News

Aetna Payment Estimators Help Determine Patients’ Costs

New online payment estimator tools for providers and members are now available from Aetna.

For Providers

Log in via NaviNet, select Aetna from your Health Plans menu, and then find "Payment Estimator" in your Transaction menu.  Based on data that you enter, the estimator will show:

• Aetna's contractual adjustment and other non-covered amounts
• Patient responsibility amounts
• Aetna's estimated payment to the provider
• Adjustment reason codes and explanatory text

Click here for additional information about obtaining payment estimates.  

For Members

A similar tool uses accesses benefits plans and fee schedules to generate estimates of members' financial responsibility.

Estimates for members may differ from those for providers.  For members, estimates are based on non-technical descriptions of services and procedures, as well as on historical claim data for costs typically associated with those descriptions.  Provider estimates are based on actual procedure and revenue codes.  However, both are intended as reliable estimates, not exact costs.

Click here for additional information about the member payment estimator.