Did Alma Change All Its Rates on August 15?

Last updated: August 26, 2026.

The short answer: Alma's updated Aetna reimbursement schedule took effect for dates of service on or after August 15, 2026. But no—the evidence does not show that Alma changed all of its rates. The confirmed change is narrower: Aetna services billed through Alma, with the exact amounts varying by clinician and service.

The August rollout has also created a new question. Some therapists are asking whether their Alma payout fell by more than the underlying Aetna rate. One public report makes that allegation, but it does not include enough matched documentation to prove what caused the difference. Therapists should audit the numbers without treating the allegation—or a portal display—as a settled fact.

What this means for therapists: check finalized Aetna claims with service dates on both sides of August 15. Match like with like, keep the payer allowed amount separate from the Alma payout, and ask for a written explanation of any unexplained difference.

This is a post-launch follow-up to our article on Alma's partial reversal of the Aetna 90837 cut.

Did All Alma Rates Change on August 15?

No. The public provider communication we reviewed says the new schedule applies to Aetna dates of service on or after August 15. It does not say that every payer contracted through Alma changed on that date.

It also does not support one national dollar figure for every therapist. Alma says its contracted rates can vary by state, degree, and type of care. Review Alma’s cost-estimator guidance.

• Confirmed scope: Aetna services billed through Alma’s contract.

• Effective dividing line: date of service on or after August 15, 2026.

• Not established: a simultaneous change to every Alma payer, every Aetna contract, or every code.

• Provider-specific: the exact dollar impact depends on the clinician and service details.

An August 14 session should use the prior schedule even if the claim was submitted or paid later. An August 15 session should use the updated schedule. Sorting by payout date alone can mix the two periods and produce a misleading comparison.

What Actually Took Effect?

The original proposal would have flattened several reimbursement distinctions. After advocacy from clinicians and professional organizations, Alma told providers that its negotiations with Aetna ended in a partial reversal. Read the reproduced July 9 Alma provider update.

• 90837 and 90834 stayed separate. The proposal to pay the two psychotherapy codes at one rate was reversed, although the prior 90837 rate was not fully restored.

• 99215 and 99214 stayed separate. The proposed consolidation was reversed.

• Degree and training distinctions stayed. The proposal to flatten those differences was reversed.

• Overall Aetna reimbursement through Alma still fell. Alma said the final schedule included reductions, including changes to some less frequently billed services.

The American Psychiatric Association and American Psychological Association Services had asked Aetna to pause the original proposal, citing access, parity, clinical, and transparency concerns. Read their June 4 letter to Aetna. That letter documents the original proposal; the later provider update documents the partial reversal.

Why Are Therapists Asking About the Payout Now?

The new concern is not simply whether the August 15 change happened. It is whether the reduction in a therapist’s Alma payout matches the relevant change in what Aetna allowed for the same service under the same contracting arrangement.

On August 25, one New York psychologist publicly reported that their Alma payout for 90837 fell by $62 while an Aetna fee schedule they accessed through Availity appeared to fall by $22. The clinician inferred that Alma retained the remaining $40. Read the clinician’s report.

What is not proven: the post does not provide the underlying fee schedule, Alma contract, matched claim, remittance, payout record, or written explanation from Alma. It is a reason to investigate—not proof that Alma added a $40 fee, increased its margin, or misrepresented the Aetna change.

There is another wrinkle: shortly after launch, a different clinician reported that an old rate still appeared in the Alma portal. The clinician later updated the post to say Alma called the display incorrect and confirmed that the new rate applied. Read the post-launch portal report. That single report does not establish a systemwide error, but it shows why a portal estimate should not be the only evidence in an audit.

Allowed Amount and Alma Payout Are Not the Same Field

The easiest way to get lost in this issue is to treat every dollar figure as the same kind of number. It is not. A clean review separates:

• Billed charge: the amount submitted on the claim.

• Payer allowed amount: the maximum recognized amount for that claim under the applicable contract, before allocating payer and patient responsibility.

• Patient responsibility: the deductible, copay, or coinsurance assigned to the client.

• Alma payout: the amount Alma pays the clinician for the service.

• Adjustment or offset: a later correction, recoupment, reversal, or deduction that can change the net deposit.

Alma’s own billing overview distinguishes payouts, client responsibility, deductions, and later adjustments. Review Alma’s billing-practices overview.

Aetna likewise says contracted providers can access fee schedules through secure provider tools and that limitations may apply. Review Aetna’s fee-schedule guidance. A fee schedule tied to your own direct contract, a different group, product, network, or credential is not automatically the schedule governing a claim billed through Alma.

How to Audit Your Post-August 15 Claims

A useful audit compares the same thing before and after the effective date. Start with a small sample of finalized claims, then expand if the pattern holds.

1. Choose one clinician and credential. Do not combine providers with different degrees, licenses, states, or Alma rates.

2. Choose one Aetna product and network. Member plans and network arrangements can adjudicate differently. Confirm that the claims actually ran through the same Alma contracting pathway.

