What Aetna's Rate Cuts Mean for Therapists on Alma

On May 20, Alma emailed its 24,000-plus clinicians with news that Aetna would be changing how it reimburses therapy sessions billed through the platform. The announcement went viral in therapist forums within hours.

What is actually changing on July 15

Three specific changes take effect on July 15 for Alma-contracted therapists billing Aetna:

Session length rates are being flattened. CPT code 90837, which covers sessions of 53 minutes or longer, will be reimbursed at the same rate as CPT 90834, which covers 38 to 52 minute sessions. Alma has historically paid roughly $15 to $25 more for a 90837 session. That differential disappears.

Doctoral-level rates are being lowered to master's-level rates. Psychologists who have been billing at a higher rate based on their doctoral credential will now receive the same reimbursement as master's-level providers for these codes.

High-complexity evaluation visits are being downgraded. E/M code 99215 (high complexity) will be reimbursed at the 99214 (moderate complexity) rate, and MDs will be paid at the same rate as nurse practitioners.

The financial math on the session-length change alone is significant. Based on a $20 differential per session:

The actual impact varies by state, license type, and how many Aetna clients a therapist carries. The table above uses a conservative estimate. For doctoral-level providers with heavy Aetna caseloads, the compounded effect of both the session-length and credential changes will be considerably higher.

Why Alma cannot simply refuse

Alma is a billing and administrative platform, not an insurance plan. It does not set Aetna's fee schedules. When Aetna updates its provider terms, Alma is contractually required to apply them. Declining would put Alma in breach of its contract with Aetna.

Alma publicly stated it disagrees with the changes, arguing that reimbursement should reflect the specialized training doctoral-level providers bring and the clinical value of longer sessions. More than 5,000 clinicians responded to Alma's survey within days of the announcement, and the American Psychological Association and the California Psychological Association have both contacted Aetna directly.

This is worth understanding clearly: the platform that handles your billing, credentialing, and insurance relationships is not in a position to protect you from the insurance company it depends on.

The Spring Health context

Alma was acquired by Spring Health on May 1, 2026, twenty days before Aetna's announcement. Whether the acquisition is related to the rate changes is not established. What is established is the sequence.

Spring Health is an employer-focused mental health platform built on AI-driven care navigation, valued at an estimated $6 to $7 billion. Its business model is structured around health plan and employer contracts, not independent practitioner autonomy. Alma has continued to operate under its own brand with Harry Ritter as CEO, and Spring Health stated at closing that nothing about the Alma membership for clinicians would change.

That statement was made on May 1. The rate cut announcement came on May 20.

The pattern this fits is one that has played out across therapy directories and platforms before. A platform builds trust with independent practitioners, scales its clinician network, and then finds that its financial obligations to investors and insurers outweigh its commitments to the practitioners who built its value. This is not a conspiracy. It is what happens when the incentive structures diverge.

What this has to do with how clients find you

The rate cut affects the billing side of a practice. The referral side is a separate but related problem that many Alma therapists are already facing.

Platform profiles on Psychology Today, which many Alma therapists rely on for client flow, have been losing effectiveness as managed platform accounts crowd the listings. The Psychology Today referral decline is well-documented and ongoing. Therapists who built their practices on two forms of platform dependency, one for billing and one for referrals, are now exposed on both fronts simultaneously.

Separately, clients are increasingly finding therapists through AI tools rather than directories. How that works, and what it means for your practice, is covered in the guide on how therapists get found on ChatGPT and other AI tools.

The billing structure and the referral structure are different systems, but they share the same vulnerability: both can be changed unilaterally by a third party, with 55 days notice or less.

What to actually do before July 15

Check your Alma contract type. If you are on an annual plan, cancellation before the renewal date may not be refunded. Do not assume you can walk away cleanly without reviewing the terms first.

Review your updated regional fee schedule. Log into the Alma Provider Portal to see what your specific rates will be after July 15. The impact varies by state.

Consider a clinical appeal if you have complex patients. According to billing consultants, Aetna's leveling of complexity codes may constitute a clinical coverage determination, which can be appealed on medical necessity grounds. Contact Alma Provider Support to ask whether they are coordinating group appeals.

Do not share Aetna rate specifics in public forums. Sharing exact reimbursement figures is a contract violation and collective rate discussions carry antitrust risk. Keep specific numbers out of public threads.

If you are considering leaving: Download all your session notes before resigning. Independent Aetna credentialing is possible but takes months and acceptance is not guaranteed. Grow Therapy, Headway, Sondermind, and Rula currently still maintain the 90834/90837 rate differential, though that could change.

The longer-term question

The rate cuts are a specific event with a specific date. The underlying dynamic they expose does not resolve on July 15.

A practice that relies on platforms for billing and for referrals is a practice whose revenue and caseload can both be adjusted by people who do not work in it. The therapists who are least exposed to what just happened on Alma are the ones who built client acquisition channels they own: a website that ranks, a Google Business Profile that shows up locally, visibility in the AI tools clients increasingly use to find care.

That is not a fast build. It takes months. But it is not subject to a 55-day notice period.

FAQ

Does this affect all Aetna therapists or only those on Alma? Currently only therapists contracted through Alma are affected. Aetna told Behavioral Health Business that its broader reimbursement policies for behavioral health providers have not changed. If you hold a direct Aetna contract outside Alma, these cuts do not apply to you yet.

What CPT codes are changing on July 15? CPT 90837 (53-plus minute sessions) will be reimbursed at the same rate as CPT 90834 (38 to 52 minute sessions). The doctoral-to-master's rate differential is also being eliminated for these codes. On the medical side, E/M code 99215 (high complexity) will be paid at the 99214 rate.

Should I leave Alma because of this? Do not make a hasty decision. Check your contract type first, as annual plans may not be refundable. If you do leave, download all session notes before resigning. Independent Aetna credentialing is possible but takes months and approval is not guaranteed.

Will Headway, Grow Therapy, and other platforms face similar cuts? As of June 2026, Grow Therapy, Headway, Sondermind, and Rula all still maintain a rate differential between 90834 and 90837. Aetna's move sets a precedent worth monitoring across all platforms.

What can I do to reduce my dependence on platforms for client flow? The most durable path is a website that ranks for the searches your potential clients are already running, combined with a Google Business Profile and visibility in AI tools like ChatGPT and Perplexity. This takes longer to build than signing up for a platform, but it is not subject to unilateral rate changes.