Insurer unveils advance peek at doctors' bills

Ever wonder how much your insurer pays your doctor for the services you receive? If your insurer is Aetna Inc., now you can find out.

South Florida is one of a dozen markets in the United States where Aetna began this week allowing members to have access to pricing information before they go to a doctor's office. Previously, they learned what the insurer paid only when they received an explanation of benefits report weeks after treatment.

The information helps consumers doctor shop because rates can vary. For example, Aetna pays West Palm Beach orthopedic surgeon Pierre Girars $1,713 for a hip replacement. But it pays another West Palm Beach orthopedic surgeon, Milan DiGiulio, $1,456 for the same procedure. Doctors get paid differently because they negotiate with insurers separately.

Although most large U.S. health insurers disclose some cost and quality data on hospitals and doctors, Aetna is the first to provide the doctor-specific pricing information to its members via the company's password-protected Web site (Aetnanavigator.com). Insurers have closely guarded payment data in the past, citing competitive pressures. Aetna is the nation's second-largest health insurer with more than 15 million members.

Aetna expects the pricing information to be most useful to the small but growing number of customers who have health savings accounts tied to a high-deductible insurance plan that require consumers to pay for most of their routine care out-of-pocket. The decision to release the data is part of Aetna's larger effort to make consumers better health-care shoppers.
But the company said even those customers in its traditional HMOs or PPOs will benefit because it will help them appreciate the true cost of their health care.

"Some people still think the cost of their health care is their $10 or $15 co-payment," Dr. Charles Cutler, Aetna's national medical director, said Tuesday. "This will help raise the level of awareness about the difference in costs and support the whole consumerism approach where people make decisions about health care the same way they act in other domains."
Aetna's member Web site also discloses whether the doctors met certain Aetna quality and efficiency standards, but it provides no specifics.

During the past decade, the federal government, most states and private health insurers have been giving consumers a growing amount of cost and quality data to compare doctors and hospitals. But some health analysts and doctors question whether consumers even look at it.
"I think its totally meaningless," Dr. Steven Rosenberg said of the Aetna data. He said patients will continue to select doctors based on proximity to where they live and recommendations from family and friends.

Aetna pays Rosenberg, a West Palm Beach dermatologist, $80.79 for a skin biopsy and $29.37 for each additional biopsy. Prices may vary because some doctors use nurse practitioners and physician assistants, which can keep their costs lower because they allow their practices to see more patients, Rosenberg said.

Doctors across the region will be interested in looking at the pricing data so they can see whether they are getting a fair deal. "We all want to know who is getting paid for what to make sure we are not being underpaid compared to other doctors," Rosenberg said.

Dianne Howard, risk management director for the Palm Beach County School District, applauds Aetna's effort to give consumers more data to make decisions. "This is part of the whole transparency movement in health care," she said.

Most school district employees get their health benefits through United Healthcare. Nonetheless, the data showing what doctors get paid would be enlightening to employees used to paying a small co-payment for their care, she said.

Aetna tested its new doctor-pricing data in Cincinnati last year. In that market, about 1,000 consumers each month looked at the database, Aetna officials said. In addition to South Florida, the program is being rolled out in other markets, including Ohio, Connecticut and the Washington, D.C., area.

Some health analysts predict that, in a few years, most consumers will be getting their health insurance through health savings account/high deductible plans and they'll want to shop for health care the same way they do for a new car. "Employers will demand to have this type of information for their workers," said a Palm Beach-based insurance broker. He predicts other insurers will release similar data. "You can't negotiate if you don't know what the price is."