Why Transparency Matters in Healthcare
Healthcare providers across the United States are facing mounting pressure from regulatory changes, billing challenges, and rising patient expectations. For many private practices, these changes feel like a constant burden. Yet, in the midst of this shifting landscape, one recent regulation, the No Surprises Act (NSA), may hold more opportunity than frustration. By rethinking patient payment management, practices can reduce bad debt, strengthen provider–patient relationships, and improve long-term trust.
What is a Good Faith Estimate in Healthcare?
The NSA was introduced to protect patients from unexpected medical bills, especially in situations where they had little choice over their provider. A key part of the law is the Good Faith Estimate (GFE).
Today, GFEs are required for uninsured and self-paid patients, providing them with an upfront cost breakdown before treatment. For providers, this requirement is a proven way to improve billing efficiency while calming financial anxiety and strengthening patient engagement.
Some view NSA as another compliance requirement. But it catalyzes improved financial performance. With the right tools and approach, private practices can transform Good Faith Estimates (GFEs) from a box to check into a strategy that strengthens revenue, patient trust, and overall provider–patient relationships.
Change is also on the horizon. Federal agencies are already working to expand GFE requirements to include insured patients. Once this takes effect, nearly every healthcare provider—large or small—will need to integrate estimates into their daily workflows.
This change signals a new era for private practices in handling patient billing and cultivating trust.
The Financial Problem Practices Face Today
51–60% of patient balances are never paid.
The average U.S. family deductible exceeds $4,000.
Each paper bill costs $3–$5 to process.
Even without new regulations, billing is one of the toughest challenges for private practices. Paper-based statements take staff time and mailing costs. Patients delay or avoid payments because they are unsure of what they owe. And once the bill ages past 90 or 180 days, payment rates fall quickly. This means that around half of these aged receivables are unlikely to be collected in cash.
Roughly 70% of charges are paid after 90 days, dropping to less than 30% after 180 days, which causes significant yearly write-offs for many healthcare practices.
In fact, many practices lose significant revenue every year simply because patients never receive clarity about costs upfront. While compliance fines are a concern, the bigger issue is the steady leakage of unpaid balances that quietly erode financial stability.
And the problem is only growing. More than half of providers report that 51–60% of patient balances are never paid, and with the average U.S. family deductible now exceeding $4,000 in employer-sponsored plans, patients face larger bills than ever (KFF).
This is where pricing transparency in healthcare becomes critical. When patients know what to expect, they are far more likely to pay their bills and continue treatment without delay.
Research and Case Studies
Case Studies Show Proven Results
Cedar survey: Over 50% of patients who got estimates were willing to pay before care.
TransUnion: 70% of patients said estimates helped them budget.
Banner Health: Increased payments by $17.8M within two years.
Research shows that patients are more likely to pay when they understand their costs ahead of time. According to PubMed Central (PMC, 2022), patients tend to have greater trust in their clinicians when they can openly discuss healthcare costs during their appointments. Similarly, prior studies indicate that patients prefer having cost information beforehand during medical visits. A study in (2021) reported that 92% of patients wanted to know their expected out-of-pocket expenses before treatment, 81% wished to discuss costs with their doctor, and 76% felt comfortable doing so. This shows that patients are generally open to including cost considerations in their healthcare decisions, highlighting the need to understand their views on how costs affect care choices.
In our recent white paper, our CEO, Jeremy Shiner, noted that transparency drives faster, more reliable patient payments. Patients consistently report that knowing costs before treatment reduces stress and helps them plan their finances. Upfront estimates make them more likely to schedule care promptly and complete recommended treatment plans, improving both outcomes and satisfaction.
Cedar’s national survey in 2024 shows that over half of patients who received estimates were willing to pay before their visit. TransUnion also found that 70% said knowing costs ahead of time helped them budget. Banner Health even reported a $17.8M increase in point-of-service payments within two years.
Clearly, an effective way to collect patient payment outcomes is to provide patients with clear information about their financial responsibilities before treatment.
Lessons from Dentistry: The Transparency Advantage
The dental industry provides a compelling example of how upfront cost transparency can drive revenue. Dental insurance has historically followed a predictable structure: preventive care often has no coinsurance, basic procedures are typically 20%, and major procedures are around 50%. By contrast, medical insurance has seen a dramatic rise in patient cost-sharing: in 2012, only 27% of plans included coinsurance, climbing to more than 63% by 2023 (Kaiser Foundation). With higher deductibles and out-of-pocket costs, patients are facing larger bills and an increased risk of unexpected charges.
Administrative costs are significant. According to the U.S. Department of Health and Human Services, each paper statement costs $3–$5 in staff time, materials, and postage. Payment rates drop sharply as balances age only 70% of charges are recovered after 90 days, and less than 30% after 180 days. With credit bureaus no longer reporting healthcare debt, payments become even harder, compounding losses through treatment abandonment, patient churn, and reputational damage.
