Aetna's Rate Cut for Alma Therapists Is Now in Effect What Changed, How Providers Responded, and What to Do Now

Danielle Wagar
May 23
10 min read

Updated: 7 days ago

Aetna's reimbursement changes for therapists credentialed through Alma took effect on July 15, 2026, as scheduled. If you are a solo therapist, psychologist, LCSW, LPC, or LMFT using Alma to bill Aetna, the rate changes are no longer something to prepare for they're now live on your claims. Here's exactly what changed, what happened between the announcement and the effective date, and what your options look like now.

women looking at graph on computer that is going down and looking upset about it.

On May 20, 2026, Alma notified its providers that Aetna would be making significant changes to how it reimburses therapy services billed through the platform. For solo providers and especially doctoral-level clinicians billing longer sessions this has turned out to be one of the more significant financial events of the practice year.

This post breaks down what changed, how providers and professional associations responded, what recourse may still exist, and how direct Aetna credentialing compares.

What Changed: Aetna's Reimbursement Policy for Alma Providers

Aetna made three specific changes to how it reimburses behavioral health providers contracted through Alma, effective July 15, 2026.

What Changed: Aetna's New Reimbursement Policy for Alma Providers

Aetna made three specific changes to how it reimburses behavioral health providers contracted through Alma, all effective July 15, 2026.

Change 1: CPT Code 90837 No Longer Pays More Than 90834

This is the change with the broadest impact. CPT code 90837 covers individual psychotherapy sessions of 53 minutes or longer. CPT code 90834 covers sessions of 37 - 52 minutes. Under standard Aetna commercial contracts, 90837 pays meaningfully more than 90834 typically 15–25% more because it reflects more clinical time with the patient.

As of July 15, Aetna reimburses 90837 at the same rate as 90834 for all providers billing through Alma. If you have been running 60-minute sessions and billing 90837, that rate differential is gone.

Change 2: Complex E&M Visits Are Leveled Down

Aetna now reimburses highly complex evaluation and management visits at the same rate as moderately complex visits for Alma-contracted providers. If you regularly see higher-acuity clients and bill accordingly, that distinction in your reimbursement no longer applies though see the appeal option below, which is specific to this change.

Change 3: Doctoral-Level Providers Lose Their Credential Rate Tier

This is the change that generated the most alarm in provider communities and for good reason.

Across most commercial payers, doctoral-level providers (PhD, PsyD) are reimbursed at a higher rate than master's-level providers like LCSWs, LPCs, and LMFTs for the same session code. Credential differentials of 10–25% are standard, reflecting the additional training, scope, and clinical complexity doctoral providers are credentialed to handle.

As of July 15, Aetna reimburses PhD and PsyD providers at the same rate as master's-level providers for E&M visits billed through Alma. Years of doctoral training, student loan debt, and advanced clinical scope same pay as a newly licensed LPC on the platform.

How Alma and Provider Groups Responded

Between the May 20 announcement and the July 15 effective date, the pushback was fast and organized.

Alma publicly stated it disagreed with the changes, arguing they don't reflect the specialized training doctoral-level providers bring or the clinical value of longer sessions. The company opened an anonymous survey for clinicians to document how the cuts would affect their caseloads, intending to bring that data to Aetna. The response was immediate Alma received more than 5,000 submissions within days and closed the survey early to get a formal response to Aetna sooner.

The pushback didn't stay inside Alma. The American Psychological Association and the California Psychological Association both contacted Aetna directly on providers' behalf.

Worth noting as context: Alma was acquired by Spring Health on May 1, 2026 twenty days before Aetna's announcement. Whether the two events are connected hasn't been established publicly, but the timing is part of the broader story providers have been discussing.

As of this writing, Aetna has not reversed or delayed the changes, and they took effect on schedule.

If You Believe You're Being Underpaid: The Appeal Option

For the complex E&M visit downgrade (Change 2) specifically, there may be a path worth exploring: a level-of-severity underpayment appeal filed with Aetna on medical necessity grounds. The reasoning is that leveling a highly complex visit down to a moderate-complexity rate can function as a clinical coverage determination and coverage determinations can generally be appealed when the documentation supports the higher level of complexity.

If this applies to you:

Review your documentation for affected visits to confirm it supports the higher complexity level.
Check with Alma's provider support to see whether they're coordinating group appeals or offering template language several practices have asked about this since the announcement.
File on a claim-by-claim basis with your supporting clinical documentation.

One important caution: sharing your specific negotiated Aetna rates in public forums, provider groups, or social media is typically a contract violation, and coordinated public discussion of specific reimbursement figures among competing providers can carry antitrust risk. Keep the appeal process itself and any specific numbers between you, Alma, and Aetna.

