Get Policy Benefits

curl --request GET \
  --url https://api.spikecare.com/public/v1/clinics/{clinic_id}/patients/{patient_id}/policies/{policy_id}/benefits \
  --header 'Authorization: Bearer <token>'

{
  "id": "<string>",
  "status": "pending",
  "data": {
    "planType": "<string>",
    "visitLimit": "<string>",
    "visitsUsed": "<string>",
    "planEndDate": "<string>",
    "networkStatus": "<string>",
    "patientCoPay": "<string>",
    "planStartDate": "<string>",
    "deductibleFamily": "<string>",
    "planEffectiveDate": "<string>",
    "benefitsExplanation": "<string>",
    "insuranceIdentifier": "<string>",
    "patientCoInsurance": "<string>",
    "visitLimitMaxType": "<string>",
    "deductibleFamilyMet": "<string>",
    "deductibleIndividual": "<string>",
    "planTerminationDate": "<string>",
    "visitLimitStructure": "<string>",
    "authorizationRequired": "<string>",
    "supplementalPlanName": "<string>",
    "therapyThresholdSpent": "<string>",
    "outOfPocketMaxFamily": "<string>",
    "deductibleIndividualMet": "<string>",
    "referenceNumberAndName": "<string>",
    "secondaryMedicareCovers": "<string>",
    "authorizationObtainedVia": "<string>",
    "therapyThresholdSpentOT": "<string>",
    "deductibleFamilyRemaining": "<string>",
    "outOfPocketMaxFamilyMet": "<string>",
    "outOfPocketMaxIndividual": "<string>",
    "visitLimitMaxTypeDetails": "<string>",
    "authorizationRequiredDetails": "<string>",
    "deductibleIndividualRemaining": "<string>",
    "outOfPocketMaxIndividualMet": "<string>",
    "medicalNecessityReviewRequired": "<string>",
    "physiciansPrescriptionRequired": "<string>",
    "authorizationObtainedViaDetails": "<string>",
    "outOfPocketMaxFamilyRemaining": "<string>",
    "outOfPocketMaxIndividualRemaining": "<string>",
    "primaryCareProviderReferralRequired": "<string>",
    "medicalNecessityReviewRequiredDetails": "<string>"
  }
}

Get Policy Benefits

curl --request GET \
  --url https://api.spikecare.com/public/v1/clinics/{clinic_id}/patients/{patient_id}/policies/{policy_id}/benefits \
  --header 'Authorization: Bearer <token>'

{
  "id": "<string>",
  "status": "pending",
  "data": {
    "planType": "<string>",
    "visitLimit": "<string>",
    "visitsUsed": "<string>",
    "planEndDate": "<string>",
    "networkStatus": "<string>",
    "patientCoPay": "<string>",
    "planStartDate": "<string>",
    "deductibleFamily": "<string>",
    "planEffectiveDate": "<string>",
    "benefitsExplanation": "<string>",
    "insuranceIdentifier": "<string>",
    "patientCoInsurance": "<string>",
    "visitLimitMaxType": "<string>",
    "deductibleFamilyMet": "<string>",
    "deductibleIndividual": "<string>",
    "planTerminationDate": "<string>",
    "visitLimitStructure": "<string>",
    "authorizationRequired": "<string>",
    "supplementalPlanName": "<string>",
    "therapyThresholdSpent": "<string>",
    "outOfPocketMaxFamily": "<string>",
    "deductibleIndividualMet": "<string>",
    "referenceNumberAndName": "<string>",
    "secondaryMedicareCovers": "<string>",
    "authorizationObtainedVia": "<string>",
    "therapyThresholdSpentOT": "<string>",
    "deductibleFamilyRemaining": "<string>",
    "outOfPocketMaxFamilyMet": "<string>",
    "outOfPocketMaxIndividual": "<string>",
    "visitLimitMaxTypeDetails": "<string>",
    "authorizationRequiredDetails": "<string>",
    "deductibleIndividualRemaining": "<string>",
    "outOfPocketMaxIndividualMet": "<string>",
    "medicalNecessityReviewRequired": "<string>",
    "physiciansPrescriptionRequired": "<string>",
    "authorizationObtainedViaDetails": "<string>",
    "outOfPocketMaxFamilyRemaining": "<string>",
    "outOfPocketMaxIndividualRemaining": "<string>",
    "primaryCareProviderReferralRequired": "<string>",
    "medicalNecessityReviewRequiredDetails": "<string>"
  }
}

