Why Pay More When the Quality is the Same?

Call Aetna 800-367-6276 to see what maximum allowable amount applies to a procedure you need.

Why pay $15,000 for a colonoscopy at a hospital when the same colonoscopy at a digital imaging center is $5,000 cheaper and just as reliable?

Ditto for CT scans, MRIs, endoscopies, hernia and cataract surgeries, tonsillectomies and other common medical procedures.

Price limits

That’s where maximum allowable amounts enter the picture. They are price limits the Exchange’s health insurance plan will pay for common outpatient procedures; you’ll pay anything above the limits.

So if you get a colonoscopy for $15,000, the insurance will pay a $10,000 limit; you’ll pay $5,000. By going to cheaper diagnostic imaging clinic, your insurance plan—and you—will pay less.

Shop around

Call Aetna, 800-367-6276, to talk about what maximum allowable amount applies to a procedure you must get.

Such limits were introduced in 2015 because of little or no quality variation, regardless of what facility in which the procedures are performed. However, costs from one area to another vary widely.

So, like you would for a vehicle, shop around for healthcare services. Use the Member Payment Estimator on Aetna.com for costs at each location, plus how much the plan and you will pay.