The short answer
Alma charges a membership fee and lets you keep whatever the insurer pays above it. Headway, Rula and Grow Therapy are free to join and take their margin out of each session instead — Headway as a percentage of the payout, Rula and Grow by paying you a set rate and keeping the difference between that and what the insurer pays.
If your insurance caseload is full and steady, a flat fee usually works out cheaper per session, because the fee stops growing while your volume doesn’t. If you’re starting out, or your weeks are uneven, the free platforms cost you nothing in a slow month. Alma and Rula credential across multiple states. Headway starts you in one.
That’s the comparison every article publishes, and it’s the easier half of the decision. The harder half is what each platform does to where your clients come from — because none of these four sell you demand. They rent it to you, and the rent is due for as long as you need them.
What these platforms actually sell you
Strip away the branding and all four do the same two jobs.
The first is credentialing. Getting paneled with insurers on your own means a CAQH profile, separate applications to each payer, and a wait measured in months. Often three to six, sometimes longer, with no way to hurry it along. These platforms have already done that work. You join their group contract and start seeing insured clients in days or weeks instead.
The second is billing. Claims, benefit verification, denials, clawbacks, the follow-up call when a payer decides a session from March needs a different modifier. It’s unpaid administrative work that most therapists are bad at, not because they’re careless but because nobody trained them for it and it competes with clinical hours.
Both of those are real problems and all four platforms genuinely solve them. That’s why so many practices join one.
What none of them sell is demand. When a platform’s directory sends you a client, that client found the platform, not you. They searched, or their insurer’s app pointed them there, or an algorithm matched them. The relationship starts inside someone else’s system. If the platform changes its matching rules, adds providers in your area, drops a payer you rely on, or renegotiates rates downward, your referral flow changes and there is nothing you can do about it from inside.
This isn’t an argument against joining one. For a therapist with an empty calendar and no marketing, a platform is the fastest route to a full week that exists, and turning that down on principle is expensive. It’s an argument for being clear about what you’re buying: access to billing infrastructure and someone else’s demand, on their terms, for as long as you need it.
The four platforms at a glance
| Alma | Headway | Rula | Grow Therapy | |
|---|---|---|---|---|
| Cost to join | $125/mo, or $95/mo billed annually ($1,140) | Free | Free | Free |
| How they earn | Your membership fee | A cut of each insurance payout | The spread between your rate and the payout | The spread between your rate and the payout |
| What you’re paid | The full negotiated rate | Payout minus their cut | A set rate per session | A set rate per session |
| Credentialing | Multi-state | Starts in one state | Multi-state | Single or multi-state, 5–7 days on average |
| Telehealth | Included | Bring your own | Included | Included |
| EHR | Light, included | Light templates | Included | Included, with AI documentation |
Rates and fees change. Confirm the current numbers with each platform before you commit to one. This table reflects published information as of August 2026.
What it actually costs you per session
Alma’s cost is the one you can calculate, so start there.
At the annual rate, membership runs $1,140 a year. If you see fifteen insurance sessions a week and take four weeks off, that’s roughly 720 sessions, and Alma costs you about $1.58 per session. At five sessions a week it’s around $4.75. The fee is fixed, so every additional session makes it cheaper. Past a certain volume it rounds to nothing.
Now try the same calculation for Headway, Rula or Grow Therapy, and you’ll find you can’t do it.
Your cost on those platforms is the difference between what the insurer paid for your session and what landed in your account. You can see the second number. The first one you generally can’t. That gap is their revenue, and it isn’t published, not because anyone is hiding it especially, but because it varies by payer, plan, state, license type and CPT code, and no platform wants to advertise a single number that makes it look expensive.
So the honest framing is this. Alma sells you a known, fixed cost that shrinks per session as you get busier. The other three sell you an unknown, variable cost that grows with every session you deliver. Neither is automatically worse. But only one of them lets you know what you’re paying.
The comparison you can actually run
Take one CPT code you bill constantly (90837 is the usual candidate) and one payer you see a lot of. Ask each platform what you’d be paid for that exact combination in your state, with your license. They will tell you, because it’s the number they recruit on. Then compare take-home per session, and set Alma’s take-home against the others minus about $1.60 a session at full caseload.
