Price is wrong: We need to solve the health insurance transparency crisis

You will confirm immediately when ordering groceries. You track Uber when you turn. Before booking, you know the cost of a hotel room. These are the digital expectations we rely on.

However, when it comes to our health, we are still in the dark.

Modern digital experiences can help people feel informed, understood and controlled. In healthcare, the most important thing is that this experience is still painful.

In the United States, many people are still struggling to find care, book an appointment, confirm coverage, or get clear answers on pricing. The impact exceeds inconvenience, leading to delayed diagnosis, increased anxiety, and financial stress that harms patients and the healthcare system.

Digital health companies have made progress and expanded access, but the insurance process remains outdated. As a result, patients often lack visibility into what is covered and what is going to be owe. Chaos is common. 77% of Americans don’t understand basic insurance terms, such as Copay, co-insurance and deductions. 58% of insured persons experienced problems using coverage, including network mismatch, authorized pre-trial and refusal to claim refusal to interrupt care.

We won't fill the gas tank without knowing whether it costs $1 or $100 per gallon. This level of unpredictability is a reality in medical billing. Nearly half of American adults struggle to afford care, six out of six are recommended for treatment, and three out of ten are paid more than they expected, and it’s time to make patients clearer. This clarity depends on immediate, automated and insurance checks integrated into the care process, such as obtaining a price estimate when booking a trip.

However, progress towards a more consumer-friendly healthcare experience is slow and there is still a lot of room for improvement. Even in areas where providers are available, high costs and long waiting times can prevent people from seeking timely treatment. Despite the emergence of innovations in scheduling, virtual care and clinical documentation, there are major obstacles in insurance workflows.

Two factors that set these obstacles. One is the sheer complexity of the provider and payer contract. Another is an outdated revenue cycle system that requires employees to manually collect information from multiple portals, delay verification and increase the likelihood of rejection.

These problems have serious consequences: 41% of adults who delay care due to reported deterioration in health conditions.

We have improved the experience for all other consumers. Now, the same standard must apply to healthcare.

Insurance qualifications and price transparency life

What should Does health care look like? When booking an appointment, patients immediately confirm that their visit has been covered and conduct a clear cost estimate. This is possible when providers built-in automated insurance verification in their scheduling systems, improving revenue predictability and reducing patient unshow rates.

In this simple case, patients feel less about their care and trust their care more, making them more likely to receive treatment because they will understand their payment responsibilities. On the provider side, this leads to higher completion rates, increased patient satisfaction and loyalty, and a competitive advantage in an increasingly experienced-driven market.

But to get there, we need to go beyond digital. Instead, we need actual consumer-friendly design. Unfortunately, the U.S. healthcare system is still running in the shadows. Patients don’t see transparency as “very happy”. They think it is a necessary condition for making an informed decision. In every other area of ​​life, people can see the cost of products or services, compare options and determine what is right for them. This does not exist in healthcare treatments, and even patients with insurance face anxiety about surprise bills.

While legislation like the 2021 hospital price transparency rule attempts to push the industry forward, compliance is at best a point. It lacks teeth and law enforcement, so it ignores rules, has little oversight, no real incentive to make insurance companies or providers prioritize transparency, and has little fines. This means that most patients are closer to understanding today’s cost of care today than before 2021.

The core reason for this failure is the architecture of the system, deliberately designed to be opaque. Insurance contracts vary widely between providers, plan types and regions. Each contract includes confidentiality clauses and different negotiation rates hidden by the public. Even if data is published, it is often buried in non-standard machine-readable files that require expensive software and data science teams to decode. Opacity payers, payers who maintain strategic controls, and providers who lack incentives, and technical tools to share prices with patients in digestible formats.

When strategically used, technology provides a way forward. Although adoption in the healthcare industry may be slow due to compliance and privacy requirements, tools that are suitable for sales teams can provide a more friendly front door for consumer therapy. For example, an AI voice agent can relieve overworked management teams and support patients by processing intake, verify benefits through real-time API calls, explain insurance coverage in simple language, and assist booking schedules. Companies like Cedar, Frescia and Port Health have proven that combining intelligent automation with understanding design can simplify operations and significantly enhance consumer experience. AI agents never miss calls, provide consistent explanations, and can extend support during peak periods. This is a model that puts patients first, and it is urgently needed by the industry.

But AI alone is not enough. To achieve true transparency, we need to address potential incentives. Currently, payers are confusing patients by rejecting claims and rejecting increased patients, thus maximizing their profit margins. Meanwhile, providers often lack regulatory motivation for change. Smart strategies may require transparency to align accountability across the industry. Regular audits, publicly available benchmarks and meaningful financial consequences of non-compliance all play a role in law enforcement. This might look like a healthcare version of nutrition labels for pricing: standardized, simple and universal.

We also need to empower consumers by showing them how much they spend before they walk through the door. When patients know what they are paying, they are more likely to engage in preventive care, adhere to treatment, and avoid expensive ED visits.

This vision is clear and the cost is known in advance, it has touched. But this requires that healthcare systems must adopt the same type of real-time automation infrastructure we expect in other industries. While there won’t be a transformation overnight, every hospital and clinic can begin by working with solutions that are more effective, more transparent and bring better experience to patients.

If we can track $20 packages in real time, we should be able to tell patients if their care is covered and how much they will cost before they walk through the door. No one should choose between caring for and taking unexpected bills. Now is the time to think of health care as what it is: one of the most important decisions we make as consumers.

Like every great consumer experience, it begins with trust, clarity and the front door, which is open, digital and built for the people who were originally intended to serve.

Photo: Weiyi Zhu, Getty Images

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