Photo by Igor Omilaev on Unsplash
A few weeks ago, I got an email from a representative of Rula, an online therapy platform. He mentioned he’d read an article on my website about using insurance to pay for eating disorder treatment. He said my explanation that Anthem Blue Cross and Blue Shield of California are two distinct companies “was helpful.” Then he offered to pay me to recommend Rula inside that article.
You will not be surprised to learn that Rula is financially backed by the Blue Venture Fund, financed by dozens of Blue Cross Blue Shield plans around the country.
To be totally clear: a large company funded by a major insurer wanted me to redirect potential eating disorder clients from my small eating disorder group practice website to its platform. They wanted to use my content to market their much larger business.
This is just a microcosm of what’s happening in outpatient mental health today. Not too long ago I wrote about how private equity was impacting higher level eating disorder care. Now I want to talk about outpatient mental health and economic forces.
Insurance companies are investing heavily in online therapy platforms:
This is part of a large shift underway in the industry.
These online platforms recruit therapists offering to handle their insurance paperwork and fill their caseload. They promise to pay more than therapists would be able to bill insurance on their own. Thousands of therapists have signed up with these platforms. However, most therapists and their patients haven’t stopped to think what this means for the larger world of outpatient mental health.
The insurance companies want to onboard more therapists to the platforms in which they’ve invested. Their objectives are greater profit and greater control. One of their tactics is to offer generous hourly rates to therapists going through platforms. (These tend to be introductory rates—below we’ll see how they get cut once the platform no longer needs to compete for their services.) In some states, joining one of the large telehealth companies has become the only way for independent providers to join an insurance network: insurance companies don’t provide the option of credentialling therapists directly, and instead direct them to join the online platforms.
When therapists join these big platforms, the platform retains the power—and it’s worth remembering who’s actually funding these platforms in the first place. It’s not just that insurance companies are paying claims through Alma, Headway, and Rula; the platforms are effectively affiliates of the insurers. The problem becomes apparent when you follow the money. The platforms dictate what they pay their therapists. The insurers fund the growth of the platforms. The business logic demands that they see a return on their investment. Wealth extraction is simply what the system does. It raises profits by cutting spending on actual care, and it pays therapists less to make that happen.
In late 2024, that’s exactly what happened: UnitedHealth’s Optum — whose venture arm, Optum Ventures, is one of Alma’s own investors — cut what it paid therapists seeing patients through Alma and Headway. Some therapists took a 30% pay cut overnight. That’s wealth extraction in its purest form: the same company investing in the platform and deciding what it pays.
It isn’t limited to insurers with an actual stake, either. In May 2026, Aetna proposed a pay cut for Alma providers — collapsing the rate for a 1-hour session down to what a 45-minute session pays, and paying doctoral-level therapists the same as master’s-level therapists. Professional associations pushed back, and by July, Aetna reversed both of those specific changes: session length and therapist credentials would still be paid differently. But the rate cuts happened anyway, just as straightforward percentage reductions instead — in New York, a standard 45-minute session dropped 3.6%, a 53-minute session dropped 10.6%, and an initial evaluation dropped nearly 10%. A few weeks after announcing the original cut, Aetna showed what it was really building toward: its own in-house therapy service, no outside therapist required — we’ll follow up more on that below.
Insurance companies are using another tactic to get therapists to join platforms—the initiation of “value-based care.” This means that the insurer pays for outcomes, not just services. While this sounds reasonable, in practice “proving outcomes” requires expensive data systems, standardized questionnaires, and automated tracking—all things to which most independent therapists have no access. A solo practitioner who wants to keep taking your insurance doesn’t have many options left. Joining one of these platforms becomes the only way to produce the paperwork insurers now require..
Here’s another caveat to value-based care— there’s no evidence this extra paperwork actually improves your care. A 2026 review found that most ‘outcomes’ in these programs just prove someone filled out a form. The review concluded that insurers “often lack incentives to ensure measures have value for patients, providers, or workflow integration.” So essentially, the metrics satisfy the insurer. They don’t track whether you’re actually getting better.
Most of these platforms classify their therapists as independent contractors, not employees. This is another cost-cutting measure. Therapists get no health insurance, paid time off, or sick days — the protections California law gives most employees. These companies do not prioritize taking care of their therapists the way that many of my fellow group practice owners do.
The nature of contract work ultimately makes the therapist’s relationship with the patient less stable. A therapist with no stake in the practice, no benefits, and no long-term relationship with the company has every reason to leave the moment a better offer comes along. On these platforms, a pay cut often speeds that up. For you as the patient, it means a real risk that you build trust with a therapist over months, only to have them leave the platform and disappear from your care right when you need continuity most.