If the gap between Alma’s rate and a free platform’s rate is more than a couple of dollars per session, the membership fee is cheaper at almost any realistic volume, and the “free” platform is the expensive one. If the rates come out close, the fee is real money and the free platforms win.
That is a fifteen-minute exercise and almost nobody does it. It’s worth more than any comparison table, this one included, because it uses your codes, your payers and your state instead of an average.
How each one actually sends you clients
All four run some version of a directory and a matching engine, but the amount of say you get differs.
Alma gives you a profile in its directory and therapists generally report that it sends a steady trickle rather than a flood. You write the profile, so there’s something to optimize — the specialties you list, how you describe your approach, whether you read as the person for a particular problem.
Headway leans hardest on automated matching. The volume is the selling point, and for a therapist with gaps in the calendar that’s a genuine advantage. The trade-off is that the algorithm decides, and you have less influence over who arrives.
Rula and Grow Therapy sit closer to Headway. Clients come through their intake, get matched, and land on your schedule. Grow works with a large payer network, which is what drives the volume.
Here’s the part that matters more than the mechanics. On every one of these platforms, the thing that generates your referrals is a page you don’t own, ranking for searches you didn’t target, inside a system whose rules you can’t see.
Look at what happens when someone searches for a therapist who takes their insurance. The platform’s directory page ranks. The platform’s brand gets the click. The platform’s matching logic decides which of its several thousand providers gets shown. You are a row in someone else’s database, competing with every other therapist on the same platform, sorted by criteria nobody has published.
You can improve your profile. You can respond faster, keep availability open, ask for the specialties you want. What you can’t do is change your position in a system that isn’t yours, or take that ranking with you. The only listing you control is your own practice website.
What a client really costs you
This is the calculation that changes how the whole decision looks, and I’ve not seen anyone publish it.
When you acquire a client through your own website — search, referrals, a directory profile you own — the cost is front-loaded. You spend to get them in the door. After that, whether they stay for six sessions or sixty, the acquisition cost doesn’t move. A client who stays two years costs the same to acquire as one who leaves after a month, which means long-term clients are where the money is.
On a platform, it works the other way round. You pay on every session, for as long as that client keeps coming.
Take a client who stays for forty sessions, which is unremarkable for weekly work over a year. On your own channel, you paid once. On a platform, you paid forty times — and the total is almost certainly larger than what the same client would have cost you through search, by a wide margin.
Which produces an odd result. The better you are at your job, the more a platform costs you. Retention is the thing every practice wants, and on a platform, retention is the thing you’re charged for. Your most loyal, longest-standing clients are your most profitable on a channel you own and your least profitable on one you rent.
None of this means the platforms are a bad deal. When your calendar has holes in it, a client at a reduced rate is worth considerably more than an empty hour at your full rate, and that arithmetic is not close. The platforms are excellent at solving an empty-calendar problem.
It means something more specific: a platform is priced like an acquisition channel but behaves like a permanent tax on revenue. That’s fine while you need it. It gets expensive once you don’t, and the moment you stop needing it rarely announces itself, which is why so many practices are still paying five years later.
What happens if you leave
Before you join, find out three things, and get the answers in writing.
Can you keep working with your clients? Most platforms have terms covering whether you can continue seeing a client outside their system. This is the one that matters most and the one people check last, usually after they’ve decided to leave.
Whose insurance contracts are they? You’re generally billing under the platform’s group contract, not your own. Leave, and you’re not taking that paneling with you — you’re starting your own credentialing from scratch, which is the months-long process you joined to avoid.
Can you export your records? Clinical notes, client history, contact details. You have obligations to your clients that don’t pause because you changed platforms.
None of these are reasons not to join. They’re the difference between leaving on your schedule and leaving on theirs.
Which one fits your practice
You’re newly licensed with an empty calendar
Take the free platform with the most volume in your state. An empty hour earns nothing, and at this stage the spread they keep is cheaper than the months you’d spend credentialing yourself with no income arriving. Headway, Rula and Grow are all built for this. Join, fill the week, and treat it as temporary.
