What Aetna's Rate Cuts Mean for Therapists on Alma, and What Was Walked Back

What was announced, and what happened next

May 20: the original notice. Alma notified providers that Aetna would, from July 15, pay CPT 90837 (sessions of 53 minutes or longer) at the 90834 rate, pay doctoral-level providers at master's-level rates, pay E/M code 99215 at the 99214 rate, and remove the nurse practitioner versus physician differential, as reported by Behavioral Health Business. Alma said: "We disagree with these changes." Aetna told the outlet that its "overarching reimbursement policies related to behavioral health providers and license levels have not changed."

Late May: the clinician survey. Alma asked clinicians for feedback. According to billing consultant Barbara Griswold, LMFT, later emails from Alma CEO Harry Ritter said more than 5,000 responses had been received.

June 4: the association letter. The American Psychiatric Association and American Psychological Association Services, Inc. wrote to Aetna "to express serious concern regarding recent reimbursement changes."

July 8: the walk-back. Alma told providers that "CPT codes 90837 and 90834 reimbursement rates will not be consolidated into a single rate" and that "reimbursement will continue to reflect degree type and training, rather than being paid at one flat rate." It added: "However, Aetna's final rates still reduce overall reimbursement for mental health services through Alma." Alma pushed the remaining cuts back to August 15, as reported by ClearHealthCosts on July 14, quoting Alma's email.

August 15: the remaining cuts. The reduced rates took effect. How much they changed depends on state, license, and code, and neither Alma nor Aetna publishes the figures (more on that below). ClearHealthCosts also reported that Aetna announced its own single-session "Mental Health On Demand" service, launching January 1, 2027.

If you are weighing whether to leave Alma over this, see what Alma, Headway, and Grow Therapy say about leaving before you decide.

Why the exact rates are hard to pin down

Alma shows each provider's rates inside its portal and asks members not to share them. Its membership overview says: "Please note our rates are highly confidential," and that sharing them "is a breach of our confidentiality provision with our payer partners." Aetna's fee schedule page says fee schedules are not available to behavioral health providers who are not MDs or DOs. So the most reliable way to see your own change is to compare your rates in the Alma Portal before and after August 15. For how to turn that into an annual figure, and whether private pay changes the math, see how to work out what the Aetna cuts mean for your practice.

How Alma's setup shapes this

Providers in Alma's insurance program are "credentialed under Alma's Tax ID." The rates therefore come from Alma's contracts with insurers, not from contracts in your own name. Alma said publicly that it disagreed with Aetna's plan, and part of it was withdrawn. The rest went ahead.

The Spring Health context

Spring Health announced an agreement to acquire Alma on January 29, 2026, and the deal closed on May 1. Spring Health said "Ritter will continue as CEO of Alma, leading the organization within Spring Health," and that together the two "now support more than 170 million lives globally across employers and health plans." The Wall Street Journal valued the combined company at between $6 billion and $7 billion, according to Behavioral Health Business. Alma's CEO told providers there would be "no changes to Alma provider pricing or contracts."

Earlier, in April 2026, Behavioral Health Business reported that Alma had laid off 45 staffers in entry-level operations and customer experience roles. People close to the deal told the outlet the cuts were unrelated to the merger.

Whether the acquisition had anything to do with Aetna's rate changes is not established. Our view: the sequence is a reminder that a platform's commitments to clinicians sit alongside its commitments to insurers and investors, and those do not always point the same way.

Our view: what this has to do with how clients find you

The rate change affects the billing side of a practice. The referral side is a separate but related question. Many Alma therapists also rely on Psychology Today for client flow, and many therapists report that Psychology Today referrals have dropped. A practice that depends on a platform for billing and a directory for referrals can have both changed by someone else, at a few weeks' notice.

The therapists least exposed to this are the ones who built client acquisition channels they own: a website that shows up for the searches clients run, a Google Business Profile, and visibility in the AI tools clients increasingly use to find care. That is what our work with private practices is about. It is not a fast build, but it is not subject to anyone else's rate notice. How clients find therapists through AI tools is covered in how therapists get cited in ChatGPT, Perplexity, and Claude.

What to check now

Compare your rates. Log into the Alma Portal and compare your Aetna rates per code before and after August 15.

Know your plan terms. Alma's Provider Terms of Use say that if you cancel, "you will not be eligible for a prorated refund of any portion of the Service Subscription Fee paid for the then-current Subscription period." That matters most on the annual plan ($1,140 a year).

Keep rate specifics out of public threads. Alma treats its rates as confidential, and APA Services warns that "mere discussions about acceptable fees from a managed care company ... can create antitrust risk, even if you have no intention of actually agreeing to fix prices."

If you are considering leaving, export your notes first. Alma lets you export your clinical documentation as password-protected PDFs from your account settings.

FAQ

Does this affect all Aetna therapists or only those on Alma? The changes reported apply to therapists billing Aetna through Alma. Aetna told Behavioral Health Business in May that its overarching reimbursement policies for behavioral health providers and license levels had not changed. We have not found reporting of the cuts extending to direct Aetna contracts or to other platforms.

Did Aetna start paying 90837 at the 90834 rate on July 15? No. On July 8, Alma told providers that 90837 and 90834 would not be consolidated into a single rate and that reimbursement would continue to reflect degree type and training. Alma also said Aetna's final rates still reduce overall reimbursement for mental health services through Alma, and the remaining cuts moved to August 15, as reported by ClearHealthCosts.

How much does Alma pay therapists for Aetna sessions? Neither Alma nor Aetna publishes these rates. Alma shows each provider's rates in its portal and calls them highly confidential, and Aetna says its fee schedules are not available to behavioral health providers who are not MDs or DOs. Rates vary by state, license, and code.

Did Spring Health's acquisition of Alma cause the cuts? That is not established. Spring Health closed its acquisition of Alma on May 1, 2026, and Alma's CEO told providers there would be no changes to Alma provider pricing or contracts. Alma notified providers of Aetna's planned changes on May 20 and said it disagreed with them.

What can I do to reduce my dependence on platforms for client flow? In our view, the most durable path is a website that shows up for the searches your potential clients already run, combined with a Google Business Profile and visibility in AI tools like ChatGPT and Perplexity. It takes longer to build than joining a platform, but it is not subject to someone else's rate changes. For how this works for US practices, see SEO for therapists in the United States.