---
title: "Get Benefits Check V1"
method: GET
path: "/public/v1/benefits-checks/{benefits_check_id}"
tags: ["V1BenefitsCheckResource"]
---

# Get Benefits Check V1

`GET /public/v1/benefits-checks/{benefits_check_id}`

## Request

- Base URL: `https://app.silnahealth.com/api`
- URL: `https://app.silnahealth.com/api/public/v1/benefits-checks/{benefits_check_id}`
- Auth: HTTP bearer

## Path parameters

- `benefits_check_id` string, required

## Response `200`

- V1BenefitsCheckResponse
  - `id` string, uuid, required: Benefits Check ID
  - `status` 'REQUESTED' | 'AWAITING_SILNA' | 'AWAITING_PROVIDER' | 'COMPLETE' | 'WITHDRAWN', required
  - `eligibility_status` 'ELIGIBLE' | 'INELIGIBLE'
  - `ineligibility_reason` 'PLAN_INACTIVE' | 'PATIENT_HAS_OUT_OF_NETWORK_IPA' | 'PLAN_HAS_TERMINATED' | 'MBI_TERMINATED' | 'NO_MEDICARE_PART_B_COVERAGE' | 'MEMBER_NUMBER_MISMATCH' | 'SPECIALTY_NOT_COVERED' | 'PATIENT_HAS_OTHER_INSURANCE' | 'NO_OUT_OF_NETWORK_BENEFITS' | 'HAS_ACTIVE_HOME_PLAN' | 'ENROLLED_IN_HOSPICE' | 'PROVIDER_PLACE_OF_SERVICE_NOT_COVERED' | 'PATIENT_DECEASED'
  - `reference` string, nullable: Reference number
  - `note` string, nullable: Notes
  - `insurance_type` 'COMMERCIAL' | 'MEDICARE' | 'MEDICAID' | 'REGIONAL_CENTER' | 'WORKERS_COMPENSATION' | 'AUTO_INSURANCE'
  - `date_verified` string, date-time, nullable: Date verified
  - `patient_plan_id` string, uuid, required: Patient Plan ID
  - `patient_id` string, uuid, required: Patient ID
  - `provider_id` string, uuid, required: Provider ID
  - `network_status` 'IN_NETWORK' | 'OUT_OF_NETWORK'
  - `plan_type` string, nullable: Plan type
  - `payor_plan_id` string, uuid, nullable: Silna identifier of the payor plan. Benefits checks with the same payor_plan_id share the same plan. Matches the id returned by GET /public/v1/payors/plans.
  - `plan_start_date` string, date, nullable: Plan start date
  - `plan_end_date` string, date, nullable: Plan end date
  - `group_number` string, nullable: Plan group ID
  - `patient_information` BenefitsCheckPatientInformation: Patient Information Schema - shared between V1 and V2
    - `subscriber_first_name` string, nullable: Subscriber first name
    - `subscriber_last_name` string, nullable: Subscriber last name
    - `subscriber_date_of_birth` string, date, nullable: Subscriber date of birth
    - `subscriber_address` string, nullable: Subscriber address
    - `subscriber_state` string, nullable: Subscriber state
    - `subscriber_city` string, nullable: Subscriber city
    - `subscriber_zip_code` string, nullable: Subscriber zip code
    - `subscriber_patient_relationship` string, nullable: Subscriber Patient relationship
  - `other_payor_information` BenefitsCheckOtherPayorInformation[], nullable: Other payor information
    - `payor_name` string, nullable: Payor name
    - `plan_order_number` integer, nullable: Plan order number
  - `other_payor_entity_name` string, nullable: Name of the other insurance payor entity when ineligibility reason is patient has other insurance
  - `independent_physician_association_name` string, nullable: Name of the Independent Physician Association (IPA) managing the provider network for the patient's plan
  - `is_qualified_medicare_beneficiary` boolean, nullable: Whether the patient is a Qualified Medicare Beneficiary (QMB)
  - `incomplete_reasons` BenefitsCheckIncompleteReasonSchema[], nullable: Details on why an automation-only benefits check could not be auto-completed
    - `type` 'AAA' | 'CAQH_CORE_ERROR' | 'VALIDATION', required
    - `code` string, nullable: Code from the payor or clearinghouse
    - `message` string, required: Human-readable description
  - `created_at` string, date-time, required: Created at timestamp
  - `silna_url` string, nullable: Silna benefits check URL
  - `specialty_specific_data` V1BenefitsCheckSpecialtyData[], required: Specialty specific benefits data
    - `specialty` 'PHYSICAL_THERAPY' | 'ABA_THERAPY' | 'SPEECH_THERAPY' | 'OCCUPATIONAL_THERAPY' | 'PSYCHOLOGICAL_TESTING' | 'HOME_HEALTH_CARE' | 'HOSPICE' | 'CARDIAC_REHABILITATION' | 'INTENSIVE_CARDIAC_REHABILITATION' | 'MENTAL_HEALTH' | 'PRINCIPAL_ILLNESS_NAVIGATION' | 'PRINCIPAL_CARE_MANAGEMENT' | 'ADVANCED_PRIMARY_CARE_MODELS' | 'PREVENTATIVE_HEALTH' | 'PARTIAL_HOSPITALIZATION_PROGRAM' | 'INTENSIVE_OUTPATIENT_PROGRAM' | 'INTERVENTIONAL_RADIOLOGY' | 'VASCULAR_SURGERY' | 'INTERVENTIONAL_CARDIOLOGY' | 'ORTHOPEDICS' | 'CHIROPRACTIC' | 'GYNECOLOGY' | 'LONG_TERM_CARE' | 'NUTRITIONAL_COUNSELING' | 'PHYSICAL_MEDICINE' | 'PULMONARY_REHABILITATION' | 'INJECTABLE_SPECIALTY_MEDICATIONS' | 'ALLERGY_TESTING' | 'SKILLED_NURSING' | 'RADIOLOGY' | 'OTOLARYNGOLOGY' | 'DURABLE_MEDICAL_EQUIPMENT' | 'DERMATOLOGY' | 'PROFESSIONAL_OFFICE_VISIT' | 'PSYCHIATRY' | 'PRIVATE_DUTY_NURSING' | 'NEUROLOGY', required
    - `auth_required` boolean, nullable, required: Whether authorization is required
    - `referral_required` boolean, nullable, required: Whether referral is required
    - `referral_info` string, nullable, required: Referral information
    - `requirement_time` 'BEFORE_SERVICES' | 'AFTER_SERVICES', required
    - `requirement_quantity` integer, nullable, required: Authorization requirement quantity
    - `requirement_unit` 'VISITS' | 'CPT_UNITS', required
    - `auth_company` string, nullable, required: Authorization company
    - `has_visit_limit` boolean, nullable, required: Whether visit limit exists
    - `visit_limit_quantity` integer, nullable, required: Visit limit quantity
    - `visits_used` integer, nullable, required: Number of visits used
    - `copay_amount` string, nullable, required: Copay amount
    - `coinsurance_percentage` string, nullable, required: Coinsurance percentage
    - `individual_deductible_amount` string, nullable, required: Individual deductible amount
    - `individual_deductible_amount_met` string, nullable, required: Individual deductible amount met
    - `family_deductible_amount` string, nullable, required: Family deductible amount
    - `family_deductible_amount_met` string, nullable, required: Family deductible amount met
    - `individual_out_of_pocket_amount` string, nullable, required: Individual out of pocket amount
    - `individual_out_of_pocket_amount_met` string, nullable, required: Individual out of pocket amount met
    - `family_out_of_pocket_amount` string, nullable, required: Family out of pocket amount
    - `family_out_of_pocket_amount_met` string, nullable, required: Family out of pocket amount met
    - `medicare_dollars_used` string, nullable, required: Medicare dollars used
    - `reimbursement_rate` string, nullable, required: Reimbursement rate
    - `exclusions_and_limitations` string, nullable, required: Exclusions and limitations
    - `buy_and_bill_allowed` boolean, nullable: Whether buy and bill is allowed
    - `patient_cost_estimates` V1PatientCostOfServiceEstimate[]: List of patient cost estimates
      - `cost_estimate_name` string, required: Name of the cost estimate
      - `cost_of_service` string, required: Cost of service
      - `cost_of_service_duration` 'PER_VISIT' | 'PER_HOUR' | 'PER_DAY' | 'PER_SESSION' | 'PER_MONTH' | 'PER_WEEK' | 'PER_PHASE' | 'NONE_HIDDEN'

