When the insurance giant Aetna imposed a pay cut on therapists practicing via the Alma practice management company this summer, an uproar followed.
Aetna’s decision to cut pay rates to therapists and psychiatrists practicing through Alma, which clams to serve more than 24,000 licensed mental health clinicians, came in late May, and was followed almost immediately by Aetna’s announcement that it would provide “mental health on demand” and that its therapists are trained in a “single session intervention model.”
The originally announced Aetna plan was that 90837 Current Procedural Terminology (CPT) session codes, for a 60-minute session, would be paid at the same rate as 90834, the 45-minute session code. Aetna also said it would pay Alma providers the same for different license types — licensed clinical social worker, Ph.D, all the same. Medical visit assessments coded as 99215 would be paid at the same rate as CPT code 99214 though the lower number is usually paid less, for presumably less severity.
Therapists pointed out that Alma was not fighting on their behalf, and criticized Aetna for the cuts. Aetna shrugged. Then Alma said it objected to the move, and was helping to facilitate a petition objecting to the rate cut. The American Psychiatric Association and its APA Services professional organization also sent a letter to Aetna objecting to the cuts.
After a large uproar, Aetna walked back some of these cuts, which were to have started July 15, but it wasn’t very clear what the walkback actually looked like. Those cuts took effect on Aug. 15. Little explanation was given, and specifics were murky. The Alma July 8 email is detailed in this Reddit post. It said: “Our negotiations with Aetna have concluded. While we were able to partially reverse the proposed changes, we did not achieve a full reversal to the current rates.”
N.Y. and N.J. rates
Now, some concrete numbers are in.
Matthew Ryan, a licensed clinical social worker on the East Coast, wrote on his site, “The What and How of Private Practice Building”:
“I’m licensed in New York and New Jersey, so those are the two states I can speak to directly,” he wrote in a blog post. “I’d expect other states to look broadly similar, but check yours to be sure. Don’t assume all cuts are the same.
“These are four of the commonly used CPT codes, and this is the change to the reimbursement rate [in New York]:
- 90791 will be reduced by 9.7%
- 90832 will have no reduction
- 90834 will be reduced by 3.6%
- 90837 will be reduced by 10.6%
“Nearly ten percent off your 60-minute session. That’s the code many therapists use for their weekly sessions.”
In New Jersey, he wrote:
“The Actual Numbers: New Jersey
- 90791 will be reduced by 16.8%
- 90832 will have no reduction
- 90834 will be reduced by 1.9%
- 90837 will be reduced by 15.2%
“One thing worth naming: the ‘no change’ on 90832 is not a win. The 30-minute session has always been reimbursed poorly. A bad rate holding steady is still a bad rate. Don’t let a flat line in a column read as good news.
“Run these percentages against your own volume for a year and you’ll see the real number. It’s not pretty.”
Alma said in its July announcement about winning some rollbacks that it had gotten Aetna to agree that codes 99214 and 99215 would not be consolidated into a single rate
It also said “Reimbursement will continue to reflect degree type and training, rather than being paid at one flat rate.”
40% cut, and $40 per claim
Detailing the concrete effects of the cuts, one therapist wrote on Reddit: “So I experienced a substantial cut as a psychologist, over 40% for 90837. Leaving Alma when my contract ends this month.”
Under the headline “Alma is ripping you off,” another therapist wrote: “As many of you know, Alma’s significant rate reductions for Aetna patients took effect last week. In CEO Harry Ritter’s town hall earlier this year, he completely blamed Aetna for these rate reductions. Out of curiosity, I checked my fee schedules for my contracts on Availity. Turns out Alma is now taking $40 per claim for 90837 whereas they were only taking $2 before the rate reduction. Absolutely no disclosure about this change and in fact Ritter misled Alma users about why this rate reduction was happening. This should really be a wake up call that these VC-backed tech companies are just lying in our faces and lining their own pockets by taking advantage of us. All of this while they try to train AI on our clinical notes. We have to boycott these companies for the sake of preserving our field and turn our attention to lobbying politicians to regulate insurance companies so we don’t need these intermediary companies anymore to bargain for rates.”
In response to a question, this therapist answered: “I’m a NY-based psychologist, my 90837 Aetna rate dropped $62. Per the new fee schedule Aetna lowered the rate $22, hence my discovery that Alma was now taking the other $40. For reference, I checked before and after the rate change went into effect, so prior Alma was only taking $2 off the higher rate.” Then this therapist added: “I thought the whole premise of the platform was that we paid a monthly fee in order to avoid the administrative fees that Headway applies in place of being ‘free.'”
(We wrote earlier about Alma taking a cut of the therapist’s fee and not being completely forthcoming about this practice.)
Another Redditor wrote: “This is like a mix between the business models of uber and Ticketmaster because (1) the middleman takes a bigger and bigger, not transparent cut, and (2) in the case of ticket master, the blame game is where two entities point the finger at each other to create the illusion of caring without ever having to address the problem.”
