When Healthcare Prices Disappear, Prevention Becomes a Luxury
On paper, healthcare prices in the United States are no longer supposed to be a mystery.
Since 2022, federal rules have required commercial health insurers to disclose the prices they negotiate with hospitals and physicians — a long-awaited attempt to bring transparency to one of the most opaque sectors of the economy.
But a recent analysis suggests that when patients, employers, and policymakers look closely, the numbers they need most are often missing.
The transparency that stops where care gets serious
According to a new study published in the American Journal of Managed Care, three of the nation’s largest insurers — UnitedHealthcare, Aetna, and Cigna — provided incomplete pricing data in their required disclosures.
The gaps are not random.
Prices are frequently available for routine, high-volume procedures, such as common orthopedic surgeries. But when the analysis examined hospital outpatient and inpatient services — the categories that drive the highest costs and the greatest financial uncertainty — the picture changed.
In one case, an insurer disclosed pricing for nearly all common orthopedic procedures, yet reported prices for only a small fraction of inpatient hospital codes.
In other words: the moment care becomes complex, transparency thins out.
Why that matters more than it sounds
For employers trying to select health plans, these disclosures are meant to be a decision-making tool. For families, they are supposed to reduce surprise bills and allow some level of planning.
Incomplete data undermines both.
“You can’t compare what you can’t see,” said one health policy analyst familiar with employer purchasing decisions. “And the services missing from these files are often the ones that bankrupt people.”
Hospital-based care is where prices vary most dramatically — and where negotiated rates can differ by multiples, not percentages. Without visibility into those prices, the promise of market discipline collapses.
Insurers say they comply. Regulators haven’t pushed back.
The insurers named in the analysis dispute the implication that they are falling short. UnitedHealthcare and Cigna maintain that they meet or exceed federal transparency requirements and continue to improve data quality. Aetna’s parent company did not respond to requests for comment.
The study itself acknowledges that large volumes of data are publicly available and that compliance has improved since the rules were introduced.
But enforcement remains limited.
The Centers for Medicare and Medicaid Services (CMS) has not taken direct action against insurers for incomplete disclosures, and federal regulators have previously indicated that states would serve as the primary enforcers of the rules.
The result is a familiar dynamic in healthcare policy: rules exist, data exists, but accountability is diffuse.
The deeper problem isn’t data — it’s incentives
The gaps in price transparency point to something more fundamental than technical compliance.
The U.S. healthcare system is not designed around early clarity or early action. It is designed around downstream billing.
Preventive care — screenings, early diagnostics, longitudinal monitoring — often sits in an uncomfortable gray zone. It saves money over time, but not necessarily within a single plan year. It prevents emergencies, but doesn’t generate large claims.
Hospitalizations do.
And so the system functions efficiently at paying for illness, while struggling to make prevention visible, accessible, or predictable.
When prevention becomes optional, alternatives emerge
This dynamic helps explain a broader shift happening quietly across healthcare.
As pricing remains opaque and preventive care remains fragmented, patients and clinicians are increasingly turning to cash-pay, membership, and hybrid care models — not as a rejection of insurance, but as a way around its blind spots.
In these models, prices are known upfront. Time is not constrained by billing codes. Preventive decisions can be made without waiting for symptoms to escalate into claims.
Their growth is often described as “disruption.” In reality, it is adaptation.
A system that reacts instead of preventing
Transparency rules were meant to empower consumers. But transparency without completeness doesn’t empower — it frustrates.
And a system that only reveals costs after care becomes acute sends a clear message: prevention is optional, illness is inevitable.
Until pricing is clear where it matters most — and until prevention is treated as a core function rather than a peripheral benefit — patients will continue to seek clarity elsewhere.
Not because they want alternatives.
But because the system leaves them little choice.
