Connecticut-based health insurer Aetna has made available online to its policyholders information on the prices it has negotiated with in-network doctors in the Cincinnati, Ohio area.
On August 18 Aetna announced the program would be effective immediately to inform consumers about what they can expect to pay at the doctor’s office before going in for a visit. Aetna is the first major insurance company to implement such a program.
“Consumers can better gauge their out-of-pocket health care expenses by having online access to the actual discounted rates for up to 25 of the most common office-based services offered by [each member’s] own primary care or specialist physician,” explained the Aetna Web site.
Pilot Program May Grow
The program will initially offer price information for approximately 600 distinct procedures provided by 5,000 individual physicians and physician groups in Cincinnati, Dayton, and Springfield, Ohio, and in northern Kentucky and southeastern Indiana.
“As an industry, we need to make it simpler and easier for consumers to access information that will support them in making well-informed health care decisions,” said Aetna President Ronald A. Williams in an August 18 statement announcing the program. “The biggest impediment to effective consumerism in health care has been the unavailability of relevant data on health care quality and cost.”
In the past, Aetna has provided members with online tools for finding health care networks, comparing hospitals, and rating physicians. “Now, we are complementing those efforts by taking the lead on opening what is often perceived as the ‘black box’ on physician-specific pricing,” said Williams.
Better Care Decisions Expected
The move is designed to help consumers manage their health care dollars by logging onto the Aetna site (http://www.aetna.com) to see the actual discounted rates specific to their health plan for office visits, diagnostic tests, and minor procedures. The published information will vary based upon the physician’s specialty and will be expanded over time based on feedback from the site’s users.
Aetna solicited opinions from the physician community to guide the creation of the program. Focus groups were conducted with physicians and their office staffs in the Cincinnati area, and the insurer met with representatives from local and state physician professional organizations as well as large group practices in Ohio.
“When a patient enters my office they should feel confident that they have enough information to discuss their health care issues with me and my staff,” said Donald Nofziger, M.D., a pediatrician who practices in Cincinnati, in a statement released by Aetna.
“Increasingly, cost is one of the issues that they’re interested in knowing more about,” Nofziger continued. “[This] approach to providing pricing information provides one more piece of data to help my patients make wise decisions, and I look forward to helping my patients understand what this information means to them.”
“Ultimately, consumers need to make the health care decision that is right for them and their families. We encourage them to take a look at the quality and cost information that is currently available, and discuss these issues directly with their family physicians,” said Williams.
More Feedback Sought
Aetna will solicit additional feedback from physicians, customers, and members prior to rolling the program out in other markets. No specific dates or locations for future rollouts have been announced.
“Prices play a crucial role in the economy,” said endocrinologist Dr. Richard Dolinar, a senior fellow of The Heartland Institute, responding to the move by Aetna. “They are how we communicate in the market place. To blind the patient to prices is wrong. He needs to know what they are in order to make better informed purchases of health care. “Could you imagine the chaos that would result in other sectors of our economy if we blinded the consumer to prices?” said Dolinar. “What would happen in the supermarket if you didn’t know the price of the items that you bought? How could you shop and stay within your budget? Yet in health care the patient has often been blinded to prices. The more information that people have, the better.”
Aetna has approximately 14.4 million medical members, 12.9 million dental members, 9.1 million pharmacy members, and 13.6 million group insurance members. The insurer has a nationwide network of more than 684,000 health care professionals, including more than 405,000 primary care and specialist doctors and 4,135 hospitals.
Susan Konig ([email protected]) is managing editor of Health Care News.
