UnitedHealthcare Benefit Check Response

Patient benefit check response with cost-sharing details

Health InsuranceHealthcareFHIRClaimsEligibility

Properties

Name	Type	Description
coveredBenefit	boolean	Whether service is covered
authorizationRequired	boolean	Prior auth required
referralRequired	boolean	Referral required
estimatedPatientResponsibility	number	Estimated patient cost
estimatedPlanPayment	number	Estimated plan payment
costSharingDetails	object	Cost-sharing breakdown

View JSON Schema on GitHub

JSON Schema

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/unitedhealthcare/refs/heads/main/json-schema/provider-benefit-check-response-schema.json",
  "title": "UnitedHealthcare Benefit Check Response",
  "description": "Patient benefit check response with cost-sharing details",
  "type": "object",
  "properties": {
    "coveredBenefit": {
      "type": "boolean",
      "description": "Whether service is covered"
    },
    "authorizationRequired": {
      "type": "boolean",
      "description": "Prior auth required"
    },
    "referralRequired": {
      "type": "boolean",
      "description": "Referral required"
    },
    "estimatedPatientResponsibility": {
      "type": "number",
      "description": "Estimated patient cost"
    },
    "estimatedPlanPayment": {
      "type": "number",
      "description": "Estimated plan payment"
    },
    "costSharingDetails": {
      "type": "object",
      "description": "Cost-sharing breakdown",
      "properties": {
        "copay": {
          "type": "number"
        },
        "coinsurance": {
          "type": "number"
        },
        "deductibleApplies": {
          "type": "boolean"
        }
      }
    }
  }
}