{
  "x-source": {
    "spec": "openapi/aetna-patient-access-api-openapi.yml",
    "operationId": "get_v2_patientaccess_ExplanationOfBenefit_id",
    "path": "/v2/patientaccess/ExplanationOfBenefit/{id}",
    "status": "200",
    "media_type": "application/json",
    "note": "Response example published verbatim by Aetna in its own Swagger document; extracted, not authored."
  },
  "example": {
    "insurance": [
      {
        "coverage": {
          "reference": "Coverage/0000000000000100327"
        },
        "focal": true
      }
    ],
    "identifier": [
      {
        "system": "https://sources.aetna.com/EOB/identifier/claimid/62",
        "type": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
              "code": "uc",
              "display": "Unique Claim ID"
            }
          ]
        },
        "value": "EPAB10914D87A"
      }
    ],
    "use": "claim",
    "created": "2021-02-25",
    "diagnosis": [
      {
        "sequence": 1,
        "onAdmission": {
          "coding": [
            {
              "system": "https://www.nubc.org/CodeSystem/PresentOnAdmissionIndicator",
              "code": "u",
              "display": "Unknown"
            }
          ]
        },
        "type": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                "code": "principal",
                "display": "Principal Diagnosis"
              }
            ]
          }
        ],
        "diagnosisCodeableConcept": {
          "coding": [
            {
              "code": "K92.2"
            }
          ]
        }
      }
    ],
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/claim-type",
          "code": "institutional",
          "display": "Institutional"
        }
      ]
    },
    "payee": {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/payeetype",
            "code": "provider",
            "display": "Provider"
          }
        ]
      },
      "party": {
        "reference": "Organization/0000000000000100319"
      }
    },
    "disposition": "Completed",
    "total": [
      {
        "amount": {
          "value": 7559.2
        },
        "category": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
              "code": "other",
              "display": "Other"
            }
          ]
        }
      }
    ],
    "supportingInfo": [
      {
        "sequence": 1,
        "valueString": "35052599711",
        "category": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
              "code": "patientaccountnumber"
            }
          ]
        }
      }
    ],
    "provider": {
      "reference": "Organization/0000000000000100319"
    },
    "meta": {
      "lastUpdated": "2021-02-25T12:04:59.714+00:00",
      "profile": [
        "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"
      ]
    },
    "patient": {
      "reference": "Patient/0000000000000100267"
    },
    "insurer": {
      "display": "Aetna or it's Affiliates (collectively, 'Aetna')"
    },
    "billablePeriod": {
      "start": "2021-06-01",
      "end": "3000-01-01"
    },
    "subType": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/ex-claimsubtype"
        }
      ],
      "text": "Inpatient"
    },
    "id": "02d44f7e-2b88-11ec-a2d4-9d79182d0000",
    "outcome": "complete",
    "careTeam": [
      {
        "sequence": 1,
        "role": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole",
              "code": "attending",
              "display": "Attending"
            }
          ]
        },
        "provider": {
          "reference": "Practitioner/0000000000000100318"
        },
        "responsible": true
      }
    ],
    "resourceType": "ExplanationOfBenefit",
    "status": "active"
  }
}