Aetna's Alma Rate Cuts and Private Pay: How to Work Out What They Cost You

Where the Aetna changes stand

In May, Alma told providers that Aetna planned to pay 90837 at the 90834 rate and pay doctoral-level providers at master's-level rates from July 15. On July 8, Alma told providers that those two changes would not go ahead, but that "Aetna's final rates still reduce overall reimbursement for mental health services through Alma," with the remaining cuts moved to August 15, as reported by ClearHealthCosts. The full timeline, with who said what, is in what Aetna's rate cuts mean for therapists on Alma. This post focuses on the numbers.

Is there a public answer to how much Aetna pays for 90837?

Not in a usable form. Aetna's fee schedule page says fee schedules are not available to behavioral health providers who are not MDs or DOs. Negotiated rates do appear in the machine-readable files Aetna publishes under the federal Transparency in Coverage rules, but Aetna says that data "is not designed for member or consumer usage." On the Alma side, the membership overview calls its rates "highly confidential." Rates also vary by state, plan, license, and code. Any single figure you see online for "what Aetna pays for 90837" is someone's own contract, not a general rate.

How to work out what the cuts cost you

Your own numbers are in the Alma Portal. A simple way to turn them into an annual figure:

• Note your Aetna rate for each code you bill (for example 90834, 90837, 90791) before and after August 15.
• Count how many Aetna sessions you billed for each code over the last three months, and divide by the number of weeks to get a weekly average.
• For each code, multiply the rate change by your weekly sessions and by the weeks you work in a year.
• Add the codes together.

For example, if your 90837 rate dropped by $10 and you see 8 Aetna 90837 sessions a week across 48 weeks, that code alone is $3,840 a year. These are illustrative numbers, not Aetna's rates. Your own figure tells you whether this is a minor adjustment or a reason to rethink how your practice gets clients.

Does private pay actually change the math?

The reflexive answer when insurance rates fall is to move toward private pay. The Heard 2026 Financial State of Private Practice Report gives a more careful picture. In 2025, the average insurance reimbursement was about $105 per session and the average private pay rate about $150. Practices that took insurance averaged $79,000 in revenue and $55,000 in profit, against $94,000 and $58,000 for cash-pay-only practices. In Heard's words: "The roughly $15K revenue advantage for cash-pay practices was largely consumed by higher marketing expenses."

So private pay pays more per session and costs more to fill. Our view on timing: a therapist on insurance panels can often fill a caseload in a few months because the panels route clients to them. In our experience, a private pay caseload takes considerably longer to fill without an established referral pipeline or owned search visibility, often six to eighteen months and longer outside major cities. Moving over usually means either savings to bridge the gap or reducing insurance volume gradually as private pay clients arrive.

Our view: the referral pipeline question

The private pay math only works if clients can find you without a directory or a platform routing them. That is the part most rate-cut articles skip.

Private pay clients do use Google to find therapists, and they tend to search by need rather than by insurance: less "therapist near me who takes my plan" and more "EMDR therapist for complex trauma in [city]" or "somatic therapy for anxiety." A therapy website that shows up for the searches your ideal clients already run fills that pipeline without a platform in the middle. Building it is what our work with private practices is about.

Clients also increasingly find therapists through AI tools like ChatGPT and Perplexity. A prospective client asking "who are the best trauma therapists in Seattle" is not using a directory. For a therapist considering private pay, the question is not just "should I leave Alma?" It is "what fills the referral gap when I do?"

What to do now

Work out your own number with the steps above, using your rates from the Alma Portal.

Check your plan terms before you change anything. Alma's Provider Terms of Use say a cancelled membership is not eligible "for a prorated refund of any portion of the Service Subscription Fee paid for the then-current Subscription period," which matters most on the annual plan ($1,140 a year).

If you are considering private pay, start the visibility work early. Because a private pay caseload takes time to fill, the months you spend building search visibility before you reduce insurance volume are the ones that count.

Watch your platform communications. The Aetna change is specific to Alma, and we have not found reporting of similar cuts on other platforms. That can change, so read panel and platform emails as they arrive.

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

FAQ

How much does Aetna pay for 90837? There is no single public figure. Aetna says its fee schedules are not available to behavioral health providers who are not MDs or DOs, and Alma calls its rates highly confidential. Rates vary by state, plan, license, and code. If you bill through Alma, your own rates are in the Alma Portal.

Did the July 15 Aetna changes take effect? Not as announced. On July 8, Alma told providers that 90837 and 90834 would keep separate rates and that pay would continue to reflect degree type and training. Alma said Aetna's final rates still reduce overall reimbursement through Alma, and the remaining cuts took effect on August 15.

Is private pay actually more profitable than insurance panels? Per session, yes. The Heard 2026 report puts the 2025 averages at about $150 for private pay and about $105 for insurance reimbursement. But Heard found the roughly $15,000 revenue advantage for cash-pay practices was largely consumed by higher marketing expenses. Private pay pays more per session and costs more to fill.

How do I work out how much the Aetna cuts cost me? Compare your Aetna rate for each code in the Alma Portal before and after August 15, multiply each change by your weekly sessions for that code and by the weeks you work in a year, and add the codes together.

How do private pay clients find therapists if not through insurance directories? In our experience, through Google searches by specialty and location, Google Business Profile, and increasingly AI tools like ChatGPT and Perplexity. Private pay clients tend to search by specific need rather than by insurance coverage. For the full approach, see SEO for therapists in the United States.