The American Psychiatric Association and American Psychological Association Services sent a joint letter to Aetna on June 4 urging the insurer to halt reimbursement rate reductions for behavioral health services delivered through Alma-affiliated clinicians.
Alma is a platform that connects mental health professionals with clients seeking therapy services, according to its website.
The letter outlines four specific changes Aetna has implemented:
- Reimburse 53-minute psychotherapy sessions (CPT 90837) at the same rate as 37- to 52-minute sessions (CPT 90834)
- Eliminate reimbursement differentials between master’s-level providers and psychologists
- Paying CPT 99215, an outpatient visit with high complexity, high medical decision-making and is at least 40 minutes, at the same rate as CPT 99214, which is a visit with moderate complexity, moderate medical decision-making and is at least 30 minutes
- Eliminate pay differentials between nurse practitioners and psychiatrists
The cuts are currently limited to Alma-contracted clinicians.
The organizations argued the changes devalue higher-acuity services medically necessary for patients with serious mental illness, trauma and substance use disorders. They also raised potential Mental Health Parity and Addiction Equity Act concerns, asking Aetna to clarify whether comparable reimbursement compression has been applied to medical and surgical services.
The groups are requesting Aetna pause implementation, explain its methodology and projected access impacts, and engage with professional organizations and patient advocates.
Aetna said its policies are grounded in outcomes rather than care setting.
“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,” the payer told Becker’s in a June 10 statement.
The American Psychiatric Association’s 2024 Practitioner Pulse Survey found more than 8 in 10 psychologists who left or never joined insurance networks cited insufficient reimbursement as a primary reason.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.