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Jason Walonoski edited this page Aug 19, 2019 · 4 revisions

By default, the project contains Payers (i.e. public and private health insurance companies) in the src/main/resources/payers/insurance_companies.csv file, which is a list of some public and private insurers who provide services nationally (US).

The default financial numbers (e.g. premiums and copays) are not accurate.

You can modify the payer file or have Synthea use an alternative payer file by altering the src/main/resources/synthea.properties file:

# Payers
generate.payers.insurance_companies.default_file = payers/insurance_companies.csv

# Payer selection behavior
# How patients select a payer:
#  best_rates - select insurance with best rates for person's existing conditions and medical needs
#  random  - select randomly.
generate.payers.selection_behavior = random

Payer File Format

The payer file is a CSV file, with a single row for each payer.

Column Header Description
The first column has no header. It is the number of the payer. The program ignores this column.
id This the payer identifier, this can just be a unique identifier.
name The name of the payer.
address The street address.
city The city.
state_headquartered The state abbreviation (or province or territory).
zip The zip or postal code.
phone The hospital or facility phone number.
states_covered The states that this payer offers plans (e.g. patients in these states can purchase coverage). Use * to signify all states. Otherwise, used a quoted comma-separated string. e.g. "MA,CT,NY"
services_covered The services covered (i.e. paid for) by this payer. Use * to signify all services. Otherwise, used a quoted comma-separated string. e.g. "wellness,medications,emergency"
deductible The amount required out of pocket from patients before the payer will reimburse.
default_coinsurance Coinsurance as a percentage. 0.0 - 1.0. Currently unused. Maybe used in future versions.
default_copay The amount required out of pocket from patients at each encounter.
monthly_premium The monthly fee paid by the patient to obtain an insurance plan from this payer.
ownership String. Government or Private
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