Managing accountability related to health insurance

Which resource/element do we use to record the amount of money coming from health insurance. In our practice, health insurance is mainly provided by the government /Which works mainly for public hospitals/. If you visit private hospitals you’d mostly pay out of pocket. But there are exceptions due to some public health programs. Some lab tests can be provided using state health insurance. How do you differentiate separate amounts coming out of pocket and state health insurance? /I assume, Out of pocket value might be recorded using Coverage.costToBeneficiary.value[x]/

Also patients pay the money when the services are being requested. How do we record cost of every service?

The costs associated with individual services may be recorded in ChargeItem.

For claims to insurers for products and services rendered you would use Claim and the insurer would return a ClaimResponse indicating the amount(s) they will pay (benefit) as per the plan.

The Coverage resource records key identification information for a patient’s (beneficiary) insurance but does not include the complete table of benefits. There would be one Coverage for each occurrence of an insurance plan for a Patient.

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