Experience with Headway

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Dr. Pookie

Dr. Pookie

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Hello all. I'm a PGY-4 graduating this month and preparing to start my solo practice. I plan to start out as an insurance practice and see where things go. Earlier in the year I learned about an organization called Headway, which says they will credential me with around 6 payors and gave me a fee schedule by CPT code for said payors. They help with marketing a little bit (SEO, online booking platform, etc.), and pay me as a 1099 twice monthly. They handle the billing and insurance stuff, which sounds appealing to me. However, I wanted to ask and see if anyone here had any experience utilizing Headway for billing. Any unforeseen pitfalls. Are the rates fair for commercial insurance?

As an aside, I compared the rates they quoted by CPT code and they seem to be ~20% lower than Medicare rates in my area (even though they tout that they negotiate rates that are supposedly higher than I would be able to get as a solo doc). I read that commercial insurers generally pay ~20% more than Medicare... Any insight would be helpful. Thank you.
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I started with Headway early this year after being cash only and am really happy with the experience. Hasn’t been long but rates are similar to my cash rate and platform has been hassle free for me and my patients. The better commercial insurances pays 20-30% more than Medicare where I am and I am not accepting patients from the lower payors which pay less than Medicare. Headway has better rates than Alma where I am.

Headway takes a cut but my hourly rate is much higher than private practice groups I've looked at and I get full control of my schedule and patient selection. I don't think I'm losing more than I would if I worked with a biller which I've been quoted at 5-8% of claims.
 
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Headway and Alma (the other company like this) take a huge cut. It really depends on what state/geographic location you are. For some, they pay more than you can get alone. For others, they pay way less. Commercial insurers vary in how much they pay (sometimes substantially less than medicare) but its not typical for commercial insurers to pay solo practitioners 20% more than medicare, though if you negotiate hard you can get 30% more than medicare. Some insurances in some locales pay even better. For big hospital systems, they often get 300% of medicare rates.

I would suggest seeing what the insurances local to you offer you when you negotiate. You may find you get a much better deal. If you are in Oregon, WA, CA etc then it won't be worth signing on with them. If youre in FL or TX it might be etc
 
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splik said:
Headway and Alma (the other company like this) take a huge cut. It really depends on what state/geographic location you are. For some, they pay more than you can get alone. For others, they pay way less. Commercial insurers vary in how much they pay (sometimes substantially less than medicare) but its not typical for commercial insurers to pay solo practitioners 20% more than medicare, though if you negotiate hard you can get 30% more than medicare. Some insurances in some locales pay even better. For big hospital systems, they often get 300% of medicare rates.

I would suggest seeing what the insurances local to you offer you when you negotiate. You may find you get a much better deal. If you are in Oregon, WA, CA etc then it won't be worth signing on with them. If youre in FL or TX it might be etc
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What kind of cut are they taking? Do they provide EMR/Telemed platform or is it truly just billing and credentialing?
 
Headway actually owns the patients. You basically become an independent contractor for their large practice. I would avoid despite the good reimbursement rates.

They are essentially a middle man that negotiates the rates and scavenges off of the hardwork of private practices without allowing a private practice to actually grow its own patient base.
 
hallowmann said:
What kind of cut are they taking? Do they provide EMR/Telemed platform or is it truly just billing and credentialing?
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It is just billing. You are credentialed under their company, not yours. You can’t up and switch billers if you wanted.

In some instances (despite being large), they can’t negotiate better than the individual rates anyone can get.

They take a cut of every code you bill, but I guess most billing companies do the same. Amount can vary.

Headway, Alma, Grow Therapy, Sondermind, etc are a growing trend of middle-men. They will credential you under them, set your rate, and your business is attached to theirs. I haven’t heard good things about any of their communication, but this is an easier way of accepting insurance. You get some ease of operations at a cost. It is up to you to decide if it is worth it. Expect to have patients sign your typical consents and also their consents.
 
“Headway”….. JFC. More like “Strip-away.”

