# Retrieve a patient's insurance coverage

You can use this API action to review details about a patient’s insurance coverage. 

> **Prerequisite: Having a patient identifier**
>
> To use this API action, you must know the patient identifier. If you don’t have one, [search for a patient with demographics](/fhir-api-actions/patients/search-for-a-patient-by-demographics) to locate an appropriate identifier first.

## Use cases

This API action may be a good fit for your organization if you perform any of these use cases:

- Look up insurance plan information for billing purposes.
- Find out whether a patient is registered for SelfPay (e.g., for worker’s compensation or uninsured patients).

## Supported systems

You can use this API action with the Redox FHIR API.

> **Talk to a Redoxer**
>
> It’s also possible to use the Redox Data Model API for this API action. [Talk to a Redoxer](https://redoxengine.com/forms/contact-us/) to learn about your options.

Your connection's system can return results with their own FHIR or query-based API. 

## Things you need to know

<details>
<summary>Organization-specific</summary>

You can only search and receive data from one organization for one patient. If you want a comprehensive list for a patient from multiple organizations, you must perform this API action for every organization you’re interested in receiving data from. 

</details>

<details>
<summary>Who are the insured, subscriber, and guarantor?</summary>

There are three types of individuals or entities that are important to identify for an insurance plan: 

- <u>Insured</u>: The patient receiving the treatment. 
- <u>Subscriber</u>: The insurance plan policy holder. The subscriber may or may not be the same individual as the insured. If not the insured, this is typically someone that’s related to the insured. 
- <u>Guarantor</u>: The individual or entity that’s financially responsible for billing. Typically, the guarantor is the same as the insured or subscriber, but there are exceptions. One exception could be if the insured is a minor. Another is if the insured is seeking treatment for a worker’s compensation case, so the insured’s company is responsible for billing.

The important thing to remember is that the insured, subscriber, or guarantor could be different people.

Heads up, the `Coverage` resource identifies only the insured and subscriber, not the guarantor. In the FHIR world, the `Account` resource identifies the guarantor, but we don’t currently support it.

</details>

<details>
<summary>Encounter or patient coverage</summary>

There’s a bit of a difference in coverage for an encounter and for an individual patient. It may be that a patient uses one insurance type for a specific type of encounter but has another insurance that’s their primary coverage. When you retrieve an encounter, the response includes a reference to the insurance used for the encounter.  

</details>

<details>
<summary>Public and private coverage priority</summary>

A patient may have a combination of private and public insurance (e.g., Medicare). Each insurance entry contains the type of insurance. The priority between insurance types is available, but it’s not often supported by EHR systems.

</details>

> **What's next? **
>
> Does this API action seem like a good fit for your unique workflow? Let your Technical Account Manager know! To start development, download the resource schema noted in the related action step. Then decide which data elements you need.
>
> If you’re new to Redox, [use the Quickstart guide](/quickstart-for-redox) to dive in. If you’re not engaged with our sales team yet, [talk to a Redoxer](https://redoxengine.com/forms/contact-us/) to get started.