You practice across state lines
Alma and Rula both credential multi-state, and Grow supports it. Headway starts you in a single state, which makes it awkward if telehealth across several states is central to how you work. Check which states each platform is actually live in before you decide — coverage varies and the marketing pages tend to describe the ambition rather than the current footprint.
Your caseload is full and mostly insurance
Run the per-session comparison above. At high volume Alma’s fixed fee is usually the cheaper structure, and the more sessions you deliver the more that’s true. This is also the point at which the question stops being which platform and becomes whether you still need one.
You want to move toward private pay
A platform won’t take you there, because the clients it sends you are on it for the insurance. You’ll need your own visibility to reach people choosing you specifically, which is a different job — and one that takes months to build, so start it while the platform is still paying the bills.
You run a group practice
The math changes when you’re paying a spread on every clinician’s every session. At that scale the platform cost is a line item large enough to fund a serious marketing program. It is worth running that comparison properly rather than by feel, which is the trade-off we work through with group and multi-clinician practices.
The part no platform solves
Every one of these platforms is a solution to a demand problem. None of them is a solution to owning demand.
The practices in the strongest position aren’t the ones that avoided platforms. They’re the ones that joined, filled the calendar, and then used the breathing room to build something of their own — so that being on a platform became a choice rather than a dependency.
In practice, that means three things.
A website that ranks for what people in your area actually search, so someone looking for a therapist in your city who treats what you treat can find you without a platform in the middle. This is slower than a platform — two to four months before it builds real momentum, and longer before it’s a steady flow, which is exactly why it’s worth starting before you need it. Local SEO for a private practice is the closest thing to an asset you can own.
Referral relationships with the people who see your future clients first: physicians, psychiatrists, schools, other therapists who don’t take your specialty. These take longer to build than any ad and they don’t stop working when someone changes an algorithm.
A way to answer inquiries quickly. The most common reason a private-practice inquiry doesn’t convert isn’t price or fit. It’s that nobody replied for two days. Platforms solve this with automated intake. On your own site, intake automation has to be built deliberately, and it is the cheapest improvement available to most practices.
You don’t have to choose. Stay on the platform, keep the calendar full, and build the other thing in parallel. The goal isn’t to leave — it’s to reach the point where you could.
Common questions
Does Alma pay more than Headway?
Often, but not always, and the honest answer is that it depends on your state, your payer mix and your license. Alma passes through the negotiated rate and charges you a membership fee; Headway pays you its own rate after taking a cut. Compare take-home for the same CPT code and payer, then subtract Alma’s fee spread across your session volume. That’s the only comparison that reflects your practice.
Is Alma the same as Headway?
They solve the same problems with different business models. Alma charges you directly and hands over the full rate. Headway costs nothing upfront and takes its margin from each session. Alma includes telehealth and credentials multi-state; Headway starts you in one state and expects you to bring your own video platform.
Which platform pays therapists the most?
There’s no single answer, and be skeptical of any article that gives you one. Rates vary by payer, plan, state, license type and CPT code. A platform that pays well for one code in one state can pay poorly for a different code two states over. Ask each one what they’d pay for your most-billed code with your most common payer.
Is Alma worth it for therapists?
At a steady insurance caseload the fee works out to a couple of dollars a session, which is usually less than what a free platform keeps from each payout. At a light or unpredictable caseload, a fixed monthly cost in a slow month is a real burden, and free is genuinely better.
Can I be on more than one platform?
Usually, and plenty of therapists are — often to compare referral quality and payout rates before committing. Check each platform’s terms on exclusivity and on seeing the same client through another route.
The decision underneath the decision
Choosing between Alma, Headway, Rula and Grow Therapy is a real decision worth ten minutes with a calculator and your own billing codes.
But it’s a smaller decision than the one sitting behind it, which is whether your practice will always depend on someone else’s directory to stay full. Every platform here is good at what it does. None of them is building anything that belongs to you.
If you’d like a look at what your own visibility currently is — what you rank for, where the inquiries are leaking, what it would take to build a pipeline alongside the platform you’re on — that is what our marketing for therapists and private practices starts with, and the audit is free.