Ashish Mandavia , 2025-04-21 13:44:00
You get an instant confirmation when you order groceries. You track your Uber as it turns the corner. You know the cost of a hotel room before you book it. These are the digital expectations on which we rely.
Yet when it comes to our health, we remain in the dark.
Modern digital experiences help people feel informed, understood, and in control. In healthcare, where that kind of clarity matters most, the experience still falls painfully short.
In the United States, many people still struggle to find care, book an appointment, confirm coverage, or get a clear answer on pricing. The impact goes beyond inconvenience, contributing to delayed diagnoses, increased anxiety, and financial stress that harms both patients and the healthcare system.
Digital health companies have made progress expanding access, but insurance processes remain outdated. As a result, patients often lack visibility into what is covered and what they will owe. The confusion is widespread. Seventy-seven percent of Americans do not understand basic insurance terms such as copay, coinsurance, and deductible. Fifty-eight percent of insured adults experience issues using their coverage, including network mismatches, pre-authorizations, and claim denials that interrupt care.
We would not fill a gas tank without knowing whether it costs one dollar or $100 per gallon. That level of unpredictability is a reality in healthcare billing. With nearly half of American adults struggling to afford care, one in six skipping recommended treatments due to insurance issues, and three in ten paying more than they expected, it’s time to give patients more clarity. That clarity depends on insurance checks that are instant, automated, and integrated into the care process, like receiving a price estimate when booking travel.
But progress towards a more consumer-friendly healthcare experience is slow, and there’s lots of room for improvement. Even in areas with available providers, high costs and long wait times discourage people from seeking timely treatment. While innovations in scheduling, virtual care, and clinical documentation are emerging, insurance workflows still present major obstacles.
Two factors set up these roadblocks. One is the sheer complexity of provider and payer contracts. The other is outdated revenue cycle systems that require staff to manually gather information from multiple portals, delaying verification and increasing the likelihood of denials.
These problems have serious consequences: forty-one percent of adults who delayed care due to cost reported worsening health.
We have improved every other consumer experience. The same standard must now apply to healthcare.
Life with insurance eligibility and price transparency
What should healthcare look like? A patient gets instant confirmation that their visit is covered, and a clear cost estimate, when booking an appointment. That’s possible when providers have automated insurance verification built into their scheduling systems, improving revenue predictability and reducing patient no-show rates.
In this simple scenario, the patient feels less anxiety and more trust in their care, making them more likely to follow through with treatment, because they understand their payment responsibility up front. On the provider side, that leads to higher completion rates, better patient satisfaction and loyalty, and a competitive advantage in an increasingly experience-driven market.
But to get there, we need to move beyond digitization. Instead, we need actual consumer-friendly design. Unfortunately, the American healthcare system still operates in the shadows. Patients don’t look at transparency as a “nice to have.” They see it as a necessity to make informed decisions. In every other area of their lives, people can see what a product or service costs, compare options, and decide what’s right for them. This doesn’t exist in healthcare treatment, and even insured patients face anxiety surrounding the potential for surprise bills.
While legislation like the 2021 Hospital Price Transparency Rule has tried to push the industry forward, compliance is spotty at best. It lacks teeth and enforcement, so there are few penalties for ignoring the rules, little oversight, and no real incentives for insurers or providers to prioritize transparency. That means most patients are no closer to understanding the cost of care today than they were before 2021.
A core reason for this failure lies in the system’s architecture, which is purposely designed to be opaque. Insurance contracts vary wildly by provider, plan type, and region. Each contract includes confidentiality clauses and different negotiated rates hidden from the public. Even when data is released, it’s often buried in non-standard, machine-readable files that require expensive software and data science teams to decode. The opacity benefits payers, who maintain strategic control, and providers, who lack incentive and the technical tools to share prices with patients in a digestible format.
Technology, when used strategically, offers a path forward. While the healthcare industry can be slow to adopt new tech due to compliance and privacy requirements, there are tools like those that have been adapted from sales teams that provide a more consumer-friendly front door to treatment. For example, AI voice agents can relieve overworked admin teams and support patients by handling intake, verifying benefits via real-time API calls, explaining insurance coverage to patients in plain language, and assisting with appointment scheduling. Companies like Cedar, Phreesia, and Health Harbor are already proving that combining intelligent automation with empathetic design streamlines operations and significantly enhances the consumer experience. AI agents never miss a call, provide consistent explanations, and can scale support during peak periods. It’s a model that puts patients first, which is something the industry desperately needs.
But AI alone is not enough. For true transparency, we need to address the underlying incentives. Right now, payers profit by confusing patients through denying claims and increasing denials, which maximizes their margins. Meantime, providers often lack the regulatory motivation to change. Smart policy can require transparency to align accountability across the industry. Regular audits, publicly available benchmarks, and meaningful financial consequences for non-compliance all play a role in enforcement. This might look like the healthcare version of a nutrition label for pricing: standardized, simple, and universal.
We also need to empower consumers by showing them how much things cost before they walk through the door. When patients know what they’re paying for, they’re more likely to engage in preventative care, adhere to treatment, and avoid costly ED visits.
This vision, where coverage is clear and costs are known upfront, is within reach. But it requires the healthcare system to adopt the same kind of real-time, automated infrastructure we expect in other industries. While transformation won’t happen overnight, every hospital and clinic can start small by partnering on solutions that bring more efficiency, more transparency, and a better experience for patients.
If we can track a $20 package in real time, we should be able to tell a patient whether their care is covered and what it’ll cost before they walk through the door. No one should have to choose between getting care and risking an unexpected bill. It’s time to treat healthcare like what it is: one of the most important decisions we’ll ever make as a consumer.
Like every great consumer experience, it starts with trust, clarity, and a front door that’s open, digital, and built for the people it’s meant to serve.
Photo: weiyi zhu, Getty Images
Dr. Ashish Mandavia, MD, is the Co-Founder & CEO of Sohar Health, an innovative AI-driven provider specializing in Front-End RCM automation for healthcare providers. Automating insurance verification eliminates administrative burdens and improves financial performance. Sohar delivers 99% eligibility accuracy, processes over 90% of verifications in less than 30 seconds, and helps providers boost revenue while enhancing patient access. Before founding Sohar, Ashish practiced Clinical Psychiatry and served as EMEA Commercial Director at Pelago (fka Quit Genius), a personalized substance use care platform. He’s passionate about AI solutions that optimize clinical workflows, enhance patient engagement, and simplify healthcare payments, enabling providers to focus on care.
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