HARTFORD, Conn.--(BUSINESS WIRE)--Jan. 15, 2009--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
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
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.
CONTACT: Aetna Inc.
Cynthia Michener, 860-273-8553
Jeff Chaffkin, CFA, 860-273-7830
Source: Aetna Inc.