{
"id": "string",
"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"
},
"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_classes": {},
"procedure_codes": [
[
{
"procedure_code": "90832",
"procedure_name": "Psychotherapy"
},
{
"is_covered": true,
"is_prior_auth_required": true,
"prior_auth_info": "Call Cigna at 1-800-997-1654",
"is_deductible_waived": false,
"copay_amount": "20.00",
"coinsurance_percentage": "20",
"frequency_limitations": "Two visits per week",
"limitations": "Family therapy is not covered.",
}
]
]
},
"request": {
"type": "BENEFITS",
"desired_completion_date": "08-19-2024",
"patient_name": "Alex Martin",
"dob": "01-31-2020",
"member_id": "123456789",
"group_id": "123456",
"insurance_in_network": true,
"npi": "1245319599",
"tax_id": "123456789",
"external_id": "health_harbor_sf",
"diagnosis_codes": ["F41.1", "F42.23"],
"benefits_query": [
"PLAN_INFO",
"MAXIMUMS",
"CODE_LOOKUP_BENEFITS"
],
"benefits_codes": [
"90832"
],
"claims_date_of_service": "01-31-2020",
"claim_number": "1234567890",
"insurance": "CIGNA",
"is_specialist": true,
"place_of_service": "office",
"practice_billing_address": "123 Main St, New York, NY 10001"
}
}