A merger closes. Three weeks pass. Then the rate letter arrives. If that sequence feels familiar, it's because this is the second time in two years an enablement platform's clinicians found out about a pay cut after someone upstream had already decided it.
What actually happened, in order
Spring Health finished acquiring Alma on May 1, 2026, a deal the two companies first announced January 29, 2026 (Spring Health, May 2026; Fierce Healthcare). Neither company disclosed a deal price. Spring Health's last public valuation, from an earlier funding round, was $3.3 billion. That number is scale context, not what changed hands here.
On May 20, 2026, less than three weeks after the deal closed, Alma emailed its network. Aetna would be flattening reimbursement for Alma-contracted therapists, effective July 15, 2026, the letter said (Behavioral Health Business, May 21, 2026). Three specific differentials were set to disappear. The pay gap between a 53-plus-minute session (CPT 90837) and a standard 37-to-52-minute session (90834) would close. The gap between high- and moderate-complexity evaluation and management coding would close. And the higher rate doctoral-level providers, PhDs and PsyDs, had been earning over master's-level clinicians would drop to match the master's rate. (Aetna partially reversed this plan before it took effect — see the correction above.)
What the cut actually costs
Numbers matter here, because "reimbursement flattening" hides what it means in an actual paycheck — which is why Behavioral Health Business ran cost estimates at the time, for a doctoral-level provider running a heavy 90837 caseload and separately for a therapist with a general full-time caseload (Behavioral Health Business, May 21, 2026). Those estimates were built on the full-flattening scenario Alma originally announced. Per Alma's July 9 email to its members, Aetna didn't fully flatten the rates — so we're not republishing BHB's original dollar figures here, since they described a scenario that didn't take the form it was announced to take. What is confirmed: Aetna's final rates still reflect an overall reduction, by Alma's own characterization, reported by a single outlet (theinsurancemaze.com, July 13 update). No comparable dollar estimate for the post-reversal rates has been published, and Aetna itself hasn't confirmed the reversal publicly.
Whatever this nets out to, it's money lost without a single client leaving and without the therapist doing anything differently — the only thing that changed is which box Aetna checks on the claim.
Why "we disagree" isn't the same as "we stopped it"
More than 5,000 Alma clinicians filled out an internal survey about the cut, an unusually large response for any provider-network poll (Behavioral Health Business, May 21, 2026). Alma's CEO, Harry Ritter, closed the survey early on May 25 to formalize the pushback into something he could bring back to Aetna. Alma's public statement: "We disagree with these changes."
Disagreement is not leverage. Alma is the party actually negotiating with Aetna on behalf of its network, and public disagreement is the strongest lever Alma has shown so far. As of this writing, the rate change was still scheduled to take effect July 15.
The American Psychiatric Association didn't wait on that negotiation. On June 4, 2026, the APA and APA Services sent Aetna a joint letter asking the insurer to pause the change and disclose the methodology and access impact behind it (APA Services, June 2026). Aetna's answer, given to Becker's Payer Issues on June 10, 2026, didn't move: "Our rate policies are based on the level of care provided with an emphasis on shared and measured outcomes aided by technology, not how providers connect with members" (Becker's Payer Issues, June 10, 2026).
Sit with that phrasing for a second. Aetna told a professional association, in writing, that how a clinician connects with a client isn't the basis for pay, but "measured outcomes aided by technology" is. Those are the insurer's own words.
That exchange nearly became the last word — until it wasn't. On July 9, 2026, six days before the new rates were due to take effect, Alma emailed its members that after further negotiation, Aetna had agreed to a "partial reversal": the 90837/90834 and 99214/99215 differentials would stay, and reimbursement would continue to reflect degree type and training rather than one flat rate (theinsurancemaze.com, July 13 update). Alma attributed the partial reversal to pushback from its own clinicians and the professional associations that got involved. Aetna's final rates still reflect an overall reduction — Alma didn't say by how much, and Aetna hasn't said anything about it publicly. So: the flattening, as originally announced, didn't fully happen. The cut isn't zero, either. That's not a clean ending, and we're not going to write it up as one.
The platform was never the leverage. You were supposed to be.
A separate Behavioral Health Business analysis, published May 27, 2026, found that small and solo providers keep moving onto platforms like Headway and Alma for the credentialing and billing help, but once inside, the pay difference is often marginal, and the platform, not the individual clinician, holds the actual negotiating leverage with the payer (Behavioral Health Business, May 27, 2026).
