openapi: 3.0.0
info:
title: ribbon-health Cost Estimates API
description: 'An API for interacting with the data provided by Ribbon Health, including information about healthcare providers, locations, insurances, and more.
'
contact: {}
version: 1.0.0
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x-server-configuration:
default-environment: production
default-server: default
environments:
- name: production
servers:
- name: default
url: https://api.ribbonhealth.com/v1
parameters: []
x-image-uri: ''
servers:
- url: https://api.ribbonhealth.com/v1
security:
- BearerAuth: []
tags:
- name: Cost Estimates
description: ''
paths:
/eligibility:
post:
tags:
- Cost Estimates
summary: getEligibility
description: 'Verify a member''s current insurance coverage and benefits. You can access detailed information including a member’s progress on their Deductible and Out-of-pocket, as well as Copay and Coinsurance information for different services.
#### Example Use Case
Inform a member of their current progress against their Deductible as well as their Copay and Coinsurance summaries so they can better estimate their out-of pocket costs.
'
operationId: getEligibility
parameters:
- name: include_full_response
in: query
description: Whether to return the full eligibility response from the payer. Defaults to `false` when not provided.
required: false
style: form
explode: true
schema:
type: boolean
example: true
default: false
requestBody:
description: Identifying information for the member to be checked
content:
application/json:
schema:
type: object
properties:
member_id:
type: string
description: The member's identification number
example: 000000000-00
first_name:
type: string
description: The member's first name
example: John
last_name:
type: string
description: The member's last name
example: Doe
birth_date:
type: string
description: The member's birth date as an ISO-format date string
format: date
example: 1980-12-31
insurance_partner:
type: string
description: The identifier for this insurance partner in the Ribbon API
example: aetna_better_health_il
description: Identifying information for the member to be checked
required: true
responses:
'200':
description: Eligibility information for the given member
content:
application/json:
schema:
required:
- parameters
- request_id
- status
type: object
properties:
parameters:
type: object
properties:
member_id:
type: string
description: The member's identification number
example: 000000000-00
first_name:
type: string
description: The member's first name
example: John
last_name:
type: string
description: The member's last name
example: Doe
birth_date:
type: string
description: The member's birth date as an ISO-format date string
format: date
example: 1980-12-31
insurance_partner:
type: string
description: The identifier for this insurance partner in the Ribbon API
example: aetna_better_health_il
status:
type: object
properties:
is_valid:
type: boolean
description: Whether the eligibility check was successful
example: true
error:
type: string
description: If `is_valid` is `true`, an error code explaining what went wrong. When `is_valid` is `false`, this will be `null`.
nullable: true
request_id:
type: string
description: A unique identifier for the given response which Ribbon can use to find it in our logs during support requests
example: '40610978'
plan_info:
type: object
properties:
insurance_partner:
type: string
description: The identifier for this insurance partner in the Ribbon API
example: aetna_better_health_il
plan_name:
type: string
description: User-friendly display name for this insurance partner
example: Aetna Better Health of Illinois
is_active:
type: boolean
description: Whether the member is actively covered by this plan
example: true
plan_start_date:
type: string
description: The starting date for the member's coverage by this plan
format: date
example: 2012-02-01
plan_end_date:
type: string
description: The ending date for the member's coverage by this plan
format: date
nullable: true
example: 2024-01-01
deductible_detail:
type: object
properties:
individual:
type: object
properties:
in_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards in-network deductibles, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards in-network deductibles, in dollars
nullable: true
example: '3000'
remaining:
type: string
description: The remaining amount the member can pay towards in-network deductibles, in dollars
example: '2983.57'
out_of_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards out-of-network deductibles, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards out-of-network deductibles, in dollars
nullable: true
example: '6000'
remaining:
type: string
description: The remaining amount the member can pay towards out-of-network deductibles, in dollars
nullable: true
example: '5983.57'
family:
type: object
properties:
in_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards in-network deductibles, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards in-network deductibles, in dollars
nullable: true
example: '6000'
remaining:
type: string
description: The remaining amount the member can pay towards in-network deductibles, in dollars
nullable: true
example: '5983.57'
out_of_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards out-of-network deductibles, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards out-of-network deductibles, in dollars
nullable: true
example: '6000'
remaining:
type: string
description: The remaining amount the member can pay towards out-of-network deductibles, in dollars
nullable: true
example: '5983.57'
out_of_pocket_detail:
type: object
properties:
individual:
type: object
properties:
in_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards their in-network out-of-pocket maximum, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards their in-network out-of-pocket maximum, in dollars
nullable: true
example: '3000'
remaining:
type: string
description: The remaining amount the member can pay towards their in-network out-of-pocket maximum, in dollars
nullable: true
example: '2983.57'
out_of_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards their out-of-network out-of-pocket maximum, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars
nullable: true
example: '6000'
remaining:
type: string
description: The remaining amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars
nullable: true
example: '5983.57'
family:
type: object
properties:
in_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards their in-network out-of-pocket maximum, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards their in-network out-of-pocket maximum, in dollars
nullable: true
example: '3000'
remaining:
type: string
description: The remaining amount the member can pay towards their in-network out-of-pocket maximum, in dollars
nullable: true
example: '2983.57'
out_of_network:
type: object
properties:
spend:
type: string
description: The amount the member has paid towards their out-of-network out-of-pocket maximum, in dollars
nullable: true
example: '16.43'
maximum:
type: string
description: The maximum amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars
nullable: true
example: '6000'
remaining:
type: string
description: The remaining amount the member can pay towards their out-of-network out-of-pocket maximum, in dollars
nullable: true
example: '5983.57'
primary_care_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
dme_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
oncology_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
vision_optometry_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
physical_therapy_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
specialist_office_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
mental_health_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
surgical_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
urgent_care_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
diagnostic_lab_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
asc_facility_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
chiropractic_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
mri_ct_scan_summary:
type: object
properties:
in_network:
type: object
properties:
copay:
type: string
description: The amount of the member's in-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
out_of_network:
type: object
properties:
copay:
type: string
description: The amount of the member's out-of-network copay, in dollars
example: '30.0'
coinsurance:
type: string
nullable: true
example: '0.0'
x_ray_summary:
type: object
properties:
in_network:
type: object
properties:
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# Full source: https://raw.githubusercontent.com/api-evangelist/ribbon-health/refs/heads/main/openapi/ribbon-health-cost-estimates-api-openapi.yml