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zaeem/Non medicare Secret

Created October 5, 2016 14:19
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Non medicare
{
"demographics": {
"subscriber": {
"last_name": "Anthony",
"first_name": "BENJAMIN",
"member_id": "AETNA00DEP_TEST",
"dob": "1955-01-08",
"address": {
"street_line_1": null,
"street_line_2": null,
"city": null,
"state": null,
"zip": null
}
},
"dependent": {
"relationship": "Spouse"
}
},
"insurance": {
"name": "Cigna HealthCare",
"id": "00001",
"payer_type": "PR",
"payer_type_label": "Payer",
"contacts": [
{
"contact_type": "url",
"contact_value": "WWW.UNITEDHEALTHCAREONLINE.COM"
},
{
"contact_type": "telephone",
"contact_value": "123-123-1231"
}
],
"service_providers": {
"physicians": [
{
"eligibility_code_label": "Other Source of Data",
"contact_details": [
{
"entity_code_label": "Payer",
"last_name": "TEST",
"first_name": "TEST",
"contacts": [
{
"contact_type": "url",
"contact_value": "WWW.UNITEDHEALTHCAREONLINE.COM"
},
{
"contact_type": "telephone",
"contact_value": "123-123-1231"
}
],
"address": {
"street_line_1": "546565 TEST TEST",
"street_line_2": null,
"city": "TEST",
"state": "TEST",
"zip": "64645"
}
}
]
}
]
}
},
"plan": {
"type": "30",
"coverage_status": "1",
"coverage_status_label": "Active Coverage",
"plan_name": "Aetna Choice POS II",
"plan_type_label": "Point of Service (POS)",
"group_name": "BLACKBOARD TEST",
"dates": [
{
"date_type": "plan_begin",
"date_value": "2015-01-01"
},
{
"date_type": "plan_end",
"date_value": "2015-01-01"
}
],
"financials": {
"deductible": {
"remainings": {
"in_network": [
{
"amount": "157.19",
"level": "INDIVIDUAL"
},
{
"amount": "0",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "1157.19",
"level": "INDIVIDUAL"
},
{
"amount": "500",
"level": "FAMILY"
}
]
},
"spent": {
"in_network": [
{
"amount": "157.19",
"level": "INDIVIDUAL"
},
{
"amount": "0",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "1157.19",
"level": "INDIVIDUAL"
},
{
"amount": "1157.19",
"level": "FAMILY"
},
{
"amount": "500",
"level": "INDIVIDUAL"
},
{
"amount": "500",
"level": "FAMILY"
}
]
},
"totals": {
"in_network": [
{
"amount": "500",
"level": "INDIVIDUAL"
},
{
"amount": "250",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "1500",
"level": "INDIVIDUAL"
},
{
"amount": "1500",
"level": "FAMILY"
},
{
"amount": "750",
"level": "INDIVIDUAL"
},
{
"amount": "750",
"level": "FAMILY"
}
]
}
},
"stop_loss": {
"remainings": {
"in_network": [
{
"amount": "987.48",
"level": "INDIVIDUAL"
},
{
"amount": "2795.02",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "2987.48",
"level": "INDIVIDUAL"
},
{
"amount": "6795.02",
"level": "FAMILY"
}
]
},
"spent": {
"in_network": [
{
"amount": "987.48",
"level": "INDIVIDUAL"
},
{
"amount": "2795.02",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "2987.48",
"level": "INDIVIDUAL"
},
{
"amount": "6795.02",
"level": "FAMILY"
}
]
},
"totals": {
"in_network": [
{
"amount": "2000",
"level": "INDIVIDUAL"
},
{
"amount": "4000",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "4000",
"level": "INDIVIDUAL"
},
{
"amount": "8000",
"level": "FAMILY"
}
]
}
}
},
"benefit_details": {
"benefit_description": {
"amounts": [
{
"comments": [
"THIS PATIENT MAY HAVE HRA/HSA/HIA DOLLARS TO USE TOWARD DEDUCTIBLE AND OUT OF POCKET EXPENSES."
]
}
]
}
},
"additional_insurance_policies": [
{
"insurance_type": null,
"insurance_type_label": null,
"coverage_description": null,
"reference": [],
"payer_type": "PRP",
"payer_type_label": "Primary Payer",
"contact_details": [
{
"entity_code": "PRP",
"entity_code_label": "Primary Payer",
"last_name": "TEST123",
"first_name": null,
"identification_type": "Member Identification Number",
"identification_code": "HHLSS5646SD",
"contacts": [
{
"contact_type": "url",
"contact_value": "WWW.UNITEDHEALTHCAREONLINE.COM"
},
{
"contact_type": "telephone",
"contact_value": "123-123-1231"
}
],
"address": {
"street_line_1": null,
"street_line_2": null,
"city": null,
"state": null,
"zip": null
}
}
],
"dates": [
{
"date_type": "eligibilty",
"date_value": "2016-12-12"
}
],
"comments": [],
"service_type_codes": []
}
]
},
"services": [
{
"type": "48",
"type_label": "Hospital - Inpatient",
"coverage_status": "1",
"coverage_status_label": "Active Coverage",
"benefit_details": {
"benefit_description": {
"amounts": [
{
"comments": [
"THIS PATIENT MAY HAVE HRA/HSA/HIA DOLLARS TO USE TOWARD DEDUCTIBLE AND OUT OF POCKET EXPENSES."
