HARTFORD, Conn.–(BUSINESS WIRE)–Aetna Inc. (NYSE: AET) today announced that it will stop using the Ingenix databases for the purpose of determining “prevailing” or “usual, customary and reasonable” charges when members receive covered care from providers outside a health plan’s network. Aetna will instead help the Attorney General to create a new independent database for this purpose, and will use the new database when it is ready for use. Aetna is contributing $20 million to a nonprofit organization to help create the new database and to help educate members about reimbursement rates.
Aetna welcomes the Attorney General’s emphasis on transparency, and is pleased to be a leader in the development of the new database as a further commitment to transparency for its members, employers who purchase benefits and providers. In this tough economy, it is more important than ever that consumers understand how much their out-of-pocket costs can increase when they go outside their insurer’s network. Aetna looks forward to cooperating with the new database administrator to help generate better information about out-of-network costs for care.
Today, members who receive care from a provider in Aetna’s network enjoy the discounts it has negotiated and access to Aetna’s online tools to help them determine in advance of a doctor’s visit the cost of care and their own financial responsibility. When members use providers outside Aetna’s network, it is challenging to provide comparable price information, and members face more uncertain out-of-pocket expenses.
When Aetna launched its price transparency effort in 2005, it was the first national health insurer to provide members with the actual, negotiated rates the company pays to participating network physicians for common services and procedures. Aetna posts the information online at its secure member web site with a suite of cost and quality comparison tools to help members make more informed health care decisions.
Aetna believes that educated consumers are better consumers. A robust independent database of provider charges, along with online access to cost data, will help consumers understand the amount their plan will reimburse before choosing an out-of-network provider. Making this data more accessible and transparent, coupled with information from their physician about the full charge for the services, will help consumers use their benefits more wisely and help the nation appropriately contain rising health care costs to ensure continued access to affordable, high quality care and insurance coverage.
Health insurance premiums and employer-sponsored health benefits are directly impacted by rising health care costs. As a result, the availability of affordable coverage is dependent on appropriate cost containment. A database that pools billing data can assist health plans and consumers in determining “reasonable” costs associated with a physician’s bill.
Under the agreement, Aetna will contribute $20 million toward the creation of the new database. The contribution will be made in installments at the Attorney General’s request over a period of up to five years. The company will also assist the appointed third party by providing relevant billing and claims information for the database.
Aetna has worked cooperatively over several months with the Attorney General’s office to share the company’s processes for determining out-of-network claim payments and to provide insight into the current database known as Ingenix that assists many insurance carriers in determining fair payments to these providers.
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 37.2 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.