Briefing · compiled August 2026

The insurer on both sides of the therapy session

In rate reports from late 2024, a therapist contracted directly with Optum received $110.30 for a 53-minute psychotherapy session (CPT 90837), while Optum reportedly paid the billing platform Alma about $151 for the identical session. At the time, Optum's venture arm held an equity stake in Alma. The same parent company, UnitedHealth Group, operates UnitedHealthcare, one of the largest US insurers, and owns therapy practices outright.

One company can hold three positions in a therapy session

A single corporate parent can set the reimbursement rate as the insurer, collect the payment as the practice owner, and hold equity in the billing platform that sits between the two. UnitedHealth Group occupies all three positions in behavioral health. UnitedHealthcare sets rates as a payer. Optum acquired Refresh Mental Health in March 2022, adding 300+ outpatient mental health locations across 37 states, in a deal reported at more than $1 billion. Further, Optum Ventures invested in Alma's 2022 round and held that position until Spring Health acquired Alma in May 2026.

The pattern extends beyond one company. Cigna Ventures invested in Alma and in Octave. Rula appears in the portfolio of the Blue Venture Fund, an investment vehicle backed by Blue Cross Blue Shield companies; the Rula company page carries the specifics. Accordingly, three of the largest payer families hold or have held financial positions in the platforms that route therapists' claims to them.

What STAT documented in medical care

STAT's "Health Care's Colossus" series (2024–2025), which won the George Polk Award for medical reporting, examined what happens when an insurer owns providers. Its central finding: UnitedHealth pays its own physician groups considerably more than it pays competing groups in the same markets for similar services. STAT reported that this arrangement lets the parent company move money past the federal rule capping the share of premiums an insurer keeps, since dollars paid to its own providers convert from a capped expense into uncapped provider revenue. A 2025 Brown University School of Public Health study independently found the same payment pattern.

What community rate reports show in behavioral health

The rate table holds several data points broadly consistent with that structure, with an important caveat: these are community reports, and most are unverified.

• Therapists in a November 2024 thread reported that Optum paid Alma roughly $151 for a 90837 session while a directly contracted solo therapist's rate was $110.30, and the therapist's payout through Alma sat between the two. Optum Ventures held Alma equity during this period.
• In November 2024, both Alma and Headway cut therapist pay on Optum contracts in the same month, with reductions reported by ClearHealthCosts at up to $43 per visit. The parallel timing likely reflects Optum changing what it pays the platforms, which then passed the cut through.
• A clinician on Grow Therapy reported that Kaiser paid the platform $213.07 for a session while the clinician received $101.20. Neither the patient nor the therapist is shown that spread in the ordinary course of billing.

Where the cost lands

While the contracts stay confidential, the consequences reach patients directly. Low and opaque rates are the reason therapists most often cite for leaving insurance networks, and a Senate ghost-network study covered in the payer practices briefing found that most listed in-network behavioral health providers were unreachable or not accepting the plan. Patients inherit the directory that doesn't work, the multi-month wait, and the out-of-pocket bill for care their plan nominally covers. Payer audit letters pressuring clinicians away from 60-minute sessions, collected in the same briefing, shorten the session itself.

How to read these findings

Several limitations apply. First, the platform rate rows are community reports rather than audited contracts, and single-thread comparisons may mix plan types, states, or license levels. Second, parallel rate cuts have an ordinary vertical explanation and are not themselves evidence of coordination. Third, minority venture stakes confer neither control nor rate-setting authority, and Alma's insurer stakes ended with the Spring Health acquisition. Nevertheless, the documented facts stand on their own: the largest payers set behavioral health rates while owning practices and holding platform equity, and the one place this structure has been tested with claims data, STAT and Brown found the insurer paying its own side more. Whether the same holds in behavioral health is exactly the kind of question rate transparency exists to answer, and it is why this site collects rates by contract type. If your remittances tell a different story than your portal, submit the numbers.

All ownership and acquisition items cite press or primary sources. Rate rows marked reported are community claims. Corrections via the form.