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The Future of Healthcare Price Transparency – What’s Changing and Why It Matters for Healthcare SaaS (Part 1)

  • Writer: Mary McKee
    Mary McKee
  • Feb 26
  • 3 min read

Why Healthcare Price Transparency Is More Important Than Ever


Imagine trying to book a flight without knowing the ticket price until you landed. That’s been the reality of U.S. healthcare for decades—patients receive care without clear pricing, only to be blindsided by surprise bills later.


Price transparency is about making costs visible so that patients can make informed decisions. While this effort includes hospitals and insurers publishing rates, these articles focus on getting cost estimates into patients’ hands before care is provided.


The movement toward transparency has gained traction, but real-world implementation remains complex. Here’s what’s happening now—and what’s next.


Doctor thinking


Major Developments in Price Transparency Policy


1. The Trump Administration’s Renewed Focus on Enforcement


In February 2025, President Trump signed an executive order to accelerate enforcement of healthcare price transparency rules. These regulations, introduced during his first term, require hospitals and insurers to disclose actual prices—not just estimates.


What’s the goal?

  • Make pricing fully transparent across hospitals, insurers, and prescription drugs.

  • Lower healthcare costs by allowing patients to compare prices before choosing care.

  • Increase compliance with existing rules that many providers have been slow to adopt.


While these regulations have been in place for a few years, many hospitals and insurers have failed to comply—this renewed enforcement push aims to change that.



2. Good Faith Estimates (GFE) vs. Advanced Explanation of Benefits (AEOB): What’s Required Now?


One of the most significant advancements in price transparency is the requirement that patients receive cost estimates before care is provided. But there’s an important distinction between Good Faith Estimates (GFEs) and Advanced Explanations of Benefits (AEOBs)—and between what's required for insured vs. uninsured patients.


✅ For Uninsured Patients:

  • Good Faith Estimates (GFEs) are currently being enforced.

  • Providers must give uninsured patients a cost estimate before treatment for services covered by the No Surprises Act.

  • Patients can dispute bills if the final charge is significantly higher than the estimate.


⏳ For Insured Patients:

  • The GFE requirement exists but isn’t being enforced yet for insured patients.

  • Once enforced, providers will send GFEs to insurers, who will then generate an Advanced Explanation of Benefits (AEOB) detailing:

    • The negotiated rate for the service

    • The patient’s out-of-pocket responsibility

    • Whether the service is in-network or out-of-network

  • CMS has delayed enforcement, so insurers and providers are not yet required to comply.



In short: Uninsured patients are already benefiting from GFEs, but insured patients won’t receive cost estimates until enforcement begins.



3. HL7 Da Vinci PCT Workgroup: The Tech Behind Transparency


Policy is one thing, but making transparency work requires the right technology. That’s where the HL7 Da Vinci Patient Cost Transparency (PCT) Workgroup comes in.


This group is developing the technical standards that will allow providers, insurers, and health tech platforms to seamlessly exchange pricing data.


Key priorities include:

  • Creating FHIR-based standards for price transparency data exchange

  • Helping providers send Good Faith Estimates (GFEs) to insurers

  • Structuring Advanced Explanation of Benefits (AEOBs) for patients


Their first implementation guide is live, and the next phase will focus on multi-provider estimates—essential for patients who need coordinated care from multiple specialists.


Challenges Slowing Progress


While these policies represent major steps forward, real-world execution still faces hurdles:


🚨 Hospital Compliance Is Low – Many hospitals haven’t fully adopted transparency rules, and enforcement has been weak.

🚨 Data Standards Need Unification – A lack of standardized pricing formats makes data-sharing messy.

🚨 Interoperability Gaps Exist – Healthcare IT systems still struggle to communicate effectively.

🚨 Provider Confusion – Many providers misunderstand Good Faith Estimate (GFE) requirements, leading to inconsistent implementation.


What’s Next? The Path to Meaningful Transparency


Despite these challenges, momentum is building. Expect to see:


✔ Stronger enforcement of hospital and insurer compliance

✔ Improved data-sharing technology for pricing estimates

✔ More patient-friendly tools that simplify cost comparisons


Price transparency isn’t just a regulatory hurdle—it’s a fundamental shift toward patient empowerment. While execution is still catching up, the days of surprise medical bills are numbered.


🚀 Want to stay ahead of healthcare tech trends? Follow along as we break down the latest updates on healthcare SaaS, AI, and industry innovation.


 
 
 

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