Coverage Behavior

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Coverage determines eligibility, pricing, and payment responsibility for appointments. Coverage must be resolved before the user can request an appointment.

Responsibility model

The platform determines coverage eligibility, validation, pricing rules, and active coverage state.
The client renders coverage options, submits selection or creation requests, and updates UI based on the returned state.

Coverage States

The platform maintains one active coverage state per session.

State	Description
With Coverage	- At least one valid policy is associated with the user. - The platform applies insurer rules to pricing and eligibility. - The client renders coverage-adjusted pricing.
Without Coverage	- No valid policy exists or no policy is selected. - The platform applies private-pay rules. - The client renders full pricing.

Coverage Resolution

Coverage must be resolved before appointment creation.

Resolution Flow

1. Select an existing policy when available. See Select Coverage.
2. Add a new coverage when no valid policy exists. See Add Coverage.
3. Submit policy details. See Add New Coverage.
4. The platform validates coverage and returns the updated state.

The platform may skip steps based on available user data.

Coverage Validation

The platform validates coverage after selection or submission.

Validation Outcomes

Condition	App behavior	SDK output
Validation succeeds	Proceed with flow and update pricing.	Response with active coverage state.
Validation fails	Display error and block progression.	Validation error response.
Validation fails in restricted flows	Return to previous state and preserve selection.	Response with validation error and unchanged coverage state.

Coverage State Update

After successful validation:

• The platform links the coverage to the user account.
• The platform sets the coverage as active.
• The platform returns updated pricing and eligibility context.
• The client updates UI accordingly.

External Coverage Provisioning

Coverage may be pre-associated with the user before entering the flow.

Corporate Programs

• The platform assigns coverage during registration.
• No manual input is required.
• The client renders pricing and branding based on the assigned policy.

Partner or Referral Flows

• The platform activates coverage after access verification.
• The client renders updated coverage state after verification.

Private-Pay Mode

If no valid coverage is active:

• The platform applies private-pay rules.
• The client renders full pricing.
• The user pays directly.

Integration Rules

• Resolve coverage before appointment creation.
• Do not treat coverage as active until validation succeeds.
• Recompute pricing after any coverage change.
• Revalidate coverage when request data changes.
• Treat coverage as a state input that affects:
  • pricing,
  • eligibility,
  • UI configuration.