By JOE FEGHALI

Healthcare has become very good at producing disclosures. It is much less good at producing understanding.

A hospital posts a price file. A health plan publishes negotiated rates. A provider gives an estimate. A patient portal contains a document somewhere. A consent form is signed. The box is checked.

But the patient may still not understand what they are being asked to approve, what the likely cost pathway looks like, or what happens when treatment changes.

This is the quiet failure of healthcare transparency. We have spent years trying 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 care begins.

Price transparency matters. It is just not enough.

The next frontier is not whether healthcare can disclose more numbers. It is whether healthcare can explain what those numbers actually mean.

The price is rarely the product

Most consumer markets understand the difference between a price and a purchase. A flight price means one thing if it includes luggage and another if it does not. A construction quote means one thing if it includes materials, labor, permits, and cleanup, and another if each of those 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 only that prices are hidden. Sometimes the prices are visible. The problem is that the object being priced is unclear.

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, revision, complication, recovery, and sometimes a second opinion when the first pathway becomes confusing.

Yet transparency policy often focuses on isolated prices rather than the care pathway the patient is actually buying into.

CMS hospital price transparency rules and Transparency in Coverage rules were major steps compared with the old world of near-total opacity. But they do not automatically solve the patient’s real question: “What will this episode of care likely cost me, and what exactly is included?”

A machine-readable file may be useful to researchers, employers, regulators, or third-party tools. It is not necessarily useful to a patient deciding whether to proceed with surgery next month, start orthodontic treatment, deliver at one hospital rather than another, or move forward with a diagnostic workup that may trigger a chain of follow-up costs.

The file exists. The confusion remains.

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 or self-pay patients. Again, this is progress. Patients should not be asked to walk into care blind.

But an estimate can still fail if it behaves more like a legal artifact than a communication tool.

There is a difference between saying, “Here is our best estimate based on the information we have,” and saying, “Here is what this pathway includes, what it does not include, where uncertainty lives, and when you will be asked to make another decision.”

The first version discloses. The second version explains.

Healthcare tends to be more comfortable with the first.

Medicine is genuinely uncertain. A surgeon may not know exactly what will be required until the procedure begins. A pregnancy can become complicated. A diagnostic scan may reveal the need for more tests. A medication may fail and require an alternative. A dental implant plan may change after imaging or grafting needs become clear.

No serious person should expect healthcare to guarantee the unknowable.

But uncertainty should not be used as a shield against explaining the foreseeable. There are predictable points where costs often change. There are common exclusions. There are typical add-ons. There are follow-up needs that may not be optional in any meaningful clinical sense.

Patients do not need false certainty. They need honest uncertainty.

“Available” is not the same as “understood”

Healthcare’s favorite defense is that information is “available.” That usually means the patient could technically find it, request it, download it, read it, interpret it, and connect it with other pieces of information from other entities.

That is a very low bar.

Patients are not confused because they are lazy. They are confused because healthcare information is often fragmented by design. The hospital knows one part. The physician group knows another. The insurer has its own view. The lab has a separate bill. The anesthesiologist may be a different entity. The pharmacy benefit sits somewhere else. The patient is then expected to assemble the truth from pieces that were never designed to fit together cleanly.

This is how a transparent system can still feel 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 getting an MRI may know the scan price but not the downstream cost of specialist interpretation, follow-up imaging, or the procedure that the scan triggers. A patient starting a specialty medication may know the sticker price but not the real cost after formulary rules, prior authorization, copay assistance, deductible resets, or insurance changes.

Dentistry makes the issue especially visible because patients often pay directly and compare offers across clinics. But the problem is not unique to dentistry.

In dental care, two implant quotes may look 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 treats them separately. One veneer quote may include temporary restorations and planning, while another adds them later.

The lower number is not always the lower cost. Sometimes it is simply the less complete explanation.

That same pattern appears across healthcare: what looks cheaper may only be less bundled, less explicit, or less honest about what is likely to happen next.

Cost confusion changes care

This is not a paperwork problem. It changes patient behavior.

KFF has reported that many adults skip or postpone needed healthcare because of cost, with the burden especially severe among uninsured adults and still significant among insured adults. When people do not trust the financial pathway, they delay. When they delay, conditions can worsen. When conditions worsen, treatment becomes more complicated and more expensive.

Then the system laments late presentation.

But late presentation is not only a clinical access problem. It is also a trust problem. Patients are more likely to move forward when they understand what they are committing to. They are more likely to avoid care when the first number feels like the opening bid in a negotiation they do not understand.

Healthcare has spent a lot of time asking how to make patients better consumers. The harder question is whether healthcare has made itself possible to consume intelligently.

In many cases, it has not.

Quote transparency is the missing layer

The next phase of transparency should focus less on publishing more disconnected numbers and more on making the treatment quote understandable.

That does not mean turning clinicians 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 care pathway, not just the headline price. It should distinguish between included services, excluded services, likely add-ons, conditional costs, and true unknowns. It should make clear when a patient will be asked for new consent if the plan changes. It should show whether follow-up is part of the treatment or a separate financial event.

This would not only protect patients. It would protect good providers.

Right now, providers who explain costs carefully can look more expensive than competitors who advertise incomplete prices. The honest quote loses to the attractive fragment. That is a perverse incentive. A transparency standard should reward completeness, not punish it.

In my own work around dental cost transparency, the most important lesson has not been that patients need a single magic number. They do not. The lesson is that patients need to understand why numbers differ, what is inside them, and what questions remain before they commit.

That is true far beyond dentistry.

Healthcare transparency should not end at disclosure. It should end at comprehension.

Until then, the system will keep congratulating itself for publishing prices while patients continue asking the only question that really matters:

“What am I actually agreeing to?”

Dr. Joe Feghali is an orthodontist and founder of LumiQuest Dental Circle, an independent patient-guidance platform focused on helping patients compare dental care more safely and transparently.