Payer Data

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