Aetna Payment Estimator Review

A certain unnamed TTAI staff member recently went in for their “free” annual physical. Many health insurers offer this as a preventative measure against major medical problems that may go undiscovered without routine screenings. Sounds simple enough…right? Wrong.

You probably already know that most doctor visits aren’t free, but just how much you’ll be on the hook for seems to be a mystery until the final bill arrives.

If you’ve been to your doctor recently, you likely heard the phrase, “we will bill your insurer and send you a bill for whatever they don’t cover.”

It can be a little disconcerting to think about the “surprise” bill you’ll get in the mail in the next few weeks.

But what if there was a magical way to determine exactly how much your bill will be? Enter the Aetna Payment Estimator.

What is the Aetna Payment Estimator?

NaviNet, the nation’s largest real-time healthcare communications network, has created a piece of computer software called the “Aetna Payment Estimator” that estimates the cost of services for doctors and their patients.

Simply put, the software automatically tallies the health care costs of medical services performed in real-time by using the member’s benefits plan details and provider fee schedules to provide an estimate of their financial responsibility.

The amount that isn’t covered is your out-of-pocket expense for the visit.

The simplest example would be calculating the cost of your copay, deductible and coinsurance and subtracting it from the cost of your overall visit. Anyone with private (non-employer sponsored) healthcare insurance knows this isn’t necessarily that easy!

(Can I get health insurance without a job?)

The Benefits

1. No surprises – this is the biggie. You can get an accurate estimate of a future bill today. Being prepared for a costly medical bill is helpful in more ways than we can count, not least of which is peace of mind.

2. Lower bills – You may opt to forego certain medical tests if you know they are not covered prior to having them performed. Anyone who has received a large surprise bill would likely agree they could have skipped a few of the “services” that ended up costing much more than they expected.

3. Better planning – Knowing just how much is due and when will help you set aside the necessary funds so you can pay the bill in full, as opposed to opting for a payment plan that costs you more.

Any Downside?

We’re glad you asked. First, if Aetna is not your healthcare provider, you can expect to do things the old-fashioned way, which means increased stress levels after your visit while you wait for your bill to arrive.

However, Aetna’s Payment Estimator is no perfect angel either. It relies on you selecting the proper procedures and services, and hoping they match up with those which your doctor uses.

If different codes are used, your estimate may be way off. The estimate could also be “unsuccessful” if the submitted procedure requires review, or if the provider does not participate with Aetna or the patient’s network.

Another potential drawback is that Aetna’s Payment Estimator provides real time estimates. This means your estimate may be “off” if you have visited multiple healthcare providers within a certain time frame.

There is no way (currently) for the program to differentiate between what you owe for “today’s” visit and “last week’s” visit. You will only see the grand total for all “claims” being processed at any given time. So your estimate will show the total amount due for all current charges.

Streamlining Experience With Aetna Payment Estimator Claims Process

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Aetna offers a convenient and user-friendly claims process for its policyholders. One notable feature is the Aetna Payment Estimator, which helps estimate the cost of medical services in real-time. This estimation is based on the member’s benefits plan details and provider fee schedules, providing transparency about potential out-of-pocket expenses.

The Aetna Payment Estimator streamlines the claims process by allowing policyholders to have a clearer understanding of their financial responsibility before receiving the final bill. However, it’s essential to note that this feature is specifically for Aetna policyholders, and those with different insurance providers may need to follow traditional claim submission procedures.

Average Claim Processing Time

While the Aetna Payment Estimator offers valuable cost estimation, the actual claim processing time may vary depending on several factors, including the complexity of the claim and the healthcare provider’s billing practices. Generally, Aetna strives to process claims efficiently and promptly.

However, policyholders should be aware that claim processing times can fluctuate, and it’s advisable to check with Aetna or refer to their policy documents for specific details on claim processing timelines.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback on Aetna’s claim resolutions and payouts can provide insights into the overall claims experience. Aetna’s commitment to transparency and accuracy in cost estimation with tools like the Aetna Payment Estimator can positively impact customer satisfaction.

However, as with any insurance provider, individual experiences may vary, and policyholders are encouraged to share their feedback on the claim resolution process with Aetna. Customer reviews and testimonials can help prospective policyholders gauge the quality of Aetna’s claims services.

Exploring Digital and Technological Innovations of Aetna Payment Estimator

Mobile App Features and Functionality

Aetna offers a mobile app that provides policyholders with convenient access to their insurance information and a range of healthcare-related features. The app allows users to view their benefits, check claim status, find in-network healthcare providers, and estimate healthcare costs using the Aetna Payment Estimator.

Additionally, it provides tools for tracking health and wellness, making it a valuable resource for managing one’s health on the go.

Online Account Management Capabilities

Aetna’s online account management capabilities empower policyholders to manage their insurance policies with ease. Through the online portal, users can review and update their policy information, pay premiums, access important documents, and track claims.

This digital convenience enhances the overall customer experience by providing a centralized platform for managing insurance-related tasks.

Digital Tools and Resources

Aetna offers a range of digital tools and resources to support policyholders in making informed healthcare decisions. These tools include health risk assessments, wellness programs, and educational resources. Policyholders can access these resources online or through the mobile app to gain valuable insights into their health and well-being.

By leveraging these digital tools, Aetna aims to empower individuals to take an active role in managing their health and healthcare-related decisions.

Final Word

While this seems like a great idea, at the end of the day it’s just an “estimator.” In other words, expect prices to vary, and for arguments to ensue.

It’s certainly not a strong reason to stay with or switch to Aetna, but it is an added frill to increase transparency in the often overly complicated medical industry.

And it’s not necessarily always a great idea to make health decisions based on cost, especially if they’re pressing issues. Perhaps having a better health insurance plan is the way to go.

Take the time to compare health insurance quotes online and/or visit an independent agent to ensure you get the best deal for your health coverage needs.

Read more: Top 10 health insurance companies.

(photo: colinmford)