This year, I decided ask Aetna directly, figuring THEY would know what their negotiated prices were. I talked to our insurance person at the health center who made the request. The response from Aetna was this:
Generally the hospital or provider will not provide an estimate for the cost of a procedure without having more information like a procedure code or the number of necessary visits.
This student can log on to Aetna Navigator to get a estimate for the cost of a colonoscopy in the provider's area. Please advise the following steps:
0. Enter username/password
0. Blah blah blah
Aetna Navigator will deliver a rough estimate for the cost of this procedure. Navigator calculates the cost based on historical claims information adjusted to take into account health care cost inflation, in the calculation of the estimated costs.
In other words, she was saying, she didn’t feel like trying at all—Those codes are in a book published by the American Medical Association. I could probably google them for her--But here’s the bigger question: This is the insurance company—do they really not have access to the procedure codes or the money they have spent at various venders (which shouldn’t even differ that much because they should have a negotiated price)? Where are all their past claim invoices, do they not have numbers and prices on them? Basically this woman was telling me that THE INSURANCE COMPANY DOES NOT KNOW WHAT THEY ARE PAYING.
In the end, I called around myself, and although I was able to get numbers, I was assured at two places that the negotiated rate was probably lower, but that THE SERVICE PROVIDERS DID NOT KNOW WHAT THESE RATES WERE, they just let the insurance company tell them. In one case, since I was talking to the woman in the billing office, I did think to ask if perhaps, they have done the procedure before (it is a very common procedure---probably half their business I’m guessing), that perhaps they have issued invoices or received checks from the insurance company that she could look at?
She said it was probably possible, but that such things were hidden deep inside the entrails of the computer and were very hard to get to—she would probably need help to gain access. But she suggested I call the insurance company because “they should have those negotiated rates” and after all, “you’re paying them to do the shopping.”
Indeed I am.