by Jennifer Jane, BSN, RN
Healthcare is one of the few situations where you can agree to something without knowing the costs, only to then get a pile of surprise bills. That’s what cost transparency is meant to fix.
Studies have shown that only 13% of patients use a cost transparency tool to find out their out-of-pocket costs before receiving care, even though, since January 2019, providers have been required by federal law to post list prices (1), in 2021, they were required to post insurance-negotiated prices, and in 2022, federal law required health insurance plans to disclose the negotiated prices they pay doctors and facilities for each service they provide (2).
What cost transparency means
Cost transparency is the ability to understand, before you receive care, what you are likely to pay and why. It can get complicated because there are multiple prices for care — chargemaster rates (comprehensive retail prices for every service, medication, procedure, and supply a hospital provides), insurance company-negotiated rates, and cash prices. Your out-of-pocket cost depends on your insurance plan (deductible, copays, coinsurance, out-of-pocket max).
Without upfront price information, patients can’t compare their options or protect themselves from extreme price variation.
Cost transparency is price clarity and benefit clarity.
- Price clarity: What the hospital or clinic charges and what your insurance company pays
- Benefit clarity: What you pay, depending on your deductible, coinsurance, and out-of-pocket max
Why cost transparency matters
When people can anticipate costs, they can plan and budget for their healthcare, helping to limit financial harm from surprise medical bills and debt.
It matters because it can reduce:
- Financial shock from surprise bills
- Medical debt
- Delayed or skipped care due to fear of bills
- Stress from billing errors
- Time spent figuring out coverage and bills
What happens when there isn’t cost transparency
Without transparency, people are forced to make decisions in the dark, without essential price information.
Common consequences:
- Surprise bills and confusing, multi-provider billing, especially with expensive hospital care.
- Huge price variation for the same service, with no easy way to compare ahead of time.
- Tools that are hard to use or inconsistent. Hospital files can be posted in formats that are difficult for people to interpret.
- Low use of transparency tools because the information is often presented in a complicated way.
How to improve cost transparency
Cost transparency improves when we make prices findable, comparable, personalized, and enforceable:
System-level improvements:
- Stronger enforcement and clearer standards for the price data hospitals publish.
- Patient-friendly estimates that combine provider prices with benefit rules (deductible/coinsurance).
- Better tools for episodes of care, like pregnancy, where costs are spread out over months and across multiple billers.
What you can do:
- Ask for a good-faith estimate or written estimate before scheduled care.
- Request billing codes (CPT/HCPCS) in advance for planned services. Codes make estimates more precise.
- Confirm that all of your providers are in-network (hospital, doctors, labs, anesthesia, imaging, etc.)
- Keep a bill log: date, provider, claim ID, amount billed, insurer decision, what you paid.
How people can demand better transparency
Healthcare survives its secretive, confusing cost ways partly because it’s exhausting to challenge. But collective pressure helps change systems.
Ways to push the system:
- Tell your employer’s benefits team that you need better cost tools and clearer estimates for pregnancy and postpartum care.
- File complaints when required price tools aren’t available or estimates are refused.
- Leave public feedback (patient surveys, hospital reviews) specifically about billing clarity and estimate accuracy.
- Support policies and organizations pushing for stronger transparency enforcement and usable data standards.
Where Lyvona fits in
Lyvona knows that people don’t just need to find prices. They also need support and easy-to-use tools, especially in pregnancy and new parenthood.
Lyvona’s offers:
- Cost modeling (comparing birth scenarios and calendar year timing)
- A deductible calculator that shows how calendar-year timing changes what you pay
- Bill verification to flag potential errors (like duplicate charges or out-of-network issues)
- Community-based support and insight from real moms and real costs and bills.
Lyvona is the first and only of its kind support resource for pregnant and new moms, helping to make their healthcare less stressful and easier to understand.
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