You know roughly what a carton of milk costs, and you’ve probably noticed, without trying very hard, when it’s cheaper at one store than another. Now ask yourself: do you know what a consultation costs at your doctor’s office? An X-ray? A CT scan? Federal law says that information should be online, no matter where you live. Go ahead and try to find it. I’ll bet you can’t.

This isn’t an abstract inconvenience. A 2022 KFF survey found that 41 percent of U.S. adults, 107 million people, carry some form of debt from medical or dental bills. Nearly one in five adults say their own health got worse because they delayed or skipped care they couldn’t afford, which is another way of saying the price tag itself becomes a medical risk factor. Americans want to know what things cost, but the system makes not knowing the default condition, and then bills people for the gap.

I recently moved to Boston and don’t yet have a primary care doctor here. Before getting an echocardiogram, I wanted to know what it would cost, and so I searched. Nothing useful came up. I asked ChatGPT, which told me I’d need my Blue Cross Blue Shield (BCBS) ID, a number I apparently already owned. Finding it meant logging into my affiliate’s health portal, handing over my information again, then logging into BCBS of Massachusetts separately. Another password. Another form. The same data, typed a second time into a second system that didn’t talk to the first.

Once I was in, I entered the procedure — “echocardiography with contrast” — and waited for a number. Not enough. The tool wanted a hospital. I tried Brigham and Women’s, then Beth Israel. Neither returned anything useful. Buried in the options was a field for a physician’s name, so I opened a hospital directory in a second tab, found someone double-boarded in cardiology and radiology with good reviews, and typed her name into the estimator. Only then did a price appear: zero dollars, fully covered under my plan.

Forty minutes. Three logins. A conversation with a chatbot just to locate a number that was already mine. I have a graduate degree and I still had to guess my way through it. I keep thinking about my grandmother’s generation trying this from a Medicare Advantage portal, with no one to call.

Another problem awaits even those with patience, time, and memorized ID number. The number on the other side may still be wrong. Federal regulators required hospitals to post these prices starting in 2021, with a matching rule for insurers phased in over the following two years. The data exists. But KFF, the same health policy research group, has gone looking and found a mess: inconsistent formats, missing files, numbers that don’t match reality. Patients have been saying some version of this for years: most don’t know the tools exist, and the few who find them rarely land on a number they can trust.

Solving those two problems still wouldn’t close the case. A correct, cleanly displayed price only tells you what the hospital charges today. It says nothing about whether the insurer will honor it tomorrow. Prior authorization can be denied after the fact. A price quoted in July can be overridden by a claim denial in September, arriving as a code on a letter with no explanation attached. Transparency law was written to fix what providers disclose. It was never built to touch what insurers decide.

Luckily, none of this happened because I was sick. There was no diagnosis, no scare. I wasn’t the patient. I was a DrPH student at Harvard’s health economics class, assigned to find out what an echocardiogram actually costs nearby. That was the whole stakes: a homework problem.

So the failure isn’t one problem. It’s at least three, stacked on top of each other. Almost no one can find the door. The few who do may be handed the wrong number once inside. And even the right number, honestly quoted, can be reversed by a company that was never part of the conversation. We passed a law requiring transparency and called the job done, without checking whether a real person could get real information. A price that, while technically public, stays practically impossible to find, comes down to the same thing as a secret.