Patient Access Basics Hero
Mark Lorenz


I promise I'll get to the 21st Century Cures Act and the 2020 CMS final rule on Interoperabilty and Patient Access in a moment, but first a little story to explain this website…

and then he deliberately drank a beaker of swamp water made from the contents of a patient's stomach.

Up until 1985 it was medical dogma that ulcers were caused by lifestyle and "stress"[1]. Two Australians, Barry Marshall and Robin Warren, thought that ulcers were caused by something different- but no one would listen. Marshall and Warren spent three years trying to change the medical establishment and failed, until Marshall decided to do something drastic.

In 1985 Marshall underwent a gastric biopsy to prove that he didn't have ulcers. The experimental control was now set for an "N of one" study on the only human being he ethically could, himself; human guinea pig. The next morning Marshall woke up early, skipped breakfast, and drove to his lab at the hospital. A coworker in the lab said, "you're crazy" as Marshall downed a beaker of "swamp water" he had made from the contents of a patient's stomach. Unsurprisingly, a few days later Marshall began to vomit and developed gastritis[2]. He also developed ulcers, ulcers that if he was right about, he could cure for himself and millions of people.

Patient Access and Interoperability

This website is my story of drinking the swamp water for you. Late in 2020 CMS gave us an incredible final rule from the 21 Century Cures Act that requires all Medicare Advantage, Medicare Part-D, Affordable Care Act (Obamacare) Exchanges, and a few other plan types, to make APIs available for "app developers". With patient permission, the app developers are granted access to the patient/member's claims history (aka the Explanation of Benefits, aka the EOB, aka THIS IS NOT A BILL). The EOB is a record of everything that your insurance company has paid for, it's almost as good as a medical record. Despite the good intentions of the 2009 Hitech Act (aka HIPAA) portable access to health information has been impossible (or at least a joke). The Interoperability and Patient Access final rule sets that right.

These rules are in effect now (as of 1-Jan-2021) but aren't being enforced until 1-July-2021[3]

In each post I will review an insurance company's implementation of the rule and throw swamp water on the ones who haven't complied yet. I've been surprised by who the laggards are. See the summary list here

Getting Your Medical Data

If you're going to give yourself ulcers for the benefit of mankind, it's a good idea to know how to cure them too, which Marshall did. He knew that it wasn't stress, but a spiral shaped bacteria called Helicobacter pylori. The swamp water he drank earlier had around a billion of them swimming in it. H. pylori can be killed with common antibiotics- so after giving himself ulcers, Marshall give himself some antibiotics and a few weeks later his ulcers were gone. His point was proven and antibiotics are now the standard of care for ulcers. In 2005 Marshall and Warren were awarded a Nobel Prize for the discovery.

I saved myself $100 at the pharmacy a week after I had filled the prescription

Not looking for any Nobel Prizes here, but let's see if we can improve healthcare together! I need your help to make sure that the patient access APIs work as advertised. If you know someone with an Aetna Medicare Advantage plan, send them over here to complete the authorization workflow for Aetna. We may be able to help you or your friend save some money on healthcare too. I saved myself $100 at the pharmacy a week after I had filled the prescription by calling and asking them to "rebill" with different coverage information. That was nice!

More about how HealthSouse helps

Still here? Thanks for reading! You seem like a nice person, who should send me an email: Encouragement and criticism are both welcome!