This is general information, not legal or billing advice specific to your contract. If you're considering an appeal, loop in Alma's provider support or a billing consultant familiar with your specific documentation before filing.

What This Means for Your Income by Credential Level

Aetna's direct commercial reimbursement rates for CPT 90837 currently run approximately $140 to $155 per session depending on your state and contract terms. The 90834 rate runs roughly 15–25% lower meaning the rate gap between the two codes is approximately $21 to $39 per session at current commercial averages.

If You Are a Master's-Level Provider (LCSW, LPC, LMFT) Billing 90837

You're affected by Change 1 only. Your 90837 sessions are now reimbursed at the 90834 rate.

Lost per session: approximately $21–$39
At 15 Aetna clients per week: approximately $315–$585 per week, or $16,000–$30,000 per year
At 10 Aetna clients per week: approximately $210–$390 per week, or $11,000–$20,000 per year

If You Are a Doctoral-Level Provider (PhD, PsyD) Billing 90837

You're affected by Changes 1 and 3 simultaneously you lose both the extended-session premium and the doctoral credential differential.

Lost credential premium per session: approximately $14–$39 (10–25% of the $140–$155 base rate)
Lost session length premium per session: approximately $21–$39
Combined potential loss per session: up to $50 or more compared to a directly-credentialed PhD or PsyD seeing the same Aetna client outside the platform

Early community estimates put the total impact for doctoral providers billing 90837 through Alma at approximately a 42% effective pay cut per qualifying session.

For context: a directly-credentialed doctoral provider with Aetna continues to have their credential recognized in Aetna's fee schedule. The rate flattening applies to Alma's platform contract specifically not to Aetna's broader reimbursement structure.

Why Is Aetna Doing This?

Aetna has not publicly stated the reason for the change. Some industry observers have speculated that utilization patterns may have played a role, but Aetna has not confirmed this.

Aetna vs. Other Payers: A Strategic Split Is Emerging

Aetna is not representative of where every payer is heading. Multiple major payers are moving in the opposite direction, partnering with behavioral health platforms to expand access:

Premera Blue Cross recently expanded its behavioral health digital partnerships to include Spring Health, Rula, Headway, and Talkspace simultaneously
Blue Cross Blue Shield of Rhode Island added Headway as a virtual provider group effective January 2025
Blue Cross Blue Shield of North Carolina partnered with Headway to expand access in rural and underserved areas
Blue Cross Blue Shield of Texas added Headway to most of its networks
Blue Cross of Idaho announced a new in-network partnership with Talkspace effective July 2025

Aetna, at least in its relationship with Alma, is moving toward lower platform-contracted rates and a preference for direct provider relationships.

This matters strategically for every therapist, counselor, and psychologist in private practice. If your entire insurance panel runs through a single platform, your income is only as stable as that platform's contract with each payer — and as this shows, those terms can change with 60 days' notice. Providers with their own direct payer contracts aren't exposed the same way.

	Alma	Direct Aetna
Own payer contract	No	Yes
Credential tier recognized	No, as of July 15	Yes
90837 differential	No, as of July 15	Yes
Platform fee	Yes	No
Control over payer relationship	Limited	Full

If you are moving toward direct credentialing, one of the most common pain points is tracking where each payer application stands across multiple insurers at once. Upstate Access is a credentialing and enrollment tracking platform built specifically for independent providers - it gives you a live dashboard for every payer status so nothing gets lost in a spreadsheet or missed because of a follow-up gap. At $29 per month, it costs less than a single hour of lost reimbursement from the Alma rate cut. You can try it at access.upstatehealthcareadmin.com.

Your Options Now That the Change Has Taken Effect

Option 1: Stay on Alma and Absorb the Rate Cut

For some providers, Alma's administrative value scheduling tools, billing support, referrals, notes workflow, malpractice coverage may still justify staying on the platform even at the reduced Aetna rates. Run the honest math: add up Alma's monthly subscription fee, apply the new Aetna reimbursement to your actual Aetna client volume, and compare your net per session to what direct credentialing would look like.

For master's-level providers with a smaller Aetna panel, the calculus may still favor staying. For doctoral-level providers with a significant Aetna caseload billing 90837, the numbers are likely to tell a different story.

Option 2: Get Credentialed Directly with Aetna as a Solo Provider

Once you hold a direct Aetna contract, you're not subject to the rate structures Aetna negotiates with any platform. Your contract is yours. Your credential tier is recognized. Your 90837 differential is preserved.

Direct Aetna credentialing for solo therapists, LCSWs, LPCs, LMFTs, and psychologists typically involves:

Completing your CAQH profile and keeping it current
Submitting a provider application through Aetna's credentialing portal
Providing your license, malpractice certificate, NPI, and practice information
Undergoing Aetna's credentialing review

With a complete application and a clean CAQH profile, most solo providers can expect a decision within 60–90 days.