Doesn’t it suck how every industry has this pack of parasites nipping at all the real value-generators’ heels, sapping wealth under the guise of “doing you a service” or “making things easier?”
 
splik said:
Headway and Alma (the other company like this) take a huge cut. It really depends on what state/geographic location you are. For some, they pay more than you can get alone. For others, they pay way less. Commercial insurers vary in how much they pay (sometimes substantially less than medicare) but its not typical for commercial insurers to pay solo practitioners 20% more than medicare, though if you negotiate hard you can get 30% more than medicare. Some insurances in some locales pay even better. For big hospital systems, they often get 300% of medicare rates.

I would suggest seeing what the insurances local to you offer you when you negotiate. You may find you get a much better deal. If you are in Oregon, WA, CA etc then it won't be worth signing on with them. If youre in FL or TX it might be etc
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I'm in California (SF Bay Area) and Alma's rates are better than what I was offered by commercial insurance. Most commercial insurances told me they were full. The one that got back, Cigna, was offering me about 20% less than Alma.

I'm still in the free trial period, they gave six months, but am considering staying with them. If they are taking a huge cut, they're taking it before the rates they have listed in their contract. I've been paid out 100% of the listed rates in their contract with me. All their rates are less than Medicare though.
 
Atreides said:
I'm in California (SF Bay Area) and Alma's rates are better than what I was offered by commercial insurance. Most commercial insurances told me they were full. The one that got back, Cigna, was offering me about 20% less than Alma.

I'm still in the free trial period, they gave six months, but am considering staying with them. If they are taking a huge cut, they're taking it before the rates they have listed in their contract. I've been paid out 100% of the listed rates in their contract with me. All their rates are less than Medicare though.
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You have to negotiate with insurance but you should be able to get more than Medicare rates for Anthem BC, Cigna and Aetna in the Bay Area. And yes the rates they offer are AFTER their deduction. How much they get is secret. I have access to rates for a major insurer so can look up how much most anyone gets with than insurance but I can't see the rates for Alma or Headway.
 
Atreides said:
I'm in California (SF Bay Area) and Alma's rates are better than what I was offered by commercial insurance. Most commercial insurances told me they were full. The one that got back, Cigna, was offering me about 20% less than Alma.

I'm still in the free trial period, they gave six months, but am considering staying with them. If they are taking a huge cut, they're taking it before the rates they have listed in their contract. I've been paid out 100% of the listed rates in their contract with me. All their rates are less than Medicare though.
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Wait....so if I'm planning to open up PP in the bay area I HAVE to do cash because I won't be able to get on a panel...?
 
Alemo said:
“Headway”….. JFC. More like “Strip-away.”

Doesn’t it suck how every industry has this pack of parasites nipping at all the real value-generators’ heels, sapping wealth under the guise of “doing you a service” or “making things easier?”
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The psychiatrist takes ALL the risk and liability and does ALL the work and these middle men companies collect 50%+ of the reimbursements. Sounds fair.
 
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Alemo said:
“Headway”….. JFC. More like “Strip-away.”

Doesn’t it suck how every industry has this pack of parasites nipping at all the real value-generators’ heels, sapping wealth under the guise of “doing you a service” or “making things easier?”
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Not every industry. In fact, I don’t think any industry other than healthcare really has this dynamic. As I say healthcare, a pet peeve of mine is how these parasites are referred to as healthcare. Blood pressure spikes every time I hear it.
edit: just to be clear, i am referring to the insurers as parasites moreso than these billing companies.
 
jbomba said:
Wait....so if I'm planning to open up PP in the bay area I HAVE to do cash because I won't be able to get on a panel...?
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It's not uncommon for panels to claim they are "at capacity" (this is not specific to the bay area) or only allow people to join at certain times of year. That doesn't mean you won't be able to get on. you can hire a consultant to do the credentialing. someone with connections with the insurance companies and can get you on. You can complain to the state insurance commissioner. You can dispute with the insurance by showing them that they are not complying with state law in terms of availability, show how you fill a network gap (if you have a specialty or serve a population that they don't cover well), or show them that their network is full of people who are dead, retired, no longer in the state, or not accepting new patients. However, at a certain point you have to ask yourself whether it is worth joining an insurance panel that doesn't want you in the first place. Imagine what it will be like getting paid once you get on.
 