That's BHB's finding about the structure. Here's our read on what the Alma sequence adds to it. When a venture-backed platform gets acquired by a bigger venture-backed platform, the combined company now answers to investors who weren't in the room when Alma set its original rates. The fastest lever available to satisfy those investors isn't cutting the platform's own take. It's letting a payer flatten what gets passed through to the 24,000 clinicians who have no seat in that negotiation. The acquisition didn't decide the cut on its own, but it's hard to look at May 1 and May 20 side by side and call that a coincidence of timing.
Ask any therapist who joined one of these platforms in year one, back when the pitch was "we handle the insurance headache so you don't have to." The headache didn't disappear. It moved. Now it shows up as a rate letter you didn't negotiate, for a change you found out about after it was already decided.
What this means if you're on Alma, or thinking about joining a platform
If you're an Alma-contracted therapist billing Aetna, don't model your caseload against the original full-flattening numbers — the 90837/90834 and E&M complexity differentials stay in place, and doctoral-level reimbursement stays distinct from master's-level, per Alma's July 9 email. But Aetna's final rates still reflect an overall reduction, and neither Alma nor Aetna has published what that reduction actually is. Watch for Alma's specific, published rate schedule before you model anything against your actual caseload. Once that number is real and confirmed, it's the real conversation to have with yourself about whether the platform's convenience still clears the bar.
If you're weighing whether to join an enablement platform at all, ask a harder question than "what will they pay me." Ask who owns the platform, who owns the platform's owner, and what happens to your rate the next time either one needs a lever that isn't its own margin. A platform that can't answer isn't offering you stability. It's offering you a seat in a pipeline, and pipelines move whichever direction the pressure comes from.
None of this requires building your practice around a platform's roadmap. Some clinicians are looking at tools built for the person doing the clinical work, not for investors upstream of it, which is part of why VibeCheck.luxury exists: a straightforward alternative for the parts of practice you can actually control, intake, notes, and scheduling, without a platform sitting between you and your rate. Book a call if you want to see what that looks like.
FAQ
When did Spring Health complete its acquisition of Alma?
Spring Health closed the acquisition on May 1, 2026, a deal first announced January 29, 2026 (Spring Health, May 2026). Neither company disclosed a deal price.
What is Aetna actually changing about Alma-contracted therapist pay?
Aetna originally announced that, effective July 15, 2026, it would eliminate the pay differential between 90837 and 90834 sessions, eliminate the high- versus moderate-complexity E&M coding differential, and lower doctoral-level provider reimbursement to the master's-level rate (Behavioral Health Business, May 21, 2026). Per Alma's July 9, 2026 email to its members, Aetna partially reversed those changes: the 90837/90834 and 99214/99215 differentials remain, and reimbursement continues to reflect degree type and training, though Aetna's final rates still reflect an overall reduction (theinsurancemaze.com, July 13 update). Aetna has not publicly confirmed the reversal.
How much income could this cost an individual therapist?
Behavioral Health Business published cost estimates in May 2026 based on the full-flattening scenario Aetna originally announced (Behavioral Health Business, May 21, 2026). Per Alma's July 9 email to members, Aetna did not fully flatten those rates — it partially reversed course after pushback from clinicians and professional associations. Because the original estimates described a scenario that didn't take effect as announced, and no comparable estimate exists for the final, partially-reversed rates, we are not republishing a dollar figure here. What is confirmed is that Aetna's final rates still reflect an overall reduction in reimbursement; Aetna has not published that number, and has not publicly confirmed the reversal itself.
Did Alma or the APA push back on the cut?
Yes. More than 5,000 Alma clinicians responded to an internal survey, which CEO Harry Ritter closed early on May 25 to formalize the pushback, and Alma said publicly, "We disagree with these changes." The American Psychiatric Association and APA Services sent Aetna a joint letter on June 4, 2026 asking it to pause the change (Behavioral Health Business, May 21, 2026; APA Services, June 2026).
Did Aetna respond to the pushback?
Yes. Aetna told Becker's Payer Issues on June 10, 2026 that its rate policies are based on "the level of care provided with an emphasis on shared and measured outcomes aided by technology, not how providers connect with members" (Becker's Payer Issues, June 10, 2026). That response held until July 9, 2026, when Alma emailed its members that Aetna had agreed to a partial reversal of the planned changes, per theinsurancemaze.com's July 13 update. Aetna has not confirmed the reversal directly.