Insurers are publishing incomplete price transparency data, with hospital inpatient information particularly sparse, according to a study published in the American Journal of Managed Care in December.
Researchers from Simple Healthcare analyzed 2025 Transparency in Coverage files from Aetna, Cigna, and UnitedHealthcare (downloaded in the second quarter of 2025) to assess how complete the data are at both the provider network and billing code level. The study was funded by the Peterson Center on Healthcare.
The researchers compared the number of providers in each insurer’s TIC files against counts from marketing materials, and calculated what percentage of the 100 most common billing codes for three physician specialties (cardiology, family practice and orthopedic surgery) and hospital outpatient settings had negotiated rates. For hospital inpatient, they assessed all 771 DRG codes. They excluded rates outside a reasonable range (50% to 800% of Medicare rates) and limited physician analysis to groups with at least 10 physicians.
Eight notes:
- Aetna and Cigna generally listed as many or more providers in their TIC files as their marketing materials claimed. UnitedHealthcare listed significantly fewer, with its TIC data showing only 47.2% of the 1.7 million physicians it advertises, and 39.8% of its 7,000 contracted hospitals.
- UnitedHealthcare had the most complete physician data, with mean completeness above 95% for cardiology, family practice and orthopedic surgery. The company’s hospital inpatient data was the weakest of all three insurers, with the median hospital having negotiated rates for just 2% of DRG codes.
- Cigna had strong physician specialty data (89% to 90% mean completeness) and good hospital inpatient completeness (81.2% mean), but very limited hospital outpatient rates. The median hospital outpatient facility had data for only 4% of common codes.
- Aetna showed moderate to good physician completeness (70% to 86% mean across specialties), mid-range hospital outpatient data (51.3% mean), and uneven inpatient results. More than half of hospitals had complete data, but the bottom quarter had rates for only 11% of codes or fewer.
- No insurers have been publicly fined or penalized by CMS for failing to comply with transparency requirements. In comparison, 27 hospitals have been fined for alleged price transparency violations.
- The authors recommend that CMS develop standardized auditing plans to evaluate TIC data completeness and perform periodic accuracy checks.
- The White House released an executive order in February 2025 calling for stronger price transparency initiatives, and the departments of HHS, Labor, and Treasury released updated guidance in May 2025 to improve TIC data quality and usability. The departments are tasked with ensuring hospitals and payers disclose actual prices, not estimates, and take action to “make prices comparable across hospitals and insurers, including prescription drug prices.”
- UnitedHealthcare spokesperson: “We have long been an industry leader in providing clear, complete and actionable data so people can make informed decisions about their health care, including meeting or exceeding federal Transparency in Coverage (TIC) requirements.”
