Uhc Member Estimate costs

POSThttps://preview.ontross.com/api/integrations/uhc-member/estimate-costs

input.procedure_code

string

required

CPT or HCPCS code priced, also the care-path search term.

Example

"73721"

input.zip_code

string

required

ZIP, or ZIP plus four, anchoring the facility cost search.

Example

"53530"

input.radius_miles

integer

Maximum distance from the ZIP-code center used to search facilities.

Example

25

Default

25

input.limit

integer

Maximum number of facilities returned after applying the radius filter.

Example

25

Default

25

auth_id

string

required

Saved connection to run this operation through, from the Authentication page. It decides which practice and login the call uses.

Example

"00000000-0000-4000-8000-000000000000"

procedure_code

string

CPT or HCPCS code priced, also the care-path search term.

Example

"73721"

care_path_id

string

UHC's internal id for the procedure's care path.

Example

"6e9f7c24-2d18-4b63-a059-8c13d52f740e"

zip_code

string

ZIP, or ZIP plus four, anchoring the facility cost search.

Example

"53530"

radius_miles

integer

Search distance from the ZIP code center, 1 to 100.

Example

25

facility_limit

integer

The cap you requested on facilities returned.

Example

25

returned_facility_count

integer

How many facilities came back after the radius filter.

Example

2

geographic_cost_range

object

Price spread for this procedure across the area.

geographic_cost_range.p25

number

Twenty fifth percentile price in the area.

Example

650

geographic_cost_range.p50

number

Median price for this procedure in the area.

Example

1000

geographic_cost_range.p75

number

Seventy fifth percentile price in the area.

Example

1450

facilities

array

Facilities within the radius, sorted with preferred ones first.

facilities[].provider_id

string

UHC's id for the provider at this location.

Example

"5d874ae2-0639-4b17-8a62-f3c91d047be5"

facilities[].location_id

string

UHC's id for this specific facility location.

Example

"7a31bc95-4e08-462d-9f13-b620d845ac79"

facilities[].name

string

Facility name as UHC lists it.

Example

"Example Valley Imaging Center"

facilities[].npi

string

Facility's national provider identifier.

Example

"1999999984"

facilities[].phone

string

Facility's listed phone number.

Example

"608-555-0147"

facilities[].address

string

Street line for the facility.

Example

"120 Example Avenue Suite 200"

facilities[].city

string

City the facility sits in.

Example

"Darlington"

facilities[].state

string

Two letter state code for the facility.

Example

"WI"

facilities[].zip_code

string

ZIP, or ZIP plus four, anchoring the facility cost search.

Example

"53530"

facilities[].distance_miles

number

Distance from the searched ZIP code center.

Example

7.4

facilities[].in_network

boolean

True when the facility is in the member's network.

Example

true

facilities[].preferred

boolean

True when UHC flags the facility as preferred.

Example

true

facilities[].cost_band

string

Relative price tier UHC assigns this facility.

Example

"LOW"

facilities[].cost

object

The member's estimated cost breakdown at this facility.

facilities[].cost.out_of_pocket_cost

number

What the member is estimated to pay here.

Example

250

facilities[].cost.full_cost

number

Total negotiated price before the plan pays anything.

Example

1000

facilities[].cost.insurance_pays

number

Share of the price the plan covers.

Example

750

facilities[].cost.copay

number

Flat copay included in this estimate.

Example

50

facilities[].cost.coinsurance

number

Member's percentage share included in this estimate.

Example

20

facilities[].cost.amount_applied_to_deductible

number

Part of this estimate that goes to the deductible.

Example

100

facilities[].cost.not_covered_portion

number

Part of the price the plan excludes entirely.

Example

0

curl --request POST \
  --url https://preview.ontross.com/api/integrations/uhc-member/estimate-costs \
  --header 'X-API-Key: REPLACE_KEY_VALUE' \
  --header 'content-type: application/json' \
  --data '{"input":{"procedure_code":"73721","zip_code":"53530","radius_miles":25,"limit":25},"auth_id":"auth_uuid_here"}'

Request BODY

{
  "input": {
    "procedure_code": "73721",
    "zip_code": "53530",
    "radius_miles": 25,
    "limit": 25
  },
  "auth_id": "auth_uuid_here"
}

Response BODY

{
  "id": "string",
  "workflow_id": "string",
  "auth_id": "string",
  "status": "string",
  "input": {},
  "output": {
    "procedure_code": "73721",
    "care_path_id": "6e9f7c24-2d18-4b63-a059-8c13d52f740e",
    "zip_code": "53530",
    "radius_miles": 25,
    "facility_limit": 25,
    "returned_facility_count": 2,
    "geographic_cost_range": {
      "p25": 650,
      "p50": 1000,
      "p75": 1450
    },
    "facilities": [
      {
        "provider_id": "5d874ae2-0639-4b17-8a62-f3c91d047be5",
        "location_id": "7a31bc95-4e08-462d-9f13-b620d845ac79",
        "name": "Example Valley Imaging Center",
        "npi": "1999999984",
        "phone": "608-555-0147",
        "address": "120 Example Avenue Suite 200",
        "city": "Darlington",
        "state": "WI",
        "zip_code": "53530",
        "distance_miles": 7.4,
        "in_network": true,
        "preferred": true,
        "cost_band": "LOW",
        "cost": {
          "out_of_pocket_cost": 250,
          "full_cost": 1000,
          "insurance_pays": 750,
          "copay": 50,
          "coinsurance": 20,
          "amount_applied_to_deductible": 100,
          "not_covered_portion": 0
        }
      }
    ]
  },
  "files": null,
  "created_at": "2019-08-24T14:15:22Z",
  "started_at": "2019-08-24T14:15:22Z",
  "completed_at": "2019-08-24T14:15:22Z"
}