Briefing · compiled August 2026

Platform economics: how the money flows

In October 2024, a therapist posted a comparison that rarely appears in public: Optum paid $110.30 for a 90837 on a solo contract, paid Alma about $151 for the same session, and the Alma therapist received $120. The gap between what a payer pays a platform and what reaches the clinician is the platform's revenue, and it is the number this site exists to collect.

The spread

Reported examples span a wide range. Kaiser Northern California paid Grow Therapy $213.07 for a 90837 while the clinician received $101.20 (September 2025). Headway billed BCBS $220 for a session and paid the therapist $110 (December 2024). The same clinician, billing the same BCBS session, reported receiving $68.51 through Grow and $104 through Headway — the platform contract, not the payer, set the difference. Alma adds a membership fee on top of its share: therapists report $125–150 per month. Full rows with sources are in the rate table.

Rate changes, 2024–2026

• Aug 2024A Headway therapist reports a rate lowered $2 without notification. community-reported source
• Nov 2024Alma and Headway cut therapist pay on UnitedHealth/Optum contracts — from a few dollars to $43 per visit, up to about 30%, per reporting by ClearHealthCosts. Therapists independently contracted with Optum reported no cut in the same period. verified source
• Jan 2025Headway drops Aetna Individual & Family Plan members after rate negotiations fail, with about two months' notice; one therapist reported losing 15 clients. community-reported source
• Jul 2026Effective July 15, Aetna sessions on Alma contracts pay 90837 at 90834 rates and doctoral-level clinicians at master's-level rates; community estimates put the reduction at 30–40%. Directly-paneled Aetna therapists report no change. community-reported source

The direct-to-consumer floor

BetterHelp pays on a stepped hourly ladder that community reports place near $30/hr at the start, capping at $70/hr, with sessions paid for 45 minutes and $10 no-show payments — effective per-session pay near $25–30. Talkspace's per-session and per-message rates are reported as comparably low. Clinicians in several threads note the knock-on effect on client expectations when subscription platforms advertise therapy at those price points.

What a 2025 survey found

A PSiAN survey of platform-based therapists circulated in October 2025 reported that 70% of respondents did not know who owns their platform, 84% said fee-splitting arrangements were not disclosed to them at signup, and 50% reported earning the same or less than in independent practice. Source thread.

Why clinicians join anyway

The trade has real terms on both sides. Platforms credential in weeks while individual paneling takes 3–9 months; they pay weekly against 14–35-day claim cycles; they absorb most clawbacks; and some deliver steady referrals. Several clinicians report earning more through platform group contracts than through the individual contracts available to them — one reported income up $60K at the same caseload versus a small group practice — while others who left report the all-in difference ran under $5–10 per session. Which side of that range applies depends on the payer, state, and license — which is what the rate table is for.

Community reports are self-reported and unverified; items marked verified cite press or primary sources. Corrections via the form.