Health plan price transparency still needs work, report finds

Wouldn’t it be nice if every patient could walk into a hospital and know exactly how much they’ll need to pay? It sure would. But we’re not there yet.

Price transparency legislation took effect for hospitals and health plans in 2021 and 2022, respectively, requiring them to publish previously proprietary negotiated rates for all medical services in clear, machine-readable files.

Audits have found many hospitals’ public files aren’t complete. An Oct. 29 report from Turquoise Health—a platform that aggregates and analyzes public pricing data from payers and hospitals—found payer files aren’t comprehensive, either.

“They’re reporting on so many entities and so many contracts, and there is a lot of complexity. If anything, it’s a little bit of an indictment into just how complicated the reimbursement landscape is,” Leland Robbins, Turquoise’s senior director of data product, said in an Oct. 27 press briefing.

A little confused, but they’ve got the spirit. The biggest issue, the report says, is that many payers list multiple rates for the same procedure, with no way to distinguish between them.

Of 97 payers analyzed, 28 gave “conflicting” rates for the majority of services. CVS subsidiary Aetna, for instance, did so for 57% of its listed services.

Aetna seemed to be the biggest offender among major insurers, compared to UnitedHealthcare (6%), Cigna (6%), and Anthem (16%).

CVS declined Healthcare Brew’s request for comment. But Robbins said during the briefing the company has been in touch with Aetna about its score, and the payer is working toward fixing this.

“I don’t think this is a case of them doing something purposefully to make it confusing,” Robbins said.

The report also checked payers’ machine-readable files for outliers, meaning obvious errors where something is clearly listed at the wrong price, like an organ transplant listed for a penny. Turquoise also tracked how many files it could successfully ingest, or parse, per payer per month, a metric that points to whether payers are making their files accessible.

These issues were rarer: Only about 10% of payers were flagged for having too many outlier prices and less than 10% were flagged for not being parsable.

The big picture. It’s important to ensure payer data is accurate because “insurers, not providers, create the algorithms that convert negotiated rates for services into actual prices that patients and employers pay,” Ariel Levin, the American Hospital Association’s director of coverage policy, told Healthcare Brew via email.

Turquoise Health Chief of Staff Carol Skenes hopes these data analyses can be a tool in the future for patients, payers, hospitals, and policymakers alike to make sense of the complex world of healthcare rates, she said during the briefing. The company has a product that incorporates both hospital and payer data plus reference data from other claims, Medicare, and Medicaid.

“There are a lot of gaps in the hospital files. There are a lot of gaps in the payer files. When you start to bring these things together…you can actually start to get a pretty good signal here of what the real truth is,” Robbins said.

In February, President Trump called for a makeover of price transparency efforts, accusing the rules of being “slow walked” by the last administration. Then in May, the federal government announced that technical requirements for payers’ machine-readable files were being updated, with the update finalized Oct. 1 and required starting Feb. 2, 2026.