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Why Untangled Mind™ Will No Longer Accept Insurance Through Headway
I always said I would never accept insurance. Then the economy changed, people were struggling, and I wanted to find a way to reach people who genuinely needed care but could no longer afford private-pay treatment. So I reconsidered. I accepted insurance through Headway, knowing I would earn substantially less, because I thought there might be a way to make it work without compromising the way I practice.
Guess what? My original decision remains.
Beginning now, Untangled Mind™ will no longer accept insurance through Headway (current clients will complete the 2026 year).
And I am angry about it.
I'm embarrassed that this is the system we've built, and I'm saddened for the people caught in the middle—people who genuinely need good mental healthcare but cannot afford to pay for it privately. This isn't the announcement I wanted to make. I wanted my little insurance experiment to prove there was some reasonable middle ground: that I could accept lower reimbursement, keep my caseload intentionally limited, maintain the standards of care I believe in, and make treatment accessible to more people without turning my practice into a high-volume therapy mill. It didn't.
The math doesn't work, the business relationship no longer works, and I'm not going to pretend otherwise simply because saying “I accept insurance” sounds better than explaining why the current system makes providing high-quality care increasingly difficult.
Why I Tried Insurance in the First Place
I didn't enter the insurance world naively. One of the reasons I had resisted it for so long was that I had no interest in building a practice where financial survival depended on cramming as many people as possible into a week.
Lower reimbursement has to be made up somewhere. The easiest answer is volume: see more clients.
That might work on a spreadsheet. It isn't how I want to practice.
The work I do often requires considerably more than the hour a client sees on the calendar. There are assessments to interpret, treatment plans to develop, progress to review, sessions to prepare, clinical notes to complete, and depending upon the treatment, substantial preparation outside the actual appointment. I decided to try insurance anyway because affordability mattered to me. I intentionally capped my insurance caseload and maintained boundaries around what was included. I wanted to know whether I could make insurance accessible to clients while still practicing the way I believe psychotherapy should be practiced.
Now I have my answer.
The Math Doesn't Work
Over time, I began looking at what was actually happening to my business rather than how busy my calendar appeared. The answer wasn't pretty.
My number of sessions remained relatively close to what I had previously been doing, while my monthly revenue declined substantially. I was doing roughly the same amount of clinical work for considerably less revenue. (So much so I don't know how I can survive at this rate- that's not hyperbolic or trying to ingratiate myself to your emotions- it's the facts).
I could solve that by increasing volume, but that defeats the entire reason I built my practice the way I did. The problem becomes even more obvious with specialized treatment.
Some of the more intensive exposure work I provide can require an hour of preparation before the appointment, the clinical hour itself, and another hour afterward for processing, documentation, and preparation for the next exposure. That can represent approximately three hours of my time.
My Headway reimbursement for the clinical encounter is approximately $93.
Three hours of professional work for $93 is $31 per hour before taxes or a single business expense is paid. After accounting for taxes and the overhead required to operate a clinical practice, the economics become indefensible.
Eventually, I stopped providing that depth of exposure treatment through insurance. That decision bothered me, and it still does. The treatment didn't suddenly become less clinically valuable because an insurance company wasn't adequately reimbursing the work required to provide it. The work still exists. Someone simply has to absorb its cost.
I am a clinician, but I am also a business owner. I have vendors to pay, technology and compliance expenses, continuing education, professional insurance, taxes, and all of the other costs involved in operating a healthcare practice. I also have a family and bills of my own.
I cannot operate indefinitely at a loss because our healthcare system has decided clinicians should absorb the difference.
Then Headway Changed the Economics Again
Headway recently announced another significant change to its provider model. Beginning with its Fall 2026 rollout, it is introducing a recurring $9.99 marketplace service fee for appointments with certain new clients acquired through its marketplace.
That new fee does not currently apply to my existing Headway clients. I want to make that very clear because I don't want anyone currently seeing me to read this and panic. But that can change, so don't hold your breath.
But that's no longer the larger issue for me. Headway has continued to change the economics and terms of its relationship with providers. At some point, I have to decide whether I trust a company enough to build part of my business around it. I don't.
