Shuman Roy is an entrepreneur, business owner, and musician. He started RoysNoys, LLC in 2013 as a music production and education service company. He also offers small business consulting and advisory services to help businesses get from start-up mode to turn-key operations. Shuman earned his M.B.A from the Stern School of Business in 2001 and has an undergraduate degree from Manhattan College in ...

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Written by Shuman Roy
Content Writer & Entrepreneur Shuman Roy

Joel Ohman is the CEO of a private equity-backed digital media company. He is a CERTIFIED FINANCIAL PLANNER™, author, angel investor, and serial entrepreneur who loves creating new things, whether books or businesses. He has also previously served as the founder and resident CFP® of a national insurance agency, Real Time Health Quotes. He has an MBA from the University of South Florida. Joel...

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Reviewed by Joel Ohman
Founder, CFP® Joel Ohman

UPDATED: Jun 28, 2022

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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?)

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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.

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)