Insurance information (Coverage) resource

I’m new to this group and fairly new to FHIR.
AS part of our project I need the patient’s Primary and Secondary insurance information. I do not see anything on the Patient that would provide me the Coverage resource. Is the following the correct way to get to Primary and Secondary insurance?

  • pull in the Encounter in context
  • get Account resource from Encounter
  • get Primary Coverage from Account where priority = 1 and Secondary coverage where priority=2.

Is there a way to get both Primary and Secondary coverage for Patient without going through the Encounter?


You can directly query Coverage to find out what coverages have the patient as a beneficiary. However the determination of what coverage is primary vs. secondary depends on the context of the care being provided. What’s primary coverage for a dental service might not be primary coverage for surgery. Thus the only place that primary vs. secondary can be explicitly declared is when the context of care is already known (e.g. Encounter). If you need to query the Coverages directly, you’ll need to figure out primary vs. secondary yourself based on your care context.