Last month, thousands of therapists opened an email and learned their income was being cut.
Not because they saw fewer clients. Not because their work changed. A payer and a platform renegotiated a contract, and the result landed in their inbox: effective in a few weeks, a 60-minute session will be reimbursed the same as a 45-minute session, and a doctoral-level clinician will be paid the same as a master’s-level one (Bomi Health, May 2026.; ClearHealthCosts, 2026; Navigating the Insurance Maze, May 2026). No negotiation. No recourse. No warning that meant anything.
If this sounds familiar, it’s because it happened eighteen months ago, too. In late 2024, the same platforms delivered the same kind of email about a different payer. Clinicians reported cuts from a few dollars a session to 30 percent. Individual therapists calculated losses of $8,000 to $13,000 a year — announced to them, not discussed with them (Behavioral Health Business, 2024; ClearHealthCosts, 2024a, 2024b).
It will happen again — because every one of these emails is a test. The platforms are testing and pushing you to see leaving is harder than staying – if you’ll absorb the cut, and that by now too much of your practice lives inside their system for you to walk. So far, what they see is they can keep cutting reimbursement and services to you — and they will. It is the history of health technology. Offer as little as possible and take as much as possible.
Here’s why — and how that test fails.
The contract isn’t yours
First, let’s be precise about what these platforms are — because the confusion is part of the trap. A billing company works for you. It submits claims under your contract and your tax ID, and if you fire it tomorrow, your payer relationships don’t change. These network platforms are the reverse: you work under them. You don’t get credentialed with insurance companies — the platform does. You bill under its tax ID, on its contract, at rates set in a room you weren’t in. Many clinicians believe they’ve hired a billing service. They haven’t. They’ve joined someone else’s network. You are at their mercy. Some say, you no longer own your practice or control your fate — as we are seeing play out now. With the insight they have with this approach, they know all your intimate business details and their mandate is to maximize the success of their own business first and to extract as much from you as possible just before you leave. Make no mistake — this extraction will continue. It is the story of healthcare technology today.
This is the entire business model. The platform sits between you and the payer, and everything flows through that position: the contract, the rates, the claims, the client relationships, and the data. When the platform and the payer renegotiate, your income changes. When the platform drops a payer, your clients lose coverage. When you decide to leave, the contract stays behind — because it was never yours.
Read that email language again, the part where they say they’re “disappointed” in the payer’s decision and are “gathering feedback.” A company that actually held power on your behalf would not be gathering feedback. It would be fighting. It can’t fight, because the payer is its business partner — and in more than one case, its investor. The companies setting your rates own a piece of the platforms that are supposed to be negotiating against them.
This is not a partnership. It’s a dependency, and the dependency is the product. These platforms are not banking on being the best. They’re banking on leaving being harder than staying; on the fact that after a year or two, your caseload, your billing history, and your insurance access all live inside a system you don’t control. Every rate cut is a test of that bet. So far, they keep winning it.
Why the honest math still favors practice independence
Let me be straight about something the pitch decks won’t be: independence is not free money on day one.
Getting credentialed under your own name takes 60 to 120 days per panel (Supanote, n.d.; Therapy Practice Services, n.d.). In some markets, a platform’s negotiated rate is genuinely higher than what a solo clinician gets walking in alone — that’s the carrot, and it’s real. If someone tells you leaving is painless, they’re selling something.
But look at what you’re actually trading. The platform rate is not a rate. It’s a variable that resets whenever two companies you don’t control renegotiate. The independent contract is yours: your name, your tax ID, your relationship with the payer. Nobody can email you a pay cut on someone else’s behalf. And every year you stay on the platform, the exit gets more expensive — more clients to transition, more history locked in, more of your practice living on someone else’s infrastructure.
Renters get their terms changed. Owners don’t. The question isn’t whether practice independence costs something up front. It’s whether you want to spend your career on a lease you can’t renegotiate.
The part nobody has solved — until now
The honest objection to practice independence has always been leverage. One clinician negotiating with a national payer has none. The big platforms built their entire pitch on solving this: join us, and our scale gets you rates you could never get alone.
