{
"id": "722b06d8-1855-402b-9916-bfa450cc1572",
"status": "SUCCESS",
"creation_ts": "2020-01-01T00:00:00.000000Z",
"summary": "Benefits retrieved successfully.",
"results": {
"call_details": {
"call_end_time": "2024-03-01T06:00:00.0000Z",
"representative_name": "Deborah M",
"reference_number": "2812129",
"call_recording_url": "https://www.google.com/voice_recording.wav"
},
"plan_information": {
"is_active": true,
"plan_type": "PPO",
"effective_date": "10-01-2020",
"termination_date": "10-31-2021",
"is_calendar_year_plan": true,
"is_provider_in_network": true,
"is_primary_insurance": true
},
"maximums": {
"individual_deductible": "100",
"individual_deductible_used": "80",
"individual_out_of_pocket_maximum": "1000",
"individual_out_of_pocket_maximum_used": "800",
"family_deductible": "200",
"family_deductible_used": "100",
"family_out_of_pocket_maximum": "2000",
"family_out_of_pocket_maximum_used": "1000"
},
"procedure_codes": [
[
{
"procedure_code": "94625",
"procedure_name": "Pulmonary Rehabilitation Coverage"
},
{
"is_covered": true,
"is_deductible_waived": true,
"copay_amount": "0.00",
"coinsurance_percentage": "20",
"more_info": "Diagnosis of medium to severe COPD is required for coverage."
}
],
[
{
"procedure_code": "94626",
"procedure_name": "Pulmonary Rehabilitation Coverage"
},
{
"is_covered": true,
"is_deductible_waived": false,
"copay_amount": "20.00",
"coinsurance_percentage": "0",
"more_info": "Diagnosis of medium to severe COPD is required for coverage."
}
]
]
},
"request": {
"type": "BENEFITS",
"desired_completion_date": "08-25-2024",
"patient_name": "Alex Martin",
"dob": "01-31-2023",
"member_id": "567891234",
"group_id": "678123",
"insurance": "UNITED_HEALTHCARE",
"insurance_in_network": true,
"npi": "1245319599",
"practice_billing_address": "123 Main St, New York, NY 10001",
"tax_id": "123456789",
"external_id": "provider_123",
"benefits_codes": [
"94625",
"94626"
],
"benefits_query": [
"CODE_LOOKUP_BENEFITS"
],
"is_specialist": true,
"place_of_service": "telehealth"
}
}