While revenue cycle management often focuses on insurance collections, the majority of bad debt originates from patient balances. Studies show that 51–60% of medical bad debt comes from patients (Crowe LLP), with some practices reporting that up to 10% of total balances are written off (Kaiser Family Foundation, Health Care Debt Survey). This highlights the growing financial impact of unresolved patient bills on healthcare providers.
The success of dental practices lies in their proactive approach. After consultations, dentists create comprehensive treatment plans with detailed cost estimates and offer flexible payment options. This long-standing workflow functions as an informal GFE and has been standard for decades. In contrast, medical practices have traditionally relied on co-pays and post-service billing, which increases uncertainty and unpaid balances. Recent trends show that medical groups are beginning to adopt flexible payment options (41% in the last year), but the full benefit requires pairing accurate estimates with transparent pricing upfront.
The dental model demonstrates that clear, early communication about costs not only protects patients from unexpected bills but also strengthens provider revenue. Emulating this approach in medical practices, combined with the GFE framework, offers a proven pathway to reduce bad debt, improve patient experience, and create sustainable financial outcomes for providers.
This proactive approach calms concerns and reassures patients before treatment begins.
The CMS Proposal vs. Reality
The Centers for Medicare and Medicaid Services (CMS) has suggested a complex model where providers send GFEs to insurers, who then generate an Advanced Explanation of Benefits (AEOB) for the patient before care is given. While well-intentioned, this mirrors the claims adjudication process and would create new delays and administrative burden. Even the American Medical Association has cautioned that this approach is unrealistic.
Patients could face slower access to care, and practices could face more red tape. A more practical approach, already working in self-pay and dental care, is for providers to deliver estimates directly to patients. Then attach the estimate to the insurance claim for auditing after the fact. This makes patient payments in medical billing faster and clearer. It also makes healthcare accessible to patients.
With the expansion of GFEs to insured patients on the horizon, practices that adopt digital will gain a competitive advantage. Adopting digital means automating patient data collection and reducing staff burden. It also makes patient feedback collection easier and overall improves communication.
Early adoption is also a great factor that positions practices to deliver exceptional patient experiences in an increasingly patient-responsible healthcare environment.
The Winning Formula for Practices
As outlined in Jeremy Shiner’s white paper, the opportunity can be distilled into three pillars:
Transparency
Give patients clarity on what they will owe.
Accuracy
Use real-time eligibility and benefit data, including deductibles, coinsurance, and negotiated rates.
Accessibility
Present costs in simple language, with flexible patient balance services such as installment plans or online portals.
Together, these create a system that improves patient engagement, strengthens trust, and accelerates payments. Patients consistently say that calming and reassuring an anxious patient can be facilitated by knowing what to expect, both medically and financially.
How to Make Healthcare in the U.S. More Accessible
The conversation about pricing transparency in healthcare ties directly into broader questions about how the U.S. healthcare system can be improved. Accessibility goes beyond affordability. It includes clarity, convenience, and trust.
Ways to improve healthcare accessibility include:
Expanding Good Faith Estimates for all patients, insured or not.
Leveraging patient engagement software and digital portals for easy access to costs, appointments, and feedback.
Offering flexible financing and healthcare communication platforms that reduce confusion and support financial planning.
Improving education so patients understand coverage, deductibles, and their options when between jobs or facing insurance gaps.
These are all key to a more accessible U.S. healthcare system. However, providing an estimate is only useful if it is trustworthy. Accurate Good Faith Estimates (GFEs) help patients plan their finances, reduce confusion, and prevent disputes that can slow payment or damage the provider–patient relationship. Accuracy involves using real-time eligibility and benefit data, factoring in deductibles, coinsurance, and negotiated rates, and continuously updating estimates when coverage or procedures change. When estimates are reliable, patients are more likely to pay on time, less likely to contest charges, and more confident in scheduling necessary care. For practices, accurate estimates reduce write-offs, minimize follow-up billing, and save staff time spent reconciling errors.
Even a highly accurate estimate is ineffective if patients cannot understand or act on it. Accessibility means presenting cost information in a patient-friendly format, simple language, itemized breakdowns, and clear visuals when possible. It also includes offering flexible payment options, such as installment plans, online payment portals, or automatic reminders, which accommodate different financial situations. By making estimates easy to read and act upon, practices encourage timely payments, improve patient satisfaction, and strengthen long-term trust. Combining accessibility with accuracy ensures that transparency is not only a regulatory checkbox but a practical tool for improving revenue and patient experience.
With the right tools in place, practices can achieve what both case studies demonstrate: informed patients, stronger relationships, and revenue that arrives when it is needed most.
Built for private providers navigating rising patient responsibility, Myriad Systems automates the Good Faith Estimate process, integrates real-time eligibility and benefit data, and delivers patient-friendly breakdowns with flexible payment options. Instead of overwhelming staff with paperwork and manual workflows, Myriad Systems turns transparency into a streamlined, automated experience that reduces bad debt and protects revenue. In other words, it brings the efficiency of the dental model and the proven success of today’s self-pay workflows into everyday medical practice.
👉 Learn how Myriad Systems can optimize your billing process and simplify payments for patients. Explore solutions today or request a personalized demo.