When a business model depends on maximizing profit and minimizing cost, quality suffers. Patients pay the price. At one large corporate-owned practice chain, former employees said the company shrank appointments from 30 minutes to 20. One person described it as “war medicine.” Obviously, a shorter appointment means less care.
And while none of this is specific to eating disorder care, I worry about how this will play out. Eating disorders are complex illnesses requiring careful coordination with medical doctors and dietitians. In addition to meeting with patients, therapists also regularly coordinate care with the dietitian or physician also treating them. When the system is focused only on efficiency, adequate care gets harder to deliver.
Here’s the promised follow-up on Aetna. In May 2026, the same insurer that was squeezing outside therapists’ pay rates announced its own in-house alternative, described as a “clinically-proven single session intervention model,” designed to provide “immediate impact—including crisis management—and a personalized plan.” The clinicians running it lean on “AI-powered tools” for note-taking and paperwork so they can, in Aetna’s own words, “remain fully focused on each member.” Maybe a single AI-assisted chat session is fine for some things. But notice what this actually is: a mental health product designed, end to end, by the company that profits every time you use less of it.
Another issue is privacy. Your therapy notes contain very sensitive information. Insurance companies increasingly own the companies storing your electronic health records. So how your data gets uses should worry you. Headway, one of the largest platforms, now requires both clients and therapists to submit a facial scan and photo ID just to keep using the service, with no way to opt out short of leaving.
The ”data” the insurance company collects does not just prove outcomes for existing contracts—it helps them develop the next product. Aetna, for instance, is building an AI-driven “on-demand” mental health tool that runs predictive analytics on member data to flag who’s at risk in near real time, aiming to catch a crisis before it requires hospitalization. Your therapist collected that data to track whether treatment was working, not to help a company build a product. Nobody asked your permission for that second use.
And the goal of that product isn’t to help your therapist do their job—it’s to ultimately replace them. Once a company can show it gets acceptable outcomes without paying a human clinician, therapists become an expense to eliminate. Your own outcomes data is what makes that case. It’s the same reporting these platforms already demand—just repurposed to build tools only they can offer.
Equity-backed platforms answer to another authority: their investors, whose fiduciary duty is to maximize return, not quality of care. These goals don’t always conflict with one another. But when they do—when better care costs more, takes more time, or serves fewer people per hour—the company’s structure puts the shareholder first.. That’s not a critique of the individual therapists working at these companies, many of whom got into this work for the same reasons the rest of us did. It’s a fact about who the business itself is ultimately built to serve.
Practitioner-owned eating disorder practices also likely have relationships with dietitians and medical doctors with whom they can coordinate care. Choose a practitioner-owned practice when you can. This is not just about supporting small business. It changes to whom your therapist actually answers: you, not a shareholder.
When you’re looking for a therapist, ask these questions:
If you’ve read this far, you already know why it matters who owns the practice treating your eating disorder. Eating disorder therapy with an independent, practitioner-owned practice means your treatment plan answers to you and your care team — not to investors. You deserve a therapist who has the time, training, and stability to actually treat you. Working with a practitioner-owned practice means getting to build a real relationship with a clinician who has a stake in your outcome, not just your session count. At our Los Angeles eating disorder therapy practice, our experienced therapists work with teens and adults using a weight-inclusive, anti-diet approach. Here’s how to get started:
At Eating Disorder Therapy LA, we provide individualized, weight-inclusive, evidence-based care to adults, college students, children, teens, and caregivers across the full spectrum of eating disorders and related concerns. In addition to treating disordered eating and food preoccupation, we offer specialized therapy for Anorexia Nervosa, Atypical Anorexia, Bulimia Nervosa, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder (ARFID), and Family-Based Treatment (FBT). Our team also provides support for Excessive Exercise, Body Image challenges, and Phobias Related to Swallowing, Choking, and Vomiting.
To connect with our team directly, call (323) 743-1122 or email Hello@EDTLA.com.
Dr. Lauren Muhlheim is the founder and owner of Eating Disorder Therapy LA. She specializes in treatment for disordered eating, anorexia, bulimia, binge eating disorder, ARFID, and related concerns across the lifespan, and brings a deeply informed, anti-diet perspective to her clinical work — one reflected throughout her published books, When Your Teen Has an Eating Disorder and The Weight-Inclusive CBT Workbook for Eating Disorders (available in 2026).
Investor ties:
Optum/Alma-Headway pay cuts, late 2024:
Aetna/Alma reimbursement fight, 2026:
Aetna’s “Mental Health On Demand” (the single-session/AI quotes):
Value-based care research:
20-minute appointments / “war medicine”:
Headway facial scan/photo ID:
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