Payer Contracting
Contract status, fee schedules, and margin analysis for behavioral health payers
Cigna / Evernorth
▼Live (via Helyx contract, pending repaper to Lean PC)
Redwood Phoenix Medical Inc DBA Helyx Health
January 2025
Needs research
Lean NPI being added to Helyx’s existing Evernorth contract. Goal: repaper to standalone Lean contract once volume established.
Aetna
▼Live (via Helyx contract)
Redwood Phoenix Medical Inc DBA Helyx Health
April 15, 2025
Needs research
165% of Aetna Market Fee Schedule (Northern California market)
Core psych/therapy CPT codes at 165%. All other services at 115% (masters), 117% (psychologists), 118% (NPs/psychiatrists).
Anthem
Target go-live Dec 2026
—
New payer contract targeted for Q4 2026.
Blue Shield
Target go-live Dec 2026
—
New payer contract targeted for Q4 2026.
Blue Cross
Target go-live Mar 2027
—
New payer contract targeted for Q1 2027.
Kaiser
Target go-live Jun 2027
—
New payer contract targeted for Q2 2027.
| CPT | Description | Provider | Cigna Rate | Aetna Rate | Aetna Base × Mult. |
|---|---|---|---|---|---|
| 90837 | 60-min psychotherapy | Psychologist | $337.00 | $239.50 | $145.15 × 1.65 |
| 90837 | 60-min psychotherapy | Masters | $200.00 | $179.62 | $108.86 × 1.65 |
| 90837 | 60-min psychotherapy | Psychiatrist | $275.00 | $239.50 | $145.15 × 1.65 |
| 90834 | 45-min psychotherapy | Psychologist | $306.00 | $181.50 | $110.00 × 1.65 |
| 90834 | 45-min psychotherapy | Masters | $136.00 | $136.13 | $82.50 × 1.65 |
| 90791 | Intake evaluation | All | $491.00 | $272.25 | $165.00 × 1.65 |
| Provider Type | Payer | Contracted Rate | Clinician Payout | Lean Margin | Take % | Margin Bar |
|---|---|---|---|---|---|---|
| Psychologist | Cigna | $337.00 | $175.00 | $162.00 | 48.1% | $162.00 |
| Psychologist | Aetna | $239.50 | $160.00 | $79.50 | 33.2% | $79.50 |
| Masters | Cigna | $200.00 | $120.00 | $80.00 | 40.0% | $80.00 |
| Masters | Aetna | $179.62 | $107.77 | $71.85 | 40.0% | $71.85 |
Blended Economics (50/50 Cigna/Aetna)
| Provider | Blended Rev | Payout | Gross Margin | Take % | EHR (4%) | Coll. Loss (3.5%) | Net Margin |
|---|---|---|---|---|---|---|---|
| Psychologist | $288.25 | $167.50 | $120.75 | 41.9% | –$11.53 | –$10.09 | $99.13 |
| Masters | $189.81 | $113.88 | $75.93 | 40.0% | –$7.59 | –$6.64 | $61.69 |
Psychologist
$288.25
$167.50
$120.75
41.9%
$99.13
Masters
$189.81
$113.89
$75.93
40.0%
$61.69
Single payer concentration risk
Cigna is primary revenue driver
Aetna margin compression
33.2% psychologist take vs 48.1% on Cigna
Contract dependency
Both contracts currently held via Helyx Health entity, not Lean PC
Renewal dates unknown
Needs research for both Cigna and Aetna