Aetna lets more patients see what doctors are being paid

Aetna has expanded an online tool that allows members in 57 markets across the country to see how much the company has agreed to pay specific physicians for care.

The online tool now lets members see prices for network doctors in more markets in Rhode Island, upstate New York and New Jersey. It also lists negotiated prices for care delivered by nonphysician health professionals, including chiropractors, audiologists, optometrists and podiatrists.

Aetna's price transparency tool was launched as a pilot in Cincinnati four years ago, then adjusted based on physician feedback before it was expanded, said Dexter Campinha-Bacote, MD, market medical director for Ohio, Indiana and Kentucky.

While supportive of transparency, the American Medical Association and others are concerned that Aetna could be sharing flawed information and that the reimbursement rates in some areas are presented without quality measures.

"If the insured is looking at the negotiated rate and it's not accurate, that patient is going to be confused," said AMA President-elect J. James Rohack, MD, a cardiologist in Temple, Texas.

Plan members wanting to see rates for specific types of visits or procedures for in-network physicians can log on to Aetna's Navigator Member Web site and select either medical, dental or hospital care. The figures displayed are supposed to reflect Aetna's current negotiated fee schedule with that physician, facility or health care professional.

But as Dr. Rohack pointed out, AMA research has found the rates that health plans agree to pay are not always what they do pay.

The AMA's National Health Insurer Report Card, released at the 2008 Annual Meeting, examined how often insurers' "allowed amount" listed on reimbursement records matched the rate specified in a physician's contract.

In a survey of 78,650 Aetna records, the two amounts matched about 70% of the time -- better than UnitedHealthcare (62%) and Cigna (66%), but worse than Humana or WellPoint-owned Anthem, which matched the rates more than 80% of the time.

"We do our best to be as accurate as possible," Dr. Campinha-Bacote said. "Nothing's 100%." He said the information posted for members is updated as fee schedules are changed in Aetna's own systems.

Physicians can check their negotiated rates either by logging on to Aetna's Web site, calling its toll-free service lines or talking to a network representative, Dr. Campinha-Bacote said.

But even where there are accurate data, there are some markets, including Utah, Michigan and Alaska, where Aetna hasn't yet posted clinical quality information.

That kind of transparency is not ideal, said Mark Jarvis, senior director of practice economics at the Ohio State Medical Assn.

"That sets up a situation where you're rewarded for possibly cutting corners, and that's just not an environment I think is healthy," he said.