But look at who they were “negotiating” with. The largest of these platforms are funded by the investment arms of major payers — the same companies that decide what a therapy session is worth. The rates weren’t won across the table; they came from partners who own a stake in the platform and continue to shape what you’re paid, contract cycle after contract cycle. That arrangement empowers the platform. It has never empowered you. Your scale bought their seat at the table; you were the inventory, not the client. The scale was yours. The leverage never was.
So the answer isn’t to go it alone. It’s to aggregate on terms where the aggregator can’t turn on you — which means the aggregator can’t be owned by the other side.
That’s the model we built. The EHR is free — not freemium, not free-for-now. We make money one way: when your claims are paid, through our own clearinghouse. We are self-funded. No private equity. No insurer money. Which means the difference between this model and the current aggregators isn’t a friendlier logo — it’s whose interests the company structurally serves. Their investors are the payers; when the payer cuts your rate, their investor just got richer. Our only outcome is your paid claim. We hold no payer contracts over you. You credential in your own name; the contract is yours; if you ever leave, everything goes with you.
And here’s where the leverage actually comes back. One clinician leaving a platform is a rounding error. Thousands of independent practices, credentialed in their own names, running claims through infrastructure that answers to them — that’s a block no payer can ignore and no platform can sell out, because there’s no one positioned to sell it. If everyone takes it back, the power in those numbers belongs to the people doing the work for the first time. You succeed, we succeed. That’s not a tagline; it’s the only way our business works.
Stop waiting for health tech to save you
Health tech has raised hundreds of billions of dollars over the years promising to fix the system — behavioral health has claimed tens of billions of it. Ask yourself what any of it has fixed for you. Rates haven’t risen. Denials haven’t fallen. Paperwork hasn’t shrunk. The one thing that reliably gets built is a new position between you and your money — because that position is where the returns are, and returns are what the investors came for. These companies are structurally short-term. Your practice is the long-term thing in this equation. Build it on the ground you own.
You built the caseload. You did the training. You do the work that actually helps people. The only thing you don’t own is the billing relationship — and that’s the only thing they have.
Take it back. And when enough of us do, the leverage comes with it.
Sam Virk, MD is a physician and the founder of MediSprout, a free EHR and practice platform for independent behavioral health practices, and Sacha Health, its clearinghouse. MediSprout is self-funded and has taken no private equity or insurer investment.
Behavioral Health Business. (2024, December 19). Recent Optum behavioral health rate cuts bring to life harsh reality of the payer-provider complex. https://bhbusiness.com/2024/12/19/recent-optum-behavioral-health-rate-cuts-bring-to-life-harsh-reality-of-the-payer-provider-complex/
Bomi Health. (2026, May 21). What’s going on with Alma, Aetna, and 90837? https://www.billwithbomi.com/blog/alma-aetna-90837-reimbursement-change
ClearHealthCosts. (2024a, November 5). 2 digital mental health platforms cut pay rates for therapists with UnitedHealth’s Optum, stirring anger. https://clearhealthcosts.com/blog/2024/11/2-digital-mental-health-platforms-cut-pay-rates-for-therapists-with-unitedhealths-optum-stirring-anger/
ClearHealthCosts. (2024b, November 13). UnitedHealth-Optum pay cut makes clinicians reassess value of tech mental health platforms. https://clearhealthcosts.com/blog/2024/11/unitedhealth-optum-pay-cut-makes-clinicians-reassess-value-of-tech-mental-health-platforms/
ClearHealthCosts. (2026, July). Aetna cuts pay rates for Alma clinicians, and adds its own therapy service. https://clearhealthcosts.com/blog/2026/07/aetna-cuts-pay-rates-for-alma-clinicians-and-adds-its-own-therapy-service/
Navigating the Insurance Maze. (2026, May 28). More clinician pay cuts? Aetna flattens Alma providers. https://theinsurancemaze.com/more-clinician-pay-cuts-aetna-flattens-alma-providers/
Supanote. (n.d.). Insurance credentialing for therapists: Everything you need to know. https://www.supanote.ai/blog/insurance-credentialing-for-therapists
Therapy Practice Services. (n.d.). Insurance credentialing for therapists & practices. https://therapypracticeservices.com/services/insurance-credentialing/