I'm new to this, but I get the impression that insurance companies are fleecing everyone anyway (patients and docs). If a third party "biller" can make my life even a little easier, what do I care if they take some off the top? As long as the rate they give me isn't drastically different from what I would get from commercial payors anyway. The only way I'd be willing to do a primarily insurance-based practice is with some way to mitigate admin headaches.
 
Dr. Pookie said:
As long as the rate they give me isn't drastically different from what I would get from commercial payors anyway. The only way I'd be willing to do a primarily insurance-based practice is with some way to mitigate admin headaches.
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This has been my logic. I know they're making money off of me but I haven't been able to get commercial payers to pay me any better. My average comes out to around $375/hour and I get paid reliably two weeks after submitting the claims. If commercial payers were offering me better rates, I'd drop Alma in a heartbeat but I haven't been able to get that yet.
 
Atreides said:
This has been my logic. I know they're making money off of me but I haven't been able to get commercial payers to pay me any better. My average comes out to around $375/hour and I get paid reliably two weeks after submitting the claims. If commercial payers were offering me better rates, I'd drop Alma in a heartbeat but I haven't been able to get that yet.
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375/hr is fantastic. As someone who is thinking of opening up shop in the Bay, it sounds like Alma is a good option.
 
Atreides said:
This has been my logic. I know they're making money off of me but I haven't been able to get commercial payers to pay me any better. My average comes out to around $375/hour and I get paid reliably two weeks after submitting the claims. If commercial payers were offering me better rates, I'd drop Alma in a heartbeat but I haven't been able to get that yet.
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It sounds to me like maybe Alma isn't the parasite as much as they are helping you to deal with the real parasite more effectively.
 
jbomba said:
375/hr is fantastic. As someone who is thinking of opening up shop in the Bay, it sounds like Alma is a good option.
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It’s clearly regional but I’m getting similar rates in the NE. Lower for intakes and higher for follow ups. Private practices in the area are offering lower rates with more restrictive non competes
 
Ironspy said:
It’s clearly regional but I’m getting similar rates in the NE. Lower for intakes and higher for follow ups. Private practices in the area are offering lower rates with more restrictive non competes
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How many patients are you seen per hour for that rate?
 
splik said:
This is quite low (and it’s much lower for new pts). Even Medicare would get you to $460+ for follow ups.
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Wow. I've seen so many people on here talking about insurance reimbursing like 90 bucks for a 99214 I was assuming much lower. I have no idea what to expect to earn when I start PP in a year...quite difficult to forecast expenses.
 
smalltownpsych said:
It sounds to me like maybe Alma isn't the parasite as much as they are helping you to deal with the real parasite more effectively.
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Idk, I agree with @splik , this is lower than Medicare here by a good margin. I would very much prefer to not need to use Alma. Going to try and renegotiate again with insurance, see if I can get any better rates.
 
jbomba said:
Wow. I've seen so many people on here talking about insurance reimbursing like 90 bucks for a 99214 I was assuming much lower. I have no idea what to expect to earn when I start PP in a year...quite difficult to forecast expenses.
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Super regional. 2x 99214 + 90833 an hour would get me high 300s/hr.
 
splik said:
You have to negotiate with insurance but you should be able to get more than Medicare rates for Anthem BC, Cigna and Aetna in the Bay Area.
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Lol, how much can I pay you to negotiate for me?
 
Atreides said:
Lol, how much can I pay you to negotiate for me?
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I do provide a range of consultation services but honestly you are better off using a cheaper service as a solo practitioner for this (though I can help with things like reviewing documentation and helping with billing to maximise revenue and survive audits once paneled). Some examples of companies you can use include payrhealth Medical Billing Company - Healthcare Contracting Services or physician's ally Physicians' Ally or ngahealthcare Negotiating Healthcare Contracting Services | NGA Healthcare or zealie Reimbursement Negotiations and I'm sure there are many others. Best to use people who are familiar with the local players.
 
smalltownpsych said:
It sounds to me like maybe Alma isn't the parasite as much as they are helping you to deal with the real parasite more effectively.
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Yea you are paying for a service. people here saying they skim your profits... well yea because they find the patients, negotiate the contract and do your billing for you. I have rental properties, and I would use a property manager to run them except all the ones in the area do a terrible job. However a good property manager places good tenants, arranges repairs and deals with evictions for 10% of your rent. It can be worth it if the service is run well. I would hardly call that "parasitic". PRetty much all service industry businesses work on this model.
 
