Imagine this: You schedule what should be a routine medical procedure. You confirm coverage with your insurer, check the hospital’s price estimator, and expect to pay around $1,400. Weeks later, the bill arrives and it’s $18,000. Your share? More than $5,000. That’s exactly what happened to Dani from South Carolina. And she’s not alone.
Every day, Americans are hit with unexpected medical bills because the healthcare pricing transparency rule is still lacking. A new executive order, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” aims to change that.
It provides a framework to ensure patients, employers, and insurers see real prices upfront—before care is delivered. It takes a strong stance on ending hidden healthcare costs.
Why Healthcare Pricing Transparency Has Been Failing
For years, hospitals and insurers have relied on complex pricing structures that leave patients in the dark about what their care will actually cost. While past rules like the healthcare pricing transparency rule (2021) and the Transparency in Coverage Rule for Insurers (2022) were intended to fix this, many organizations failed to comply. As of early 2023, only 21% of U.S. hospitals fully met federal transparency requirements.
Even those that did post prices often buried them in hard-to-find webpages or uploaded massive, unreadable spreadsheets. Meanwhile, insurers released machine-readable price files so large that they were nearly impossible to use. The result? Patients like Dani continued to face unpredictable medical costs.
What the New Executive Order Changes
This isn’t just another attempt at transparency; it’s an aggressive push for real, actionable pricing data that patients and employers can actually use. Here’s what’s different:
✅ Standardized Price Information: Right now, every hospital and insurer presents pricing differently, making it impossible to compare costs. This order pushes for a single, consumer-friendly format, reinforcing the healthcare pricing transparency rule so patients can shop for care.
✅ No More Estimates That Aren’t Accurate: Hospitals and insurers must disclose actual prices, not just vague estimates. If your hospital knows it will bill your insurer $5,000 for surgery, you’ll see that number upfront—no more surprises six months later.
✅ Stronger Enforcement: Hospitals and insurers that ignore these rules will face stricter penalties, with shorter timelines for compliance. CMS has already started cracking down, but this order ensures that price opacity is no longer tolerated.
✅ Expanded Transparency Beyond Hospitals: The order extends pricing requirements to labs, imaging centers, outpatient surgery centers, and more. Whether you need an MRI, a lab test, or an elective procedure, the healthcare pricing transparency rule ensures you’ll have pricing details before making a decision.
What This Means for You
For patients, this means fewer surprise bills and more control over healthcare spending. Cynthia’s story is another perfect example. After getting hit with an unexpected physical therapy bill, she started calling around for pricing on other services. She found that one hospital charged $1,039 for a mammogram, another $1,098, but an independent imaging center offered it for just $239.
Had transparent pricing been available from the start, Cynthia could have made an informed decision before getting stuck with an outrageous bill. The healthcare pricing transparency rule aims to make sure all patients have that opportunity.
Employers also stand to benefit. With access to real pricing data, businesses can negotiate better rates for employee health plans. The 32BJ SEIU union has already saved $100 million by using pricing transparency to push back on excessive hospital charges. Imagine what’s possible when all healthcare costs are transparent and comparable.
A Step Toward Smarter, More Affordable Healthcare
The healthcare pricing transparency rule alone won’t solve every issue in the system, but it’s a crucial step toward empowering patients and businesses to make informed choices.
At DSP Insurance, we believe that knowledge is power when it comes to managing healthcare costs. Whether it’s helping employers maximize price transparency in health plans or guiding individuals through coverage decisions, we’re committed to making sure our clients have the tools they need to make informed choices.
Transparency is long overdue. With this new executive order, we may finally see an end to hidden medical prices and, perhaps, a future where patients and businesses can take control of their healthcare spending.
Learn more at our Hidden Cost of Healthcare workshop on April 17th.
Real patient stories sourced from: PatientRightsAdvocate.org
