Nearly 60% of hospitals don’t honor patients’ requests to see their own billing information, in violation of the federal HIPAA Right of Access law that requires hospitals to give patients access to their records.
In the past 90 days alone, 219 of 368 hospitals analyzed by Goodbill may have violated patients’ right to access their own records, as required by HIPAA. Anyone can now check for recent violations at more than 6,000 hospitals, with Goodbill’s newly launched hospital directory.
The prevalence of these violations underscores how many patients have yet to penetrate the black box of medical billing, despite recent efforts by the government to enforce price transparency. Without access to itemized billing records with industry-standard codes, patients are hard-pressed to understand or verify their hospital charges.
“Any patient staring at a hospital bill just wants to know that it’s fair and correct,” said Patrick Haig, CEO and co-founder of Goodbill. “The information is there, but hospitals make it very, very hard for patients to access it. Price transparency is meaningless if patients can’t leverage it.”
The prevalence of these violations underscores how many patients have yet to penetrate the black box of medical billing, despite recent efforts by the government to enforce price transparency.
While hospitals have been required to publish their procedure prices online since January 2021, when the Hospital Price Transparency final rule took effect, many patients still can’t take advantage of that information. The bill that a patient gets in the mail usually isn’t detailed enough to cross-check against published prices; the patient can only do a line-by-line comparison with an itemized bill that contains standard procedure codes. If they’re insured, the patient also benefits by seeing the claim form the hospital submitted to their insurer, to understand how the insurer was charged.
Goodbill helps patients request both of these billing records, and tracks whether hospitals comply within 30 days, as required by HIPAA. As of February 2023, Goodbill has interacted with over 1,100 hospitals, representing over 350 health systems, across the country. This proprietary data is what appears in Goodbill’s hospital directory. A violation is flagged when a hospital doesn’t respond by fax or email, as requested by the patient, within 30 calendar days of the request being sent.
Price transparency is meaningless if patients can’t leverage it," said Goodbill CEO and co-founder Patrick Haig.
Here are the worst and best hospitals when it comes to honoring patient billing rights, based on Goodbill’s analysis of hospitals. To give hospitals a fair chance to comply, Goodbill only included hospitals that were sent at least five separate HIPAA right of access requests for patients' billing records, and had a deadline to fulfill those requests within the past 180 days.
Hospitals were then scored based on two main components: Speed, which measures how quickly the hospital responds to a patients' request, if at all; and quality, which measures whether the hospital provided the patient with the records they requested. HIPAA laws require hospitals to respond to requests for billing records within 30 calendar days, provide patients with requested records as long as they exist, and in the format that the patient specifies.
Goodbill has observed that these hospitals make it challenging for patients to get access to their own billing records. These hospitals scored low on speed, taking multiple months to respond to HIPAA right of access requests, or not responding at all. When they did respond, they were not likely to provide patients with the right documents.
Goodbill has observed that these hospitals are above-average at fulfilling patients' requests to get access to their billing records. These hospitals scored high on speed, and most of them met the HIPAA deadline to respond to requests within 30 calendar days. Patients also had a higher likelihood of getting exactly the documents they requested, reducing the need for back-and-forth.
You can also search for a specific hospital at hospitals.goodbill.com.
Despite HIPAA requirements, some hospitals continue to actively block patients from getting access to their records. In one recorded call to a hospital in January, a hospital administrator told Goodbill that all requests for patients’ records “will be shredded,” because honoring the requests would inevitably lead to patients challenging their hospital charges.
Listen to the recording here:
By bringing more transparency to an opaque industry, Goodbill aims to equip consumers with the information they need to understand, trust, or challenge their hospital bill. Currently, one in two Americans have medical debt, and the biggest drivers of this medical debt are hospital visits, according to a recent study by Affordable Health Insurance. Half of those with debt owe $10,000 or more.
“Patients are tired of fighting against a billing machine that doesn't seem to care about them,” Haig said. “They're tired of making countless phone calls to billing departments, not getting documents they asked for, and worrying about being sent to collections while trying to understand their bill. Patients deserve to know exactly how their bill was calculated. This is a first step toward changing that.”
The new hospital directory also lets users compare prices among nearby hospitals for common emergency room visit reasons such as headaches, heart palpitations, food poisoning and urinary tract infections.
Consumers can also find helpful tools, like an estimate for when a bill from a nonprofit hospital might get sent to a collections agency; or how to file a complaint if a hospital hasn’t complied with a request for records, doesn’t give electronic access to medical records, or doesn’t publish their prices.
Goodbill plans to gradually expand the platform to include more features, including customer reviews.
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