In the middle of a so-called “therapist shortage” combined with a wildly inflationary economy, you wouldn’t think that an insurance company could be dumb enough to actually lower clinician compensation. Or could they be?
Ok, it wasn’t exactly an insurance company, but the next thing to it. On May 20th, the mental health tech platform Alma’s announcement of upcoming changes to Aetna’s reimbursement effective July 15th quickly went viral.
- “Extended” sessions lasting 53+ minutes (90837) will be reimbursed at the same rate as 90834 sessions.
- Psychologists will be reimbursed at the same rate as master-level clinicians.
- MD’s will be reimbursed at the same rate as nurse practitioners.
- 99215 procedures (High-complexity visits with a psychiatrist or nurse practitioner), will be reimbursed at the same rate as 99214 sessions (the next-lower level of complexity).
Are they insane!?
No comment.
What happens now!?
I don’t usually make public prophecies or speculations, but in this instance, I think it’s worth exploring some hypotheses.
Will this affect clinicians in-network with Aetna via the other platforms, or who contract independently?
You’ll notice that in the above screenshots, Alma is putting the blame on Aetna. Is that really the case, though?
So far, I’d have to say the answer is no. Other platforms were quick to reassure the clinicians utilizing them that they have no such similar policy changes forthcoming. Nor do the reimbursement rate reductions affect practitioners who are independently-contracted, according to a statement made by Aetna.
And, given the volume of clinicians contacting me for consultations, reimbursement rate inquiries, and help with starting the process of independently contracting with Aetna, it seems like I’m not the only one who believes that Alma’s to blame here, rather than Aetna.
So why would Alma, now part of Spring Health, stick its corporate neck out and risk perpetuating the so-called “therapist shortage?” Spring Health is now easily the largest of the tech platforms, valued at an estimated $6-7 billion according to a paywalled article in the Wall Street Journal on January 29, 2026, just after the acquisition was announced.
Hypotheses
I’m going to float a few hypotheses. These are theories that cannot be substantiated with publicly-available documentation available today.
Given Spring Health’s dominance among the venture-capital platforms, they could be counting on any or all of the following:
- Future ability to negotiate substantially higher rates with payers other than Aetna.
- If this occurs, other payers’ significantly-higher rates could potentially rectify the Aetna “therapist shortage” on Spring’s platform. In other words, Spring could be hoping to deliver higher-than-average rates overall, even if Aetna’s rates are lower than average.
- If this is true, Spring might be counting on their size and market dominance to force member clinicians to take Aetna despite the reimbursement rate reductions, in a sort of carrot-and-stick arrangement.
- Currently, mental health clinicians working for Spring Health are a mix of 1099 and W2 clinicians. With the influx of Alma clinicians (all 1099), it’s possible that Spring might intentionally be hoping that a significant percentage of Alma clinicians will leave Alma altogether, as opposed to simply dropping Aetna but remaining with Alma. If enough clinicians leave Alma completely, Spring could then concentrate on a W2 model, which would allow them greater control over the clinicians who deliver their product.
- Although the exact purchase price of Alma wasn’t revealed, I’m sure it set Spring Health back by a few million or two, give or take. Shaving off “excess” reimbursement in the form of the differentials between 90837 and 90834, 99215 and 99214, psychologists and masters, and MD’s and nurses, might be a quick way for Spring to recoup some of Alma’s purchase price on the backs of the clinicians delivering their product. After all, they have to please their billionaire investors and quickly resume profitability, right?
None of these hypotheses are necessarily mutually exclusive. One, all, or none of them could be true. And I’ll reiterate – these are hypotheses. There is no publicly-available documentation at this time to support what I’m speculating.
But what does this mean for the so-called “therapist shortage”?
You’ll notice I’ve been referring to it as a so-called “therapist shortage.” This is because I personally don’t believe there’s a shortage of clinicians. Instead, the “therapist shortage” consists of mental health professionals of any discipline who are willing to accept insurance (whether through platforms or independently), if the reimbursement rates are unsustainably low.
And that leads me to one final, very “rock and a hard place” hypothesis:
- Spring/Alma could be making a gamble based on current economic conditions. Everyone’s feeling the pinch: not just the mental health professionals, but also their clients. Who, as long as the economy is in the toilet, will feel the need to stay in-network (assuming they retain insurance coverage). Spring may be gambling that a low fee is better than none, and therefore no significant “therapist shortage” will occur as a result of last week’s announcement.
No therapist shortage at Spring Health would only take place, though, if enough others followed Spring’s lead and reconfigured their reimbursement structure to match. However, if Headway, Rula, Grow, SonderMind and the rest don’t follow suit, to say nothing of Aetna itself and/or other payers, Spring will lose clinicians. Given my previous hypotheses, this might not be catastrophic for Spring.
But what’s NOT a hypothesis, in my opinion, is that the reactions of clinicians who currently accept Aetna through the Alma platform, will have broader implications. My belief is that all platforms, Aetna, and the other insurance payers, will be watching -closely!- to see what the Alma-Aetna clinicians do.
People’s business decisions in this regard will largely be based on their own individual circumstances. I certainly can’t and won’t advise anyone that they should leave, just based on a sense of outrage or hypotheses about the state of the industry, however strong my feelings on the matter might be. Not everyone has the same level of privilege, and I think it’s important that clinicians who are more economically privileged extend understanding to those who aren’t. We won’t get anywhere by continually fighting amongst ourselves.
What else could happen?
It’s been well-documented that there IS a therapist shortage on most insurance panels, despite the increasing prevalence of the platforms. It isn’t just a therapist shortage, though. Medical professionals of all disciplines -not just in behavioral health- are leaving for cash-based practices, for the same reasons mental health clinicians do.
IF the upcoming midterm elections result in a progressive majority, and result in meaningful healthcare reform in 2027 and beyond, then who knows?
As long as I’m fantasizing, I’ll mention that the abuses of payers and venture-capital entities largely persist because of a dangerously unequal balance of power, which has contributed over time to create the current “therapist shortage.” Collective bargaining, which could restore some balance, is an illegal act for most self-employed healthcare professionals. However, Texas has a modified legal form of collective bargaining with insurance companies, which occurs under the supervision of the Texas state Department of Insurance. This is a model I’d love to see adopted nationwide.
Are you in Texas? Get a good lawyer and consider it.
