Price transparency with gaps: assessing the completeness of payer Transparency in Coverage data

To assess payer-level completeness of 2025 Transparency in Coverage (TIC) negotiated-rate files for physician, hospital outpatient, and hospital inpatient service lines.

Cross-sectional descriptive review of 2025 TIC releases from 3 national payers (Aetna, Cigna, and UnitedHealthcare).

We created cleaned analysis files by ingesting machine-readable files and parsing and deduplicating TIC data sets for the major national plan of each insurer. We compared the network size from the TIC files against marketing materials that reported how many physicians and hospitals were in-network. We calculated what percentage of the most common billing codes had negotiated rate data for large family medicine, cardiology, and orthopedic surgery physician groups, hospital outpatient departments, and inpatient hospitals.

Aetna and Cigna generally listed as many-or more-physicians and hospitals as their marketing materials did, whereas UnitedHealthcare listed fewer. Negotiated-rate completeness was highest for physician specialties and lowest-often minimal-for inpatient files. UnitedHealthcare's physician groups were near complete, but inpatient data were sparse. Cigna showed high completeness for physician specialties and inpatient data, but limited hospital outpatient rates. Aetna demonstrated moderate to good physician completeness, midrange outpatient hospital data, and heterogeneous inpatient results. Overall, physician and hospital outpatient data were typically usable; inpatient data were insufficient.

For these payers, 2025 TIC files support analysis of physician and hospital outpatient prices but are inadequate for inpatient benchmarking. CMS should evaluate TIC completeness-internally or via an external auditor-and enforce penalties when required information is not published.