Transparency Revolution: Executive Order Demands Actual Prices, not Estimates

Imagine holding, in your very own hands, a smart phone that can show you “actual” prices for any procedure at any hospital across the Fruited Plains. Imagine further that you can select any hospital of your choice, click a button and discover how much your health plan will pay and how much you will pay, if any.

Then imagine the impossible………You need to see a doctor. Where do you go, how long will the wait be, and how much will it cost you? You enter “I need to see a primary care doctor in Zip Code 12345……….before you can say “What’s taking so long?” your smart phone springs to life with page after page of doctors. You select one nearest you and discover your plan will pay 100% of the visit. Intrigued, you press “Make Appointment” and instantly the screen springs into action once again. “Do you want 8:30 tomorrow morning or 2:15 tomorrow afternoon?

AI is changing the way we access and finance health care. Providers will no longer need to file claims. Instead they will be paid in real time, at the point of service. TPA’s will become a shadow of their former selves. Managed care networks will only exist in Websters Dictionary, 2026 edition.

Transparency Revolution: Executive Order Demands Actual Prices, not Estimates

MyHealthGuide Source: Christine Cooper, Benefits Pro (full text), 4/9/2025

Excerpts

The Healthcare Price Transparency Executive Order (released 2/25/2025) mandates that hospitals and insurers disclose actual health care prices—not estimates—with standardized, enforceable reporting.

For employers and self-funded plans, the new transparency mandates offer several key advantages, reshaping how health care costs are managed and controlled.

1. Strengthens cost management.

Clear, enforceable pricing disclosures give plan sponsors unprecedented visibility into actual negotiated rates. With access to this data, employers can identify excessive markups, spot discrepancies in provider billing and benchmark costs against competitors, Medicare rates or reference-based pricing models.

2. Supports long-term sustainability.

Employers are equipped to avoid unnecessary overpayments, reduce year-over-year spending volatility and reallocate resources toward employee wages, retirement benefits or business reinvestment. It’s more than a compliance obligation. It offers a foundation for building a benefits structure that is financially stable and competitive.

3. Opens the door to real cost reductions.

Research suggests that broad-based price transparency could lower health care costs by as much as 20% to 27% on commonly used services. Transparent pricing creates a competitive environment where hospitals and providers must justify their rates.

4. improves the employee experience.

The benefits to employees Standardized, upfront pricing tools—maintained by health plans—will give participants new visibility into what services will actually cost. Employees can compare rates for “shoppable” services before scheduling care, gaining greater predictability over their out-of-pocket expenses.

About the Author

Christine Cooper, founder and CEO of aequum LLC, is a transformative leader in the health care industry who is recognized for her pioneering spirit, dedication to positively move the needle for constituents in the self-insured community and assist and defend plans and patients. Cooper continues to bring technological advancements to the market space and has assembled a tech-driven team that effectively partners with TPAs, insurers, medical cost management companies and stop-loss carriers throughout the country. Visit aequumhealth.com.

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