Price Transparency With Gaps: Assessing the Completeness of Payer Transparency in Coverage Data
By David Muhlestein, Yuvraj Pathak
Key takeaways
This paper uses 2025 insurer machine readable files to evaluate completeness of data. The files examined in this study generally supported physician and hospital outpatient price analysis, but were inadequate for reliable inpatient benchmarking. Researchers compared provider counts and common billing-code coverage across three national insurers. The findings show why healthcare price comparisons need explicit checks for missing providers and services.
Summarized with AI
In this paper, the authors analyzed 2025 publicly available Transparency in Coverage (TIC) machine-readable files from three major national insurers — Aetna, Cigna, and UnitedHealthcare — to assess how complete the data are for physician, hospital outpatient, and hospital inpatient service lines. The analysis revealed wide variation by insurer and service type: Aetna and Cigna generally listed as many—or more—physicians and hospitals as their marketing materials did, whereas UnitedHealthcare listed fewer.
Physician specialties and outpatient hospital services were much more thoroughly documented; however, inpatient hospital data were often sparse or incomplete. The authors conclude that while TIC data today can support analyses of prices for physician and outpatient hospital services, they are inadequate for reliable inpatient benchmarking— and recommend that the Centers for Medicare & Medicaid Services (CMS) audit insurers’ TIC data and enforce compliance to improve data quality.