> ## Documentation Index
> Fetch the complete documentation index at: https://docs.maxcare.ai/llms.txt
> Use this file to discover all available pages before exploring further.

# Get insurance policy by ID

> Returns a single insurance policy by ID. Requires read:insurance_policies scope.



## OpenAPI

````yaml /openapi-v3.json get /insurance-policies/{id}
openapi: 3.0.0
info:
  title: Max AI Public API
  description: API for third-party marketplace apps
  version: '3.0'
  contact: {}
servers:
  - url: https://api.maxcare.ai/v3
security: []
tags: []
paths:
  /insurance-policies/{id}:
    get:
      tags:
        - Insurance Policies
      summary: Get insurance policy by ID
      description: >-
        Returns a single insurance policy by ID. Requires
        read:insurance_policies scope.
      operationId: InsurancePoliciesPublicController_getInsurancePolicy
      parameters:
        - name: id
          required: true
          in: path
          description: Insurance policy ID
          schema:
            type: string
        - name: X-Organization-Id
          in: header
          required: true
          schema:
            type: string
          description: Target clinic organization ID
      responses:
        '200':
          description: Success
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/GetInsurancePolicySuccessResponseV3'
        '400':
          description: Missing or invalid request parameter
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/PublicApiBadRequestResponse'
        '401':
          description: Invalid or missing API key
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/PublicApiUnauthorizedResponse'
        '403':
          description: Insufficient scope
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/PublicApiForbiddenResponse'
        '404':
          description: Resource not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/PublicApiNotFoundResponse'
        '429':
          description: Rate limit exceeded
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/PublicApiRateLimitResponse'
      security:
        - api-key: []
components:
  schemas:
    GetInsurancePolicySuccessResponseV3:
      type: object
      properties:
        code:
          type: string
          description: Response code
          example: success
        data:
          $ref: '#/components/schemas/ExternalInsurancePolicyResponseV3'
      required:
        - code
        - data
    PublicApiBadRequestResponse:
      type: object
      properties:
        code:
          type: string
          description: Error code
          example: bad_request
        message:
          type: string
          description: Human-readable error message
          example: '''id'' must be a valid UUID'
        trace_id:
          type: string
          description: Trace ID for debugging
          example: 550e8400-e29b-41d4-a716-446655440000
      required:
        - code
        - message
        - trace_id
    PublicApiUnauthorizedResponse:
      type: object
      properties:
        code:
          type: string
          description: Error code
          example: unauthorized
        message:
          type: string
          description: Human-readable error message
          example: Invalid or missing API key
        trace_id:
          type: string
          description: Trace ID for debugging
          example: 550e8400-e29b-41d4-a716-446655440000
      required:
        - code
        - message
        - trace_id
    PublicApiForbiddenResponse:
      type: object
      properties:
        code:
          type: string
          description: Error code
          example: forbidden
        message:
          type: string
          description: Human-readable error message
          example: Insufficient scope
        trace_id:
          type: string
          description: Trace ID for debugging
          example: 550e8400-e29b-41d4-a716-446655440000
      required:
        - code
        - message
        - trace_id
    PublicApiNotFoundResponse:
      type: object
      properties:
        code:
          type: string
          description: Error code
          example: not_found
        message:
          type: string
          description: Human-readable error message
          example: Resource not found
        trace_id:
          type: string
          description: Trace ID for debugging
          example: 550e8400-e29b-41d4-a716-446655440000
      required:
        - code
        - message
        - trace_id
    PublicApiRateLimitResponse:
      type: object
      properties:
        code:
          type: string
          description: Error code
          example: rate_limit_exceeded
        message:
          type: string
          description: Human-readable error message
          example: Rate limit exceeded. Maximum 1000 requests per 60 seconds.
        trace_id:
          type: string
          description: Trace ID for debugging
          example: 550e8400-e29b-41d4-a716-446655440000
      required:
        - code
        - message
        - trace_id
    ExternalInsurancePolicyResponseV3:
      type: object
      properties:
        id:
