Turquoise Health Details Payer Price Transparency Scores for 2025

Turquoise Health released its 2025 impact report evaluating machine-readable file quality and payer price transparency across 97 health insurance payers. The report highlights ten key findings related to data transparency, including conflicting rates, outlier data, parsability, and payer coverage. Conflicting rates—where multiple prices for the same service lack clear differentiation—remain a significant issue, with nearly a third of scored payers having over 50% conflicting rates. Some payers, including WellSense Health Plan and Healthfirst NY, exhibit near-total conflicting data in their files. While outlier rates are less frequent, they still present challenges for about 6% of payers, with extreme examples of rates vastly exceeding Medicare benchmarks. Most surgical HCPCS codes make up these outliers, underscoring discrepancies between commercial payer reimbursements and Medicare standards. File parsability is generally strong industry-wide, with Turquoise successfully parsing 94% of tracked files, although a few payers exhibit low parsability rates. Large national insurance carriers demonstrate generally high transparency metrics. UnitedHealthcare, Cigna, Anthem, and Aetna show variation in parsability and conflicting rates, with Aetna displaying higher conflicting and outlier rates despite high parsability. Provider coverage also varies, with UnitedHealthcare and Aetna capturing the largest portions of Net Patient Revenue among major payers. The analysis reveals substantial disparities among Blue Cross Blue Shield affiliates in hospital and ambulatory surgery center coverage and data quality, ranging from excellent to poor ratings. Furthermore, the report identifies a significant data gap regarding stop-loss and outlier reimbursements, estimating these omissions represent over $100 billion in unreported high-acuity care costs. This comprehensive evaluation by Turquoise Health underscores ongoing challenges in payer price transparency, particularly in data consistency and completeness. It highlights the importance of improving machine-readable file quality to enable accurate market analysis, regulatory compliance, and enhanced healthcare cost transparency. The report's findings serve as a critical reference for payers, providers, and policymakers aiming to improve transparency standards and data reporting practices in the U.S. health insurance industry.