember, many of us have navigated these changes before...it wasn't long ago that the only way to advertise your therapy practice was to place an ad in the yellow pages. When the internet took off, we started developing websites and trying to rank on google.

For trauma therapists who want to have a practice that doesn't include the platforms, it is possible, but we have to shift into a more active state as a business owner.

Once we identify as a business owner, we can look at our business through a lens of income streams and diversification.

Diversification means avoiding total dependence on one payer, one platform, one referral source, or one business model. It may include a mix of selective platform participation, private-pay, providing consultation or supervision, developing groups or teaching (to name a few).

I believe high-quality trauma therapy will be needed more than ever, but convincing people there is a difference will become harder. There is no doubt we will have to get better at visibility and communicating who we help and how we help them.

So much of how the industry unfolds is out of our control. What we can control is whether we keep waiting to be found, or step into running our practices like the business owners we are.