Aetna, paying 45 percent less than Medicare, is schooled on Twitter

Aetna pays 45 percent less than what Medicare pays, at least for one treatment in California. Aetna also pays half of what other insurers pay.

This is startling because a lot of the noise in the health-care marketplace is about low government reimbursement rates, via Medicare  (the federal program for the elderly and disabled) and Medicaid (the state/federal program for low-income Americans). Complaints about low government reimbursement rates seem to suggest, then, that private insurance companies pay more.

Well, not so true.

Mark Bertolini, the CEO of Aetna, tweets as @mtbert. He was excoriated lately on Twitter by a Southern California doctor tweeting as @NabiMD, who pointed out that Aetna pays 45 percent less than Medicare for a certain “medically necessary” vein treatment. @NabiMd explained to @mtbert why he was leaving Aetna’s embrace.

Since he has only 13 followers, we tripped across the conversation by accident, so we don’t know much more than what’s here, but it’s sure interesting. (Set aside for a second that 45 percent less than Medicare is murky and borderline innumerate — does that mean nearly half of the Medicare rate?)

Among the info: “Patients will be informed that Aetna pays me just about half of what every other insurance company does.” and “I’d like to thank Aetna for not only barely paying me, but also for making it impossible to fire them. What did you make this year,@Aetna ?”

Actually, because the negotiated or reimbursed rate for a given procedure is so hard to find — doctors agree in their contracts with insurers not to reveal prices, we understand — it’s hard to figure out, but we

guess this might be fairly widespread. The assumption that the government negotiated a low rate because it’s buying in bulk and is therefore entitled to a low rate seems to have led the insurers to negotiate even lower rates for themselves. The free market does work, but I would have to say that if this free market was transparent people would be shocked.

One of our favorite questions here is “how much does an MRI cost?”

The prices paid by insurers to various providers for our one benchmark procedures, the MRI of the lower back, without contrast, CPT code 72148, range from $400 (see this blog post about our friend in the billing office) to $2,300 (what my insurance company paid for my MRI). Here’s a list of cash or self-pay prices for that MRI in the New York area.

You need to read from the bottom to get the full sense of @nabimd’s unhappiness.

We’ll look into it and get back to you.

Oh, and Aetna was slapped around for an excessive rate increase request in California earlier this year.