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Aetna Pilot Site Details Fees Paid to Doctors


Starting today, an insurance company will do something that no major player in the industry has ever done. As part of a pilot program in Cincinnati, Aetna will disclose the amount it pays area health-care providers for office visits and other services. That information could help consumers gauge their out-of-pocket expenses before they visit the doctor. NPR's Wendy Kaufman explains.

WENDY KAUFMAN reporting:

When you buy a box of cereal at the supermarket you know what's in it and how much it costs, but when you go to the doctor, you almost never have that information up-front. But now, Aetna says it wants you to have it, at least if you live in metropolitan Cincinnati. Mark Bertolini is a senior vice president at Aetna.

Mr. MARK BERTOLINI (Senior Vice President, Aetna): We believe that the amount of money that the general consumer, John Q. Public, is paying out of pocket will continue to increase over time. And as people make decisions about how to spend their money, they will want to have the best information available.

KAUFMAN: And that includes price. Bertolini says beginning today, an Aetna Web site will show how much the insurance company pays Cincinnati area doctors for 600 distinct services.

Mr. BERTOLINI: When you go onto our site under Aetna Navigator, you will be able to find for your doctor the most common procedures in English. And next to them, you will have a fee.

KAUFMAN: And that fee can help you figure out how much you will have to pay. Let's take the cost of an office visit. If you have a high deductible or a health savings account where you pay sizable health-care costs yourself, the published price is what you will pay, or if Aetna normally pays 80 percent of that office visit, you'll pay 20 percent of that amount. The amount is negotiated between Aetna and physicians and is often substantially less than the retail price for the same service. The 5,000 Cincinnati area doctors whose negotiated fees will be online have expressed mixed reactions to the pilot program, according to the president of the local medical society. But Harvard Business School Professor Regina Herzlinger, an advocate of consumer-directed health care, is unequivocal. `Hooray for Aetna,' she says.

Professor REGINA HERZLINGER (Harvard Business School): Isn't it terrible that you know the price of the box of cereal and you know a lot about the quality of that cereal and you don't know the price of the person who's going to operate on you and you know nothing about the quality of care that he or she may give you? So isn't it wonderful that at least we have the price information now available?

KAUFMAN: She's quick to add that we also need to know how good the physician is, and she says if she were a Cincinnati doctor she would make sure that consumers have that information about her, as well. Similar views were expressed by Kirsten Sloan of the AARP. She says consumers do use price information when buying prescription drugs but that picking a doctor is far more complicated.

Mr. KIRSTEN SLOAN (AARP): Price information is only one factor. We have to look at quality. We have to look at whether your primary care physician recommends a specialist. There are lots of different factors to consider.

KAUFMAN: Aetna says it provides some quantifiable information about the quality of care from various doctors in more than 20 cities, but Cincinnati isn't among them; though Aetna says Cincinnati consumers can get some subjective information about various doctors from its Web site. Health policy analyst Robert Lashefsky(ph) says Aetna's move to put its fees online is a watershed event and could propel other insurance companies to do the same. He says publication of the fees probably wouldn't drive consumers to pick doctor A over doctor B, but it would affect which insurance network consumers sign on with. Will it be Aetna or someone else?

Mr. ROBERT LASHEFSKY (Health Policy Analyst): So you might find there are three different networks out there that have your doctor that you have confidence in. Which of those networks negotiated the best price with your doctor? That's going to be important to you.

KAUFMAN: Aetna says if things go well in Cincinnati, it will probably expand the program to other cities. And will other insurance companies follow Aetna and publish prices? The company and some health policy analysts say yes.

Wendy Kaufman, NPR News.

INSKEEP: You're listening to MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.

Wendy Kaufman