By JOE FEGHALI
Healthcare has become very good at producing disclosures. It is much less good at producing understanding.
A hospital publishes a price file. A health plan publishes negotiated rates. A supplier gives a quote. A patient portal contains a document somewhere. A consent form is signed. The box is checked.
But the patient may not yet understand what they are being asked to approve, what the likely cost path is, or what happens when treatment changes.
This is the silent failure of transparency in healthcare. We have been trying for years to make prices more visible. That was necessary. But visibility is not the same as usability. A price that exists somewhere is not the same as a patient understanding the financial commitment they are making before beginning care.
Price transparency matters. It’s just not enough.
The next frontier is not whether healthcare can reveal more numbers. It’s about whether healthcare can explain what those numbers really mean.
The price is rarely the product.
Most consumer markets understand the difference between a price and a purchase. The price of a flight means one thing if it includes luggage and another if it doesn’t. A construction quote means one thing if it includes materials, labor, permits and cleaning, and another if each of them becomes an add-on.
Healthcare often asks patients to make decisions with less clarity than they would expect in much simpler markets.
The deeper problem is not just that prices are hidden. Sometimes the prices are visible. The problem is that the object being priced is not clear.
A patient does not experience healthcare as a billing code or a machine-readable file. A patient experiences healthcare as a journey: consultation, diagnosis, imaging, procedure, medication, facility involvement, follow-up, review, complication, recovery, and sometimes a second opinion when the first path becomes confusing.
However, transparency policy often focuses on isolated prices rather than the path of care the patient is actually purchasing.
CMS’s hospital price transparency rules and coverage transparency rules were important steps forward from the old world of near-total opacity. But they don’t automatically resolve the patient’s real question: “How much is this episode of care likely to cost me and what exactly does it include?”
A machine-readable file can be useful for researchers, employers, regulators, or third-party tools. It is not necessarily helpful for a patient to decide whether to proceed with surgery next month, begin orthodontic treatment, give birth in one hospital instead of another, or move forward with a diagnostic study that can trigger a chain of follow-up costs.
The file exists. The confusion persists.
Estimates can become compliance theater
The No Surprises Act moved the discussion in the right direction by making good faith estimates part of the conversation for uninsured and self-pay patients. Once again, this is progress. Patients should not be asked to come to the care center blind.
But an estimate can still fail if it behaves more like a legal artifact than a communication tool.
There’s a difference between saying, “Here’s our best estimate based on the information we have,” and saying, “Here’s what this path includes, what it doesn’t include, where you live in uncertainty, and when you’ll be asked to make another decision.”
The first version reveals it. The second version explains it.
Healthcare tends to be more comfortable with the former.
Medicine is truly uncertain. A surgeon may not know exactly what will be needed until the procedure begins. A pregnancy can be complicated. A diagnostic scan may reveal the need for further testing. A medication may fail and require an alternative. A dental implant plan may change after the images or graft become clear.
No serious person should expect healthcare to guarantee the unknown.
But uncertainty should not be used as a shield to explain the foreseeable. There are predictable points at which costs change frequently. There are common exclusions. There are typical plugins. There are monitoring needs that may not be optional in any meaningful clinical sense.
Patients do not need false certainties. They need honest uncertainty.
“Available” is not the same as “understood”
The favorite defense of health care is that information is “available.” Typically, that means the patient could technically find it, request it, download it, read it, interpret it, and connect it to other information from other entities.
That’s a very low bar.
Patients are not confused because they are lazy. They are confused because health information is often fragmented by design. The hospital knows part of it. The group of doctors meets another. The insurer has its own opinion. The laboratory has a separate invoice. The anesthesiologist may be a different entity. The pharmacy benefit lies elsewhere. The patient is then expected to piece together the truth from pieces that were never designed to fit neatly together.
This is how a transparent system can appear opaque.
A maternity patient may know the hospital’s posted charge but not understand how anesthesia, neonatal care, complications or out-of-network professionals could change the final bill. A patient undergoing an MRI may know the price of the scan, but not the subsequent cost of a specialist’s interpretation, follow-up imaging, or the procedure that triggers the scan. A patient starting a specialty medication may know the label price but not the actual cost after formulary rules, prior authorization, copay assistance, resetting deductibles, or insurance changes.
Dentistry makes the problem especially visible because patients often pay directly and compare offers between clinics. But the problem is not exclusive to dentistry.
In dental care, two implant quotes may seem comparable, while one includes the crown and the other only includes the surgical placement. One orthodontic plan may include retainers, refinements, and follow-up visits, while another addresses them separately. One veneer quote may include temporary restorations and planning, while another adds them later.
The lowest number is not always the lowest cost. Sometimes it is simply the least complete explanation.
The same pattern appears across healthcare: What seems cheaper may just be less bundled, less explicit, or less honest about what is likely to happen next.
Cost confusion shifts care
This is not a paperwork problem. Changes the patient’s behavior.
KFF has reported that many adults skip or postpone necessary medical care due to cost, with the burden being especially severe among uninsured adults and still significant among insured adults. When people don’t trust the financial path, they delay it. When they are delayed, conditions can worsen. When conditions worsen, treatment becomes more complicated and more expensive.
Then the system regrets the late submission.
But late presentation is not just a clinical access problem. It’s also a trust issue. Patients are more likely to move forward when they understand what they are committing to. They are more likely to avoid worrying when the first number seems like the opening offer in a negotiation they don’t understand.
The healthcare industry has spent a lot of time asking how to make patients better consumers. The more difficult question is whether healthcare has made smart consumption possible.
In many cases, this is not the case.
Quote transparency is the missing layer
The next phase of transparency should focus less on publishing more disconnected numbers and more on making treatment pricing understandable.
That doesn’t mean turning doctors into accountants or forcing providers to predict every possible complication. It means creating a clearer standard for financial communication before care begins.
A usable quote should explain the path of care, not just the headline price. You must distinguish between included services, excluded services, likely add-ons, conditional costs, and true unknowns. You should make it clear when the patient will be asked for new consent if the plan changes. You must show whether the follow-up is part of the treatment or a separate financial event.
This would not only protect patients. It would protect good suppliers.
At this time, suppliers who explain costs carefully may appear more expensive than competitors who advertise incomplete prices. The honest quote loses to the catchy snippet. That’s a perverse incentive. A transparency standard should reward integrity, not punish it.
In my own work around dental cost transparencyThe most important lesson has not been that patients need a single magic number. They don’t. The lesson is that patients need to understand why the numbers differ, what’s inside them, and what questions remain before committing.
This is true far beyond dentistry.
Transparency in healthcare should not end with disclosure. It should end in understanding.
Until then, the system will continue to pat itself on the back for publishing prices while patients continue to ask the only question that really matters:
“What am I really accepting?”
Dr. Joe Feghali is an orthodontist and founder of LumiQuest Dental Circlean independent patient guidance platform focused on helping patients compare dental care more safely and transparently.