## Other responses

- `401`
- `404`
- `429`

## Changes

- **2026-10-15** `d5adf321aa4b`: 1 info
  - added the optional property `payor_plan_id` to the response with the `200` status
- **2026-10-09** `21a1da5cc32a`: 1 info
  - added the optional property `specialty_specific_data/items/buy_and_bill_allowed` to the response with the `200` status
- **2026-10-08** `2487b06b9480`: 1 warning
  - added the new `NEUROLOGY` enum value to the `specialty_specific_data/items/specialty` response property for the response status `200`
- **2026-10-02** `455a258c70bc`: 1 info
  - added the optional property `incomplete_reasons` to the response with the `200` status
- **2026-09-03** `fd526e716e77`: 19 breaking, 26 warning, 7 info
  - the response property `date_verified` became optional for the status `200`
  - the response property `eligibility_status` became optional for the status `200`
  - the response property `group_number` became optional for the status `200`
  - the response property `insurance_type` became optional for the status `200`
  - …48 more

[Operation history](https://skmtc.dev/silnahealth/apis/silna-public-api/changes/public/v1/benefits-checks/:benefits_check_id/get.md)

---

[API](https://skmtc.dev/silnahealth/apis/silna-public-api.md) - [All operations](https://skmtc.dev/silnahealth/apis/silna-public-api/llms.txt) - [OpenAPI document](https://skmtc.dev/silnahealth/apis/silna-public-api/revisions/06b4547aa602?raw)