Overview
The insurance endpoints let you read the insurance information tied to a practice and its patients. There are two related resources:
- Insurance plans (
/insurance_plans,/insurance_plans/{id}) hold general information about an insurance policy: payer ID, group number, employer name and carrier address. A plan represents the policy itself, independent of any one patient. - Insurance coverages (
/insurance_coverages,/insurance_coverages/{id}) connect a patient to an insurance plan. A coverage holds patient-specific details: the subscriber number, the patient's relationship to the subscriber (subscription_relation), coverage priority, and effective and expiration dates. A patient can have more than one active coverage, for example primary and secondary.
A single plan can be fetched with patient_coverages, subscribers and fee_schedule embedded through the include parameter. Coverages return only active records by default. Pass active=false to list inactive ones.
Example use cases
- Show patients which insurance plans and coverages are on file in a patient portal, so they can confirm their information is current before an appointment.
- Give front-desk staff a patient's active coverages and plan details before a visit, so they can confirm insurance without opening the health record system.