Transparency in Coverage: Exposing Ghost Rates and Holding National Payers Accountable with David Muhlestein, PhD

On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with David Muhlstein, PhD, JD, founder and CEO of Simple Healthcare, about his recent articles highlighting Transparency in Coverage (TIC) files and ghost rates from 119 insurers, including 3 national commercial payers. Aetna, Cigna, and United Healthcare TIC files were more than 90% ghost rates—billing codes for procedures that would never be performed by a specific physician. For example, there were billing codes for heart surgery performed by a psychiatrist, Muhlstein said. These ghost rates increase the size of TIC files, making them difficult to evaluate for consumers, researchers, and analysts. Data files of this size muddle the true aim of the TIC files to provide actual transparency that would allow consumers to compare the prices of health care services and choose more affordable options.

You can listen to Transparency in Coverage: Exposing Ghost Rates and Holding National Payers Accountable with David Muhlestein, PhD online on Radio and Podcast. Open the player on this page to stream the available audio.

Transparency in Coverage: Exposing Ghost Rates and Holding National Payers Accountable with David Muhlestein, PhD is an episode from Managed Care Cast by Managed Care Cast.

This episode is 00:31:27 long.

This episode was published on Jan 20, 2026.

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