Option 3: Audit Your Entire Payer Mix

This is also a useful prompt to look at every panel you hold through Alma, Headway, Grow Therapy, or any other platform. What are you actually netting per session after platform fees and at current contracted rates? What would those same payers pay you as a directly-credentialed solo provider?

Many providers who run this analysis find that the platform fee combined with below-market platform-contracted rates creates a meaningful gap compared to direct credentialing even without rate negotiation.

Frequently Asked Questions

Did the Aetna rate change for Alma providers actually take effect on July 15?

Yes. As of this writing, Aetna has not delayed or reversed the changes despite the pushback from Alma and provider advocacy groups. The three changes described above are now in effect for Alma-contracted providers.

Does this Aetna rate change affect providers on Headway, Grow Therapy, Rula, or Sondermind?

As of this writing, the confirmed changes apply specifically to Aetna contracts held through Alma. As of June 2026, Headway, Grow Therapy, Rula, and Sondermind all still maintain a rate differential between 90834 and 90837 with Aetna. This is a developing situation, and it's worth monitoring whether Aetna extends similar changes to other platform relationships.

Can I have both an Alma contract and a direct Aetna contract at the same time?

Generally no. You cannot bill the same payer through two separate contracting arrangements simultaneously. Moving to a direct Aetna contract means transitioning your Aetna clients off the Alma billing relationship for that payer.

What is the difference between CPT 90837 and CPT 90834?

CPT 90837 is used for individual psychotherapy sessions of 53 minutes or longer. CPT 90834 covers sessions of 37–52 minutes. The 90837 code has historically reimbursed 15–25% higher than 90834 because it reflects more clinical time. Under the Aetna/Alma policy now in effect, that differential is eliminated for platform-contracted providers.

Does Aetna recognize doctoral credential tiers for direct-credentialed providers? Yes.

The doctoral rate flattening applies to providers contracted through Alma's platform agreement not to Aetna's broader fee schedule. Directly-credentialed PhD and PsyD providers continue to have their credential level recognized in Aetna's reimbursement tiers. This is one of the more meaningful financial arguments for direct credentialing for doctoral-level providers specifically.

Is there anything I can do if I think a specific claim was underpaid under the new complex-visit rules?

Possibly. See the appeal section above a level-of-severity underpayment appeal on medical necessity grounds may be worth pursuing for complex E&M visits with strong supporting documentation. Check with Alma's provider support about whether they're coordinating appeals, and avoid discussing specific rate figures in public or shared provider spaces.

Is Aetna worth getting credentialed with directly as a solo therapist?

Aetna is generally considered one of the more favorable commercial payers for behavioral health providers. Direct commercial 90837 rates typically range from $140–$155 depending on location, and direct-credentialed providers aren't subject to platform-negotiated rate structures. For solo providers with a meaningful Aetna client base or a market with strong Aetna commercial penetration, direct credentialing is typically worth the process.

How long does Aetna credentialing take for a solo provider?

With a complete application and current CAQH profile, most solo behavioral health providers can expect a credentialing decision within 60–90 days.

Thinking About Leaving Alma?

If you're considering direct credentialing with Aetna, there's a step-by-step guide for therapists who want to move away from platform dependency: Un-Platformed: The Therapist's In-Depth Guide to Direct Aetna Credentialing

Get Credentialed Directly with Aetna

un-platformed. in depth guide to credentialing

Ready to Talk Through Your Situation?

Let's Get You Off Platform Dependency

The Aetna rate cut for Alma providers is no longer hypothetical it's live on your claims. If you want to talk through what direct Aetna credentialing would look like for your specific caseload, or take a broader look at your entire payer mix across Alma, Headway, or Grow, the fastest way to start is a free exploratory chat. No pressure, no obligation — just a real conversation about your numbers and your options.

Book a free 15-minute exploratory chat

Thinking about going independent? Upstate handles the credentialing, billing setup, and platform exit planning so you keep your caseload and your revenue. Run your numbers with the Hidden Spread Calculator, or book a free 15-minute call to talk through your situation.

Prefer email? Reach out directly at info@upstatehealthcareadmin.com and tell us where you're at with Alma we'll respond personally with next steps.

If you're also curious about your broader payer mix whether any of your other panels through Alma, Headway, or Grow are costing you more than you realize that's exactly the kind of thing a free exploratory chat is built for.

Danielle Wagar, CPES, is a billing and credentialing consultant and the founder of Upstate Healthcare Admin, serving solo providers and small group therapy and mental health practices. Upstate Healthcare Admin specializes in insurance credentialing, payer strategy, and revenue cycle consulting for behavioral health practices. Learn more at upstatehealthcareadmin.com.