]
}
]
}
},
"financials": {
"deductible": {
"remainings": {
"in_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
]
},
"spent": {
"in_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
]
},
"totals": {
"in_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
]
}
},
"coinsurance": {
"percents": {
"in_network": [
{
"percent": "10",
"level": "INDIVIDUAL"
},
{
"percent": "10",
"level": "FAMILY"
}
],
"out_network": [
{
"percent": "10",
"level": "INDIVIDUAL"
},
{
"percent": "30",
"level": "FAMILY"
}
]
}
},
"copayment": {
"amounts": {
"in_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "0",
"level": "INDIVIDUAL"
},
{
"amount": "0",
"level": "FAMILY"
}
]
}
}
},
"additional_insurance_policies": []
},
{
"type": "98",
"type_label": "Professional - Inpatient",
"coverage_status": "1",
"coverage_status_label": "Active Coverage",
"benefit_details": {
"benefit_description": {
"amounts": [
{
"comments": [
"THIS PATIENT MAY HAVE HRA/HSA/HIA DOLLARS TO USE TOWARD DEDUCTIBLE AND OUT OF POCKET EXPENSES."
]
}
]
}
},
"financials": {
"deductible": {
"remainings": {
"in_network": [
{
"amount": "1527",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "352",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
]
},
"spent": {
"in_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "255",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "486",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
]
},
"totals": {
"in_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "798",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "398",
"level": "FAMILY"
}
]
}
},
"coinsurance": {
"percents": {
"in_network": [
{
"percent": "10",
"level": "INDIVIDUAL"
},
{
"percent": "10",
"level": "FAMILY"
}
],
"out_network": [
{
"percent": "30",
"level": "INDIVIDUAL"
},
{
"percent": "30",
"level": "FAMILY"
}
]
}
},
"copayment": {
"amounts": {
"in_network": [
{
"amount": "200",
"level": "INDIVIDUAL"
},
{
"amount": "200",
"level": "FAMILY"
}
],
"out_network": [
{
"amount": "0",
"level": "INDIVIDUAL"
},
{
"amount": "0",
"level": "FAMILY"
}
]
}
}
},
"additional_insurance_policies": []
}
],
"AppointmentPatientInsuranceData": {
"Meta": {
"DataModel": "Scheduling",
"EventType": "Reschedule"
},
"Patient": {
"Identifiers": [
{
"ID": "123123123",
"IDType": "MR"
}
],
"Demographics": {
"FirstName": "TEST12",
"LastName": "TEST123",
"DOB": "1965-01-15",
"Sex": "Male",
"MaritalStatus": null,
"PhoneNumber": {
"Home": "+1231223123",
"Office": "+1212312333",
"Mobile": "+1231231233"
},
"EmailAddresses": null,
"Address": {
"StreetAddress": "56646 TEST TEST",
"City": "TEST",
"State": "TEST",
"ZIP": "123123",
"County": null,
"Country": "US"
}
}
},
"Visit": {
"VisitNumber": "1234",
"VisitDateTime": "2016-10-04T08:43:39.420Z",
"Duration": 15,
"Reason": "Check up",
"Balance": "0.00",
"AttendingProvider": {
"ID": 123123123,
"FirstName": "Pat123",
"LastName": "ANTHONY123"
},
"Location": {
"Department": "Unknown"
},
"Guarantor": {
"Number": "241110",
"FirstName": "TEST123",
"LastName": "TEST123",
"Spouse": {
"FirstName": "TEST123",
"LastName": "TEST123"
},
"Address": {
"StreetAddress": "65656 Test",
"City": "TEST",
"State": "M5",
"ZIP": "5646",
"County": "Green",
"Country": "US"
},
"PhoneNumber": {
"Home": "+12312312313",
"Business": "+12312312312"
},
"Type": null,
"RelationToPatient": "Father",
"Employer": {
"Name": "Accelerator Labs",
"Address": {
"StreetAddress": "123123 TEST Roald",
"City": "TEST",
"State": "WID",
"ZIP": "5666",
"County": "Dane",
"Country": "USA"
},
"PhoneNumber": "+123123123"
}
},
"Insurances": [
{
"Plan": {
"ID": "31572",
"IDType": null,
"Name": "HMO Deductable Plan"
},
"Company": {
"ID": "60054",
"Name": "aetna (60054 0131)",
"Address": {
"StreetAddress": "Po Box 5600",
"City": "TEST City",
"State": "MO",
"ZIP": "123123",
"County": "Fayette",
"Country": "US"
},
"PhoneNumber": "+123123123123"
},
"GroupNumber": "1233212313323",
"EffectiveDate": "2014-12-01",
"ExpirationDate": "2020-12-31",
"PolicyNumber": "123121313"
}
]
}
},
"system":{
"type": "spce101"
}
}
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