          type: string
          description: Insurance policy unique identifier
          example: pol_a1b2c3d456784abc9def0123456789ab
        patientId:
          type: string
          description: Patient ID this policy belongs to
          nullable: true
          example: pat_8de030393a9e417ab2b3a8b8df183631
        coverageOrder:
          type: number
          description: Coverage ranking (1 = primary, 2 = secondary, ...)
          example: 1
        memberId:
          type: string
          description: Member / policy number
          nullable: true
          example: XYZ123456789
        groupNumber:
          type: string
          description: Group number
          nullable: true
          example: GRP001
        planName:
          type: string
          description: Plan name
          nullable: true
          example: Blue Shield PPO
        policyType:
          type: string
          description: Policy type (e.g. PPO, HMO, MEDICARE)
          nullable: true
          example: PPO
        payerName:
          type: string
          description: Payer name
          nullable: true
          example: Blue Shield of California
        payerCode:
          type: string
          description: Payer ID (clearinghouse payer code)
          nullable: true
          example: BS001
        subscriberFirstName:
          type: string
          description: Subscriber first name
          nullable: true
          example: Jane
        subscriberLastName:
          type: string
          description: Subscriber last name
          nullable: true
          example: Doe
        patientRelationshipToPolicyHolder:
          type: string
          description: Patient relationship to policy holder
          nullable: true
          example: SELF
        copayAmount:
          type: string
          description: Copay amount
          nullable: true
          example: '25.00'
        deductibleRemaining:
          type: string
          description: Remaining deductible, refreshed by the latest eligibility check
          nullable: true
          example: '1250.00'
        referralRequired:
          type: boolean
          description: Whether a referral is required
          example: false
        policyEffectiveDate:
          type: string
          description: Policy effective date
          nullable: true
          example: '2025-01-01T00:00:00.000Z'
        policyEndDate:
          type: string
          description: Policy end/termination date reported by the EHR
          nullable: true
          example: '2026-01-01T00:00:00.000Z'
        terminatedAt:
          type: string
          description: >-
            When the policy was terminated/archived in the EHR (soft delete).
            Terminated policies remain listable with includeTerminated=true.
          nullable: true
          example: null
        eligibilityStatus:
          type: string
          description: Latest eligibility determination
          nullable: true
          enum:
            - ACTIVE
            - INACTIVE
            - PENDING
            - UNKNOWN
            - TERMINATED
            - UNAVAILABLE
          example: ACTIVE
        integrationEligibilityStatus:
          type: string
          description: Raw eligibility status string from the EHR
          nullable: true
          example: Eligible
        eligibilityVerifiedAt:
          type: string
          description: When eligibility was last verified
          nullable: true
          example: '2026-08-01T12:00:00.000Z'
        payerPhone:
          type: string
          description: >-
            The payer's contact phone number, from the payer directory this
            policy's plan resolves to. Null when the payer has no contact on
            file or the plan is unmapped. Not policy-specific — it is the
            payer's number, which is what a manufacturer hub form asks for.
          nullable: true
          example: (800) 555-0123
        source:
          type: string
          description: EHR source
          nullable: true
          enum:
            - modmed
            - ezderm
            - manual
        createdAt:
          type: string
          description: Created timestamp
          example: '2026-03-20T18:35:10.209Z'
        updatedAt:
          type: string
          description: Last updated timestamp
          example: '2026-03-23T03:15:47.285Z'
      required:
        - id
        - patientId
        - coverageOrder
        - memberId
        - groupNumber
        - planName
        - policyType
        - payerName
        - payerCode
        - subscriberFirstName
        - subscriberLastName
        - patientRelationshipToPolicyHolder
        - copayAmount
        - deductibleRemaining
        - referralRequired
        - policyEffectiveDate
        - policyEndDate
        - terminatedAt
        - eligibilityStatus
        - integrationEligibilityStatus
        - eligibilityVerifiedAt
        - payerPhone
        - source
        - createdAt
        - updatedAt
  securitySchemes:
    api-key:
      scheme: bearer
      bearerFormat: JWT
      type: http
      description: Marketplace API key

````