Authorizations

Authorization

string

header

required

Bearer authentication header of the form Bearer <token>, where <token> is your auth token.

Path Parameters

clinic_id

string

required

Clinic ID

patient_id

string

required

Patient ID

policy_id

string

required

Internal Policy ID

Response

Policy Benefits Response

string

required

Benefits Id

status

enum<string>

required

Status

Available options:

pending,

success,

failure

data

object

Policy Benefits Data

Show child attributes

data.planType

string

Plan Type

data.visitLimit

string

Visit Limit

data.visitsUsed

string

Visits Used

data.planEndDate

string

Plan End Date

data.networkStatus

string

Network Status

data.patientCoPay

string

Patient Co-Pay

data.planStartDate

string

Plan Start Date

data.deductibleFamily

string

Deductible Family

data.planEffectiveDate

string

Plan Effective Date

data.benefitsExplanation

string

Benefits Explanation

data.insuranceIdentifier

string

Insurance Identifier

data.patientCoInsurance

string

Patient Co-Insurance

data.visitLimitMaxType

string

Visit Limit Max Type

data.deductibleFamilyMet

string

Deductible Family Met

data.deductibleIndividual

string

Deductible Individual

data.planTerminationDate

string

Plan Termination Date

data.visitLimitStructure

string

Visit Limit Structure

data.authorizationRequired

string

Authorization Required

data.supplementalPlanName

string

Supplemental Plan Name

data.therapyThresholdSpent

string

Therapy Threshold Spent

data.outOfPocketMaxFamily

string

Out of Pocket Max Family

data.deductibleIndividualMet

string

Deductible Individual Met

data.referenceNumberAndName

string

Reference Number and Name

data.secondaryMedicareCovers

string

Secondary Medicare Covers

data.authorizationObtainedVia

string

Authorization Obtained Via

data.therapyThresholdSpentOT

string

Therapy Threshold Spent OT

data.deductibleFamilyRemaining

string

Deductible Family Remaining

data.outOfPocketMaxFamilyMet

string

Out of Pocket Max Family Met

data.outOfPocketMaxIndividual

string

Out of Pocket Max Individual

data.visitLimitMaxTypeDetails

string

Visit Limit Max Type Details

data.authorizationRequiredDetails

string

Authorization Required Details

data.deductibleIndividualRemaining

string

Deductible Individual Remaining

data.outOfPocketMaxIndividualMet

string

Out of Pocket Max Individual Met

data.medicalNecessityReviewRequired

string

Medical Necessity Review Required

data.physiciansPrescriptionRequired

string

Physician's Prescription Required

data.authorizationObtainedViaDetails

string

Authorization Obtained Via Details

data.outOfPocketMaxFamilyRemaining

string

Out of Pocket Max Family Remaining

data.outOfPocketMaxIndividualRemaining

string

Out of Pocket Max Individual Remaining

data.primaryCareProviderReferralRequired

string

Primary Care Provider Referral Required

data.medicalNecessityReviewRequiredDetails

string

Medical Necessity Review Required Details

Get Benefits Checks for Patient Plan

On-Demand Eligibility Verification

⌘I

API Documentation

Insurance Providers

Clinics

Webhooks

Files

Patients

Benefit Verification

Eligibility Verification

Get Policy Benefits

Authorizations

Path Parameters

Response