They gave me what at least appeared to be a transparent call about their rates when I called for more info. Rates were good, probably more than the cash rates locally
 
Hello All,
I am looking into starting a PP in Cali. Thank you all for the information on sdn... so helpful! I also am interested in Headway if anyone has recent interactions with them thank you in advanced.
 
I also had a call with them after reading this thread. Their rates were not better than those I'm already getting. However, it would be a very good option for someone without their own PP infrastructure.
 
My review has not changed much. I’ve been with them 3-4 years in 2 states. I do not document or get referrals with them, billing only. My practice is mostly full so 2 follow ups/hour which pay ~500/hour. Intakes are $270-290/hour but rare. I get paid every 2 weeks. No audits or clawbacks yet. Happy to answer questions
 
Ironspy said:
My review has not changed much. I’ve been with them 3-4 years in 2 states. I do not document or get referrals with them, billing only. My practice is mostly full so 2 follow ups/hour which pay ~500/hour. Intakes are $270-290/hour but rare. I get paid every 2 weeks. No audits or clawbacks yet. Happy to answer questions
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How often are you submitting therapy add-ons? Did you build your practice through them or did you have patients prior to working with them?
 
Just started with them in the South, slow so far..rates do not seem as good as what @Ironspy is copping..
 
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MedMan80 said:
Just started with them in the South, slow so far..rates do not seem as good as what @Ironspy is copping..
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You should be able to see rates for all states in your contract. I have surmised that they’ve decreased the rates for people who are joining now. I left Alma but as of the end of 2024, they were paying around 500/hour in quite a few states. A colleague who joined them in my state wouldn’t tell me the rates he was offered for some reason (he didn’t sign so no agreement with them to keep rates confidential) but he said it was definitely not 500/hour.
 
Stagg737 said:
How often are you submitting therapy add-ons? Did you build your practice through them or did you have patients prior to working with them?
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Virtually every 30 min follow up is 99214+90833. I see patients who prefer longer appointments. I have a website, networked with some therapists and psychology today for referrals.
 
Ironspy said:
My review has not changed much. I’ve been with them 3-4 years in 2 states. I do not document or get referrals with them, billing only. My practice is mostly full so 2 follow ups/hour which pay ~500/hour. Intakes are $270-290/hour but rare. I get paid every 2 weeks. No audits or clawbacks yet. Happy to answer questions
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Those are great rates, would you mind sharing what region you are in. So Cal doesn't seem to be as robust.
 
Thinking this was an easy way to do a small telepsych only business, I had signed up. The rates didn’t match what I was told at the beginning. Either they pulled a bait/switch or they’ve been purposefully lowering rates and your true rates are what occurs when you credential fully. They wouldn’t match what I had been told (higher rate). You can only see your rate in your state.

A friend with them for years said no rate increase ever, and they don’t negotiate with clinicians.

Their cut is over 20%.

When you have your own contract with insurance, you can re-negotiate rates. You can also change billing companies whenever you wish. Typical fees are 3-8% with outside billers.

If your goal is to be telepsych only and small, I can see the allure. If ok with the downsides, they make starting an insurance telepsych business easier. If you want a typical clinic with the ability to grow, I’d advise credentialing on your own. They keep costs low by offering no phone support and collect over 20%. If they were a typical biller for general clinics, they would go bankrupt as they aren’t competitive there.
 
TexasPhysician said:
Thinking this was an easy way to do a small telepsych only business, I had signed up. The rates didn’t match what I was told at the beginning. Either they pulled a bait/switch or they’ve been purposefully lowering rates and your true rates are what occurs when you credential fully. They wouldn’t match what I had been told (higher rate). You can only see your rate in your state.

