Patient Insurance

The Patient Insurance feature allows the user to view and modify a patient's insurance. Note, if you are trying to add a case policy, please use the case policy specific endpoint. /patients/{patientid}/insurances is deprecated for this purpose. For more information, please refer Adding and updating Insurance Information.

There are times when an API user wants to add insurance for a patient or to manipulate the insurance that a patient has. This happens in several situations, such as when using the API to add a patient prior to sending charges, or even for a new patient being added for scheduling. 

There are two main calls to use. 

The first call,  /v1/{practiceid}/misc/topinsurancepackages, allows you to gather the athenahealth insurance package IDs a given practice uses. You must maintain some sort of mapping from your own representation of this information to our insurance package ID. For practices with a wide geographic footprint, you might want to consider calling this with a department ID since the top payers vary. In the future, we'll provide tools for determining the correct insurance package based on the patient’s ID number and general information. This process will be closer to how this is done in athenaNet proper. 

Once you have the insurance package ID, use POST (to create), PUT (to update), or DELETE (to remove) /v1/{practiceid}/misc/topinsurancepackages to add/update/remove an insurance package from a patient. The POST is to create a new insurance package, while PUT should be used to update information (e.g., member ID change). You should DELETE and POST a new insurance if the insurance package itself changes for a patient. (The GET call shows you the current insurance for a patient.)

Previously, partners were able to add case policy insurance packages via the insurance POST endpoint. However, the fields specifically related to certain types of case policies (auto, worker’s comp, legal, etc.) were not available in the endpoint. A new POST endpoint was built to allow partners to add case policies with the additional relevant information related specifically to case policies.  Note: It is highly encouraged that partners start using the new case policy POST to add case policies instead of using the insurance POST endpoint. 

There are two main calls to add a case policy for a patient. 
GET /insurancepackages/casepolicies, allows partners to retrieve an insurancepackageid that corresponds to the patient’s case policy. For more information on packages, see the Insurance Package Search page. 

Once you have the insurance package ID, use 
POST /patients/{patientid}/insurances/casepolicies to add a case policy for a patient. There are fields that are conditionally required based on the insurancepackageid selected. The insurancepackageid indicates the type of case policy (e.g., auto insurance, legal, worker’s comp). 

To update information in the case policy, use 
PUT /patients/{patientid}/insurances/{insuranceid}. 

To retrieve the insuranceid needed to update the case policy use
GET /patients/{patientid}/insurances/{insuranceid} endpoint. 

To delete case policies use
DELETE /patients/{patientid}/insurances/{insuranceid} endpoint.

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Create patient's insurance package
POST
/v1/{practiceid}/patients/{patientid}/insurances

Creates a new record of patient insurance for a specific patient

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Get patient's insurance packages
GET
/v1/{practiceid}/patients/{patientid}/insurances

Retrieves all patient insurances for a specific patient Note: This endpoint may rely on specific settings to be enabled in athenaNet Production to function properly that are not required in other environments. Please see <a href="https://docs.athenahealth.com/api/resources/best-practices-and-troubles… Rollout of APIs</a> for more information if you are experiencing issues.

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Update patient's insurance package
PUT
/v1/{practiceid}/patients/{patientid}/insurances

Updates a patient insurances for a specific patient

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Delete patient's insurance packages
DELETE
/v1/{practiceid}/patients/{patientid}/insurances

Deletes the record of patient insurances for a specific patient

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Update patient's specific insurance-package
PUT
/v1/{practiceid}/patients/{patientid}/insurances/{insuranceid}

Updates a patient insurances for a specific patient

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Delete patient's specific insurance-package
DELETE
/v1/{practiceid}/patients/{patientid}/insurances/{insuranceid}

Delete a patient's specific insurance package

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Reactivate patient's specific insurance-package
POST
/v1/{practiceid}/patients/{patientid}/insurances/{insuranceid}/reactivate

Re-activates patient's specific insurance-package

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Create patient's specific case policy
POST
/v1/{practiceid}/patients/{patientid}/insurances/casepolicies

Create a record of a patient's specific case policy

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