Stream: implementers
Topic: Coverage.payor Cardinality
David Gutknecht (Feb 02 2021 at 16:18):
Hello everybody,
I noticed something strange on the Coverage.payor Cardinality.
Actually Coverage.payor has cardinality 1..*, but how can a coverage be linked to many payors ?
The description is also "Issuer of the policy"
Is it possible to have multiple Issuers for one policy ?
If you have multiple payors, then you should have multiple policies, this means multiple coverage or ?
Best regards,
David
Lloyd McKenzie (Feb 02 2021 at 16:56):
@Paul Knapp
Paul Knapp (Feb 02 2021 at 18:45):
@David Gutknecht The Coverage resource is used to represent both insurance, where you would constrain to 1..1, and self pay where the cardinality would be 1..* as the patient may be paying for some services, their parent pay for others and some organization pay for yet others.
Lloyd McKenzie (Feb 02 2021 at 19:27):
Wouldn't each of those technically be separate coverages? Each might have different 'rules' about what costs they cover and there could be different precedence between Coverages for different services.
Lloyd McKenzie (Feb 02 2021 at 19:28):
(@Paul Knapp )
David Gutknecht (Feb 03 2021 at 07:15):
Hello @Paul Knapp ,
thanks for you answer.
Does this mean that Cardinality should be like following depending on the payor ?
payor = Organisation => Cardinality = 1..1
payor = Patient => Cardinality = 1..1
payor = RelatedPerson => Cardinality = 1..*
And as @Lloyd McKenzie said, in the case of multiple RelatedPerson we still don't know who has to (or will) pay how much
Paul Knapp (Mar 23 2021 at 15:26):
@David Gutknecht For insurance: payor = Organisation => Cardinality = 1..1, for Selfpay payor = Organization or Patient or RelatedPerson => Candinality 1..*.
Last updated: Apr 12 2022 at 19:14 UTC