A friend with them for years said no rate increase ever, and they don’t negotiate with clinicians.

Their cut is over 20%.

When you have your own contract with insurance, you can re-negotiate rates. You can also change billing companies whenever you wish. Typical fees are 3-8% with outside billers.

If your goal is to be telepsych only and small, I can see the allure. If ok with the downsides, they make starting an insurance telepsych business easier. If you want a typical clinic with the ability to grow, I’d advise credentialing on your own. They keep costs low by offering no phone support and collect over 20%. If they were a typical biller for general clinics, they would go bankrupt as they aren’t competitive there.
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Thanks for the info. How long did you stick with them and was it difficult to terminate your contract? There seems to be differing information about taking the patients with you.

And do you think it is feasible to use them for insured patients and only accept the insurances with the higher rates and see cash patients on your own? Can you request only to be credentialed with certain insurance or Headway is all or none? My understanding is if you are credentialed with an insurance then you have to bill the insurance and do not have the option to bill cash pay even if the patient wanted to do that. Another concern is once you are credentialed under them, it is difficult to terminate and then credential on your own so you get stuck with them with no rate increases...
 
It seems to make sense to use them while building a private practice and getting credentialed with insurance as it can take some time. Then drop if/when you get credentialed if you are able to get better rates on your own. Am I understanding this correctly?
 
For what it's worth, BCBS of Tx is still taking 5 months to credential with them. I don't recall signing any contract, so can drop them whenever I wish and get credentialed on my own.
 
Gizmo2020 said:
There seems to be differing information about taking the patients with you.
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Headway's policy is the patients are theirs and you are supposed to refer the patients back to them if you leave (since you are working for their practice). However, they don't have a legal leg to stand on. Patients are free to see whomever they want.

The scary thing is I've heard some people in some states saying they can no longer credential with insurances directly, they're telling them they have to go through one of these companies. This is really the main issue with working with these companies is they will be death knell of private practice. I understand why people go with them, especially if they aren't good with business or can't get decent rates themselves, but these companies are not good for our profession or ability to practice autonomously. There is a reason they have 10 NPs for every psychiatrist.
 
splik said:
Headway's policy is the patients are theirs and you are supposed to refer the patients back to them if you leave (since you are working for their practice). However, they don't have a legal leg to stand on. Patients are free to see whomever they want.

The scary thing is I've heard some people in some states saying they can no longer credential with insurances directly, they're telling them they have to go through one of these companies. This is really the main issue with working with these companies is they will be death knell of private practice. I understand why people go with them, especially if they aren't good with business or can't get decent rates themselves, but these companies are not good for our profession or ability to practice autonomously. There is a reason they have 10 NPs for every psychiatrist.
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As usual splik hits the nail on the head
 
Thanks all, appreciate the insights. I worry about the future of our profession...
 
I had a conversation recently with a residency peer. We were comparing compensation from my contract with the one insurance I take and for one of her patients through Headway with the same insurance.

For a 99214+90838 I get paid ~$275. The peer who works through Headway claims to receive ~$325 for the same codes.

I've gotta say, an extra $50/hour sounds nicer than all the admin work I have to do to ultimately get paid less.

If headway is taking 20%, that means headway is collecting more like $405. That's $130 more than I am for the same codes. 33% higher.
 
ObsequiousAplomb said:
I had a conversation recently with a residency peer. We were comparing compensation from my contract with the one insurance I take and for one of her patients through Headway with the same insurance.

For a 99214+90838 I get paid ~$275. The peer who works through Headway claims to receive ~$325 for the same codes.

I've gotta say, an extra $50/hour sounds nicer than all the admin work I have to do to ultimately get paid less.

If headway is taking 20%, that means headway is collecting more like $405. That's $130 more than I am for the same codes. 33% higher.
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Drop the insurance. Charge $400/hr cash only and get a $125/hr raise. Avoid the admin headaches. Problem solved. Jk...kind of...
 
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