Raw schema
{
"type": "object",
"properties": {
"reason": {
"type": "string",
"enum": [
"medical_necessity",
"emergency",
"experimental",
"out_of_network",
"prior_auth",
"coding",
"generic"
],
"description": "Why the claim was denied: medical_necessity, emergency (said it wasn't an emergency), experimental, out_of_network, prior_auth, coding or generic. Required unless denial_code is given."
},
"denial_code": {
"type": "string",
"description": "The reason code on the notice, like CO-50 or PR-197. Picks the reason when reason is left out, and is quoted in the letter."
},
"plan_type": {
"type": "string",
"description": "Same values as plan_type in get_appeal_rights. Changes the wording for Medicare."
},
"name": {
"type": "string",
"description": "Member's name."
},
"plan": {
"type": "string",
"description": "Insurer or plan name."
},
"member_id": {
"type": "string",
"description": "Member ID or Medicare number."
},
"claim": {
"type": "string",
"description": "Claim or reference number."
},
"service": {
"type": "string",
"description": "The care that was denied, like \"MRI of the right knee\"."
},
"date": {
"type": "string",
"description": "Date of service."
},
"denial_date": {
"type": "string",
"description": "Date on the denial notice."
},
"doctor": {
"type": "string",
"description": "Treating doctor's name."
},
"provider": {
"type": "string",
"description": "Hospital, clinic or provider name."
},
"details": {
"type": "string",
"description": "A sentence or two in the user's words on why the care should be covered."
},
"urgent": {
"type": "string",
"enum": [
"yes",
"no"
],
"description": "Set to yes to ask for an expedited review."
}
},
"required": [],
"additionalProperties": false
}