3. Match the service details. Use the same CPT code, modifiers, place of service, and comparable patient-responsibility setup.

4. Compare dates of service. Select finalized claims before August 15 and on or after August 15. Do not group by submission or deposit date.

5. Record each payment field separately. Capture the allowed amount if available, payer payment, patient responsibility, Alma payout, and any later adjustment or offset.

6. Calculate the unexplained difference. If the Alma payout changed by more than the comparable allowed amount, identify whether patient responsibility, a correction, a different contract, or another documented item explains the gap.

7. Ask Alma in writing. Give support the claim identifier and service details, and ask for a line-by-line explanation rather than a general statement about the rate change.

A simple audit worksheet

• Claim identity: clinician, state, Aetna product/network, date of service, CPT, modifier, and place of service.

• Before August 15: allowed amount, patient responsibility, Alma payout, and adjustments.

• On or after August 15: the same four fields from a comparable finalized claim.

• Difference: change in allowed amount, change in Alma payout, and any remaining unexplained spread.

• Evidence: claim detail, remittance or allowed-amount record if accessible, payout detail, and Alma’s written response.

Keep client identifiers out of shared spreadsheets, emails, or public posts unless the tool and recipient are authorized for protected health information. You can investigate the payment mechanics without publishing another therapist’s confidential rate or a client’s claim details.

What Should You Ask Alma?

If a matched comparison still does not reconcile, ask specific questions:

• What exact reimbursement rate applies to this clinician, code, location, and August 15-or-later service date?

• What Aetna allowed amount was used for this exact claim under Alma’s contract?

• How did patient responsibility affect the insurer payment and the Alma payout?

• Were any adjustments, offsets, or corrections included in this payout?

• Is any portion of the difference a platform fee, spread, or other retained amount? If so, where is that term documented?

If support answers only with the posted rate, repeat the request using one finalized claim. The goal is to reconcile the actual payment trail, not debate an estimate.

What This Means for a Therapy Practice

Even a modest per-session reduction compounds. Multiply the verified payout change by your average weekly Aetna sessions and by the number of working weeks in your year. That gives you a practice-level estimate without assuming that someone else’s rate applies to you.

The broader lesson is concentration risk. When one platform controls credentialing, claim submission, payment visibility, and the clinician payout, it can be harder to independently reconstruct what changed. That does not prove wrongdoing; it does mean your practice should retain its own rate notices, claim-level records, payout reports, and support responses.

For more context, read our guide to therapy platforms and insurance reimbursement cuts and our review of whether Aetna is increasing audits of therapists.

A shameless but relevant Bomi plug: Bomi helps therapy practices track claims, remittances, adjustments, and payer follow-up outside a black-box payout view. If you want help reconciling what an insurer allowed with what actually reached your practice, talk with us about therapy billing.

Whatever the financial result, keep coding the service you actually provided and documented. A lower payout is a contracting and practice-management problem—not a reason to choose a longer or shorter code.

Frequently Asked Questions

Did all Alma reimbursement rates change on August 15, 2026?

No. The confirmed August 15 change concerns Aetna services billed through Alma. It does not establish that every Alma payer, every Aetna contract, or every CPT code changed.

Which Alma/Aetna claims use the new rates?

Alma told providers the new schedule applies to dates of service on or after August 15, 2026. The service date, not the claim submission or payout date, determines which schedule applies.

Is Alma keeping an extra $40 from each 90837 session?

That is not established by the public evidence reviewed for this article. One clinician reported a $62 payout reduction and a $22 Aetna fee-schedule reduction, but did not publish the underlying contract, matched claim, remittance, or payout records needed to verify the comparison.

How should a therapist compare the old and new rates?

Compare finalized claims for the same clinician, credential, state, payer product, CPT code, modifiers, place of service, and similar patient-responsibility setup. Separate the payer allowed amount, patient responsibility, Alma payout, and later adjustments.

Should therapists change their coding because reimbursement fell?

No. Code the service that was actually provided and documented. A reimbursement change does not change the clinical or time requirements for a CPT code.

Bottom Line

Alma’s Aetna change is real, and August 15 is the date-of-service dividing line. But “Alma changed all its rates” is too broad, and the claim that Alma is retaining an extra $40 per 90837 session is not established by the public evidence available today.

The practical response is a matched-claim audit: same clinician, same payer product, same code and modifiers, same place of service, and finalized claims on both sides of August 15. Separate the allowed amount from the payout, document any remaining gap, and ask Alma to explain it in writing.

Sources

• Reproduced July 9 Alma provider update

• APA and APASI June 4 letter to Aetna

• Alma cost-estimator guidance

• Alma billing-practices overview

• Aetna fee-schedule guidance

• Post-launch portal-display report

• August 25 clinician payout allegation

This article separates official guidance and provider communications from clinician anecdotes. It is educational, not legal or financial advice, and we will update it if Alma or Aetna publishes a claim-level explanation.