These continued changes have led me to conclude that Headway is no longer a trustworthy business partner for my practice. I cannot responsibly plan the future of a healthcare business around a third-party company when I cannot rely upon the financial terms under which I agreed to participate. Headway is entitled to make decisions about its business. So am I. And mine is that this relationship will end in 2027.
The Irony Is That Headway Also Just Confirmed Something I've Been Saying for Years
There was another part of Headway's Fall 2026 announcement that interested me considerably more than the marketplace fee.
Headway says health plans are increasingly tying their best rates and access to more clients to measurement-informed care and clearer evidence that treatment works. Its latest changes include greater use of standardized outcome assessments, annual chart reviews, increased attention to treatment goals and documentation, and additional tools intended to connect treatment planning, measurement and clinical care.
I have been saying this was coming. Mental healthcare has enjoyed an unusual amount of insulation from the accountability expected elsewhere in healthcare. We document that someone came to therapy. We document what we discussed. We submit another claim.
What we have historically been much worse at answering is whether any of it worked. What exactly are we treating? What are the goals? What intervention are we using? Are the symptoms improving? Is functioning improving? If the patient isn't improving, what are we changing? Why are we continuing the same treatment? When should treatment end?
Those aren't unreasonable questions. They're the questions that should have been asked all along.
My practice was built around them.
Untangled Mind™ uses structured treatment planning, assessment, measurable goals, active intervention, and reassessment because I believe psychotherapy should have a purpose beyond perpetuating psychotherapy. My goal is not to keep a client forever. My goal is to help that person accomplish what we agreed we were treating and eventually leave my office without needing me.
So I find myself in the strange position of agreeing with the direction Headway says the industry is moving while simultaneously concluding that I can no longer afford to participate in Headway's model. If insurers want increasingly sophisticated assessment, documentation, treatment planning, and evidence of outcomes, fine. I welcome that scrutiny.
But someone has to pay for the work required to provide it. You cannot demand more accountable, evidence-informed, carefully documented mental healthcare while continuing to squeeze the clinicians responsible for delivering it and then act surprised when those clinicians leave insurance networks.
What This Means for My Current Clients: Nothing changes immediately.
If you currently use insurance through Headway to see me, your treatment and billing will continue as usual through the remainder of 2026. The newly announced marketplace fee does not currently apply to your existing treatment with me.
I am announcing this now because I refuse to spring a major financial change on clients at the last minute.
Over the coming months, I will work individually with affected clients to determine what makes sense based upon treatment progress, clinical needs, and financial circumstances. For some people, that may mean completing treatment before the transition. Others may choose to continue privately, investigate out-of-network benefits, or transition to another clinician who remains in network. There is nothing current clients need to do today. There will be time to figure this out.
Wish I Had a Better Answer
This is the part that makes me angry.
There are people who need competent mental healthcare and cannot afford $175 every time they see a therapist. Telling those people simply to “invest in themselves” is insulting. Rent exists. Groceries exist. Children need things. Cars break. People have deductibles and student loans and utility bills. Insurance is supposed to help solve that problem.
Instead, we have created a system where patients may technically have mental-health benefits while clinicians increasingly have to decide whether accepting those benefits makes it financially possible to remain in business.
I don't celebrate leaving insurance. I am embarrassed that our healthcare system puts patients and clinicians in this position, and I am deeply saddened for the people who will have fewer options because of decisions being made far above either of us.
I'm also scared.
I own a small business in an uncertain economy. Walking away from a predictable source of referrals while people are cutting spending is not some brave entrepreneurial moment for me. I don't know exactly what 2027 will look like, and I'm not going to manufacture a tidy inspirational ending pretending that I do. I pray that my practice makes it through this transition.
What I do know is that fear cannot make this decision for me. Staying in an arrangement that I no longer trust and cannot financially sustain doesn't become responsible simply because leaving it is frightening.
I tried insurance because I wanted to reach more people. I wish the experiment had worked.
It Didn't. And I would rather be honest about that than quietly lower the standard of care, pack more people into my schedule, and pretend we solved the access problem.
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