Understanding Pricing Transparency

Patients are paying 40% more out-of-pocket for medical procedures than they did just 5 years ago. Something needs to change.

Imagine getting a medical bill for a procedure you believed was fully covered, only to find unexpected charges. Navigating healthcare costs is challenging – even with insurance, the price of a doctor’s visit or treatment often remains frustratingly unclear. Recently, nearly 45% of insured U.S. adults reported receiving a surprise medical bill. Many face financial strain and uncertainty as a result. Recognizing this issue, the federal government introduced the Hospital Price Transparency rule in January 2021, requiring hospitals to publish cost data online. This effort aims to promote transparency, increase competition, and ultimately lower prices.

The Current Landscape: Progress, Challenges, and What's Next.

As patients, we are increasingly bearing the burden of rising healthcare costs. According to the Commonwealth Fund, deductibles in employer-sponsored plans more than doubled between 2008 and 2017, rising from $869 to $1,808. Even more concerning, only 62% of adults report feeling confident in their ability to afford healthcare.

Though most hospitals now publicly disclose their prices, this does not fully solve the problem. While price visibility has improved for insurance companies, Medicaid, and Medicare, it still fails to address the critical question: How much will patients actually pay out-of-pocket? 

Why Transparency Matters More Now Than Ever

Today, consumers are used to high levels of price transparency – from clothing to media services. As patients face rising out-of-pocket costs and turn to the internet for information, expectations around healthcare pricing are changing. Around 94% of Americans actively seek out health information online, taking more control over their healthcare decisions. 

At Citrus, we’ve developed patient-centric tools that empower individuals to search, validate, and compare costs for 6 million doctors and 95% of hospitals nationwide. Our models analyze billions of negotiated rates from thousands of hospitals, providing accurate estimates that factor in variables like treatment lines, location, and timing.

Real-World Impact: Delivering Results with Citrus

In April 2024, Citrus partnered with a direct primary care service in Maine to help patients navigate specialist referrals and care. One member used our Citrus Care Connect platform to find a pediatric cardiologist specializing in Postural Orthostatic Tachycardia Syndrome (POTS). By finding an in-network doctor who was the right fit, they saved $500 on a single visit – a cost reduction that translates to savings of $22,500 per 1,000 members. This partnership highlights how transparent, efficient care can drive significant savings while improving patient outcomes.