Aetna shows HSA patients what doctors charge

The experiment lets some Midwest consumers know in advance what medical services will cost.

By Tyler Chin, AMNews staff. Sept. 12, 2005.

Departing from standard industry practice, Aetna in August launched an experiment enabling its members to access the prices it negotiates with physicians so they will know what medical services cost before they walk into a doctor's office.

Under the test, every Aetna member can access a secure Web site listing the rates the health plan negotiated with 5,000 primary care and specialist physicians in the greater Cincinnati area, including northern Kentucky and southeast Indiana. If the project goes well, Aetna will expand it to the rest of the country, said Dexter Campinha-Bacote, MD, medical director for Aetna's north-central region.

"The goal is to provide information to individuals who are in consumer-directed health plans so they can make better informed [health] decisions," Dr. Campinha-Bacote said.

Consumer-directed health plans, or CDHPs, typically pair a tax-exempt health savings account with a high-deductible insurance plan. The number of people nationally who have HSAs is small but growing as more employers use them to shift health costs to employees, under the theory that employees will make more cost-effective health care decisions if they have to spend more of their own money.

Aetna's test, which primarily targets members with HSAs, is thought to be the first in which an insurer makes a fee schedule transparent to patients before the visit. But how will this initiative affect business for physician practices?

Under the plan, any Aetna member can access the rates the insurer has negotiated with doctors. But individual doctors are told only their own rates. This raises questions about what physicians can do to ensure they are acting within the law and not inadvertently breaching their Aetna contracts if they become aware of the rates their colleagues negotiated with the health plan.