Aetna’s Commitment to Transparency

Tuesday, April 5, 2016


Aetna has been a leader in supporting and improving health care transparency for more than a decade.

Aetna was the first insurer to:

  • Provide physician-specific price, clinical quality and efficiency information to members.

  • Offer site-specific cost information to members for hospitals and other facilities (not regional averages).

  • Give members personalized estimates for cost of care based on Aetna’s actual negotiated rates with specific health care providers and not claim averages.

Aetna Member Payment Estimator Overview

The Member Payment Estimator improves transparency for members by giving them a more complete, personalized picture of the costs involved with their health care. It provides real-time out-of-pocket cost estimates based on a member’s personal benefits plan.

  • Price Information for Hundreds of Health Care Services – The Member Payment Estimator provides cost estimates and cost comparisons for more than 650 commonly used, non-emergency in-network health services. It displays up to 10 cost estimates at a time for the selected procedure in a geographic area, which can help make members more aware of the cost differences among different health care providers.

  • Consumers Save on Health Care Costs – Our research has shown that after members use the Member Payment Estimator to obtain cost estimates on one of more than 30 of the most frequently selected health care services, they chose the provider that helps them save approximately $170 in out-of-pocket costs compared with the average of the estimates they received.

  • Millions of Cost Estimates for Members – In 2015, members accessed the Member Payment Estimator 1,787,215 times, an average of 148,935 hits per month. This was an 11 percent increase in hits from the previous year. There have been more than 6.6 million hits since the tool was launched in 2010.

  • Helping Members Understand Their Health Care Costs – We employ our virtual assistant, “Ann,” alongside our Member Payment Estimator tool on Aetna Navigator to guide our members through using the tool.

  • Available on the Go – Aetna members can access the Member Payment Estimator with their smartphones through the Aetna Mobile app.

External Recognition for the Aetna Member Payment Estimator

  • In 2011, the U.S. Government Accountability Office released a report regarding the transparency of health care costs. Aetna’s Member Payment Estimator was recognized at the time as the only tool from a private health insurance company that “provided estimates of a consumer’s complete cost.”

  • Aetna’s Member Payment Estimator was highlighted in an April/May 2012 Commonwealth Fund report on the importance of health care price transparency.

  • The National Business Coalition on Health (NBCH) gave the Member Payment Estimator an eValue8 Innovation Award in 2013.

WellMatch Overview

WellMatch is the latest innovation in Aetna’s family of transparency solutions. Building on the foundation of Aetna’s Member Payment Estimator, the WellMatch transparency application enables employers to help their employees make more informed decisions. Employees can access health care information, learn about their benefits, estimate costs, and find providers that offer the services they need. Employees can also read reviews by other patients and see anonymous co-worker recommendations.

WellMatch is helping employees lower their out-of-pocket expenses while building stronger engagement in the health care decision-making process.

Using WellMatch, employees are able to:

  • Compare providers and facilities by quality rating, out-of-pocket costs, and distance from any location through their employer’s portal or using their mobile, tablet, or PC device.

  • Read reviews by other patients and see anonymous co-worker recommendations.

  • See accurate cost information for a service based on their own insurance plan and the provider’s network status.

  • View simple, real-time snapshots of personal health care spend and benefit coverage.

  • See any direct-to-consumer discounts offered by providers or facilities when comparing options for a procedure.