Our provider payment estimator tool helps your office estimate how much your patients will owe for an office visit or procedure. And it approximates how much Aetna will pay for services. Plus, you can use it prior to a patient’s scheduled appointment or procedure.
The payment estimator is available to participating providers through our secure provider website, and through Availity.
After entering basic patient and claims information, the payment estimator uses your fee schedule and your patients’ benefits plans to:
This tool provides fee information for a sample scope of services that a doctor can provide. Contracted physicians can access fee schedules online on our secure provider website.* Fees displayed are based on contracted amounts negotiated for specified treatments. They reflect the amounts allowed for services as if Aetna is paying each ASA/CPT/HCPCS code on a line-by-line, fee-for-service basis.
Note that physician fee schedule information will not display accurate rates for care services provided to Aetna members who participate in an accountable care organization (ACO) arrangement. A member with an ACO arrangement will have a member ID card with an ACO logo and/or network name. Providers should use the provider payment estimator tool to estimate costs for these patients.
*Fee schedules are not available to an office classified as a hospital, ancillary or IPA/PHO; to an office with a billing set-up; or to behavioral health providers who are not MDs/DOs.