Bedrock vs Direct OpenAI and Anthropic BAAs vs a Gateway BAA: Which to Use for PHI in 2026
A gateway BAA simplifies HIPAA compliance across multiple AI models.
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There are three ways to send protected health information (PHI) to models like GPT and Claude under HIPAA: run them on Amazon Bedrock under the AWS BAA, sign a BAA directly with OpenAI and Anthropic, or sign one BAA with a gateway that holds the provider BAAs and sells the inference. Bedrock is simplest if every model you need runs on Bedrock. Direct BAAs work if you use one or two providers. A gateway BAA like Concentrate's is the shortest path when you want Claude, GPT, Gemini and open-weight models under one agreement.
What's the quick comparison?
Option
Who signs the BAA
Models covered
Fees beyond tokens
Amazon Bedrock
AWS
Models you run on Bedrock in your AWS account
None from AWS for the BAA; you pay Bedrock rates
Direct OpenAI and Anthropic
Each provider, separately
LLM Gateway
Instant access to every model
Change models, providers, add fallbacks, and more by running all AI usage through one platform.
$499/month with a BAA (no subscription fee without one); no per-request fees or token markup
Model counts as of November 2026. See Model Fortress for the live list.
When is Amazon Bedrock under the AWS BAA the right choice?
Bedrock is the right choice when every model you need is available on Bedrock and you already run on AWS. Amazon Bedrock is on AWS's list of HIPAA-eligible services, and AWS says covered entities and business associates must enter into the AWS BAA before using those services for PHI.
The limit is scope. The AWS BAA covers what runs inside AWS. If you also want a model that isn't served on Bedrock, or a provider-specific feature that ships first on the provider's own API, you need another BAA for that route.
How do direct BAAs with OpenAI and Anthropic work?
Direct BAAs work one provider at a time, and each provider sets its own process and covered features.
OpenAI. Eligible organizations can accept OpenAI's standard BAA in the API Platform under Settings, Organization, General, HIPAA compliance support. OpenAI says self-serve enrollment requires an established history of API usage; otherwise you contact [email protected]. Once enabled, HIPAA compliance support can't be turned off in the settings.
Anthropic. For the Claude API, Anthropic's BAA article says the organization's Primary Owner signs the BAA and then works with Anthropic's sales team to enable it. The BAA covers only the organization that accepted it, and some APIs, including Batch, Files and Code Execution, are excluded.
Direct BAAs make sense if you use one provider and want its newest features on day one. The cost is paperwork and configuration that multiplies with every provider you add: separate agreements, separate covered-feature lists, and separate settings to keep straight.
How does a gateway BAA work on Concentrate?
On Concentrate you sign one BAA with us, and we hold the BAAs with the providers that serve covered routes. You call every covered model through one API. Today the BAA-eligible providers include OpenAI, Anthropic, Google Vertex AI, Azure, Azure Fireworks, Fireworks AI and Baseten, covering 72 models such as Claude, GPT, Gemini, DeepSeek, GLM, Kimi and Grok.
Once the BAA is signed, Concentrate turns on HIPAA mode for your organization, and these settings lock for every key under it:
Zero data retention stays on.
Request-content logging stays off, so prompt and response bodies are not stored.
Uncovered provider routes are blocked, including fallbacks and the auto router.
Pricing is $499/month for BAA use, with inference billed at provider rates and no per-request fees or markup on tokens. Without a BAA there is no subscription fee. The subscription stays the same however many tokens you send. Details are on the HIPAA LLM gateway page.
What about bring-your-own-key gateways?
A gateway that routes requests through your own provider keys does not remove the provider BAAs. Open-source and self-hosted gateways like LiteLLM, Bifrost and Kong connect to provider accounts with your credentials, so you still need a BAA with every provider you call. Some gateways sign a BAA for their own infrastructure, but that covers the gateway, not the inference. That's why Bring Your Own Key is off on a Concentrate HIPAA organization: our BAAs cover our provider accounts, not yours.
Which option should you choose?
Choose Bedrock if you're all-in on AWS and every model you need runs on Bedrock.
Choose a direct BAA if you use a single provider and want its first-party features as they ship.
Choose a gateway BAA if you use, or expect to use, models from several providers, want failover between covered providers, or don't want to run a BAA process with each one.
What do you still own under any of these options?
A BAA is required, but it doesn't make your product HIPAA compliant by itself. Under HHS guidance, a cloud or AI service that handles ePHI for you must sign a BAA. You still own your own HIPAA obligations: risk analysis, access controls, keeping PHI out of your own logs, and sending only the data the model needs. Data redaction at the gateway helps with the last one.
FAQ: Bedrock, direct BAAs and gateway BAAs
Does Amazon Bedrock sign a BAA?
AWS does. Amazon Bedrock is on AWS's list of HIPAA-eligible services, covered under the AWS BAA.
Can I get a BAA from OpenAI without an enterprise contract?
Yes, if eligible. OpenAI offers self-serve acceptance in the API Platform for organizations with an established history of API usage.
Is the Anthropic API BAA self-serve?
No. Anthropic's article says the Primary Owner signs the BAA and then contacts Anthropic's sales team to enable it.
Can one BAA cover OpenAI, Anthropic and Google models?
Yes, on Concentrate. One BAA covers every model on a BAA-eligible provider. See Model Fortress.
Does Concentrate sign a BAA?
Yes. BAA use is $499/month, with no per-request fees and no markup on tokens. Without a BAA there is no subscription fee. Start at concentrate.ai/compliance.
Does a LiteLLM or Bifrost gateway cover my PHI?
Not by itself. Those gateways route through your own provider keys, so you still need a BAA with each provider.
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