Provider:	{{ verification.provider }}
Policy Number:	`{{ verification.policy_number }}`
Verification ID:	`{{ verification.verification_id }}`

Verification Date:	{{ verification.verification_date }}
Response Time:	{{ verification.response_time }}
Status:	{{ verification.status\|title }}

{% if verification.status == 'verified' %}

Name:	{{ verification.policy_holder.name }}
Date of Birth:	{{ verification.policy_holder.dob }}
Member ID:	`{{ verification.policy_holder.member_id }}`
Relationship:	{{ verification.policy_holder.relationship\|title }}

Plan Name:	{{ verification.coverage_details.plan_name }}
Plan Type:	{{ verification.coverage_details.plan_type }}
Effective Date:	{{ verification.coverage_details.effective_date }}
Expiration Date:	{{ verification.coverage_details.expiration_date }}
Group Number:	`{{ verification.coverage_details.group_number }}`
Network:	{{ verification.coverage_details.network }}

Deductible:	${{ verification.benefits.deductible\|floatformat:0 }}
Out-of-Pocket Max:	${{ verification.benefits.out_of_pocket_max\|floatformat:0 }}
Primary Care Copay:	${{ verification.benefits.copay_primary }}
Specialist Copay:	${{ verification.benefits.copay_specialist }}
Coinsurance:	{{ verification.benefits.coinsurance }}%

Prior Authorization Required: {% if verification.authorization.prior_auth_required %}Yes{% else %}No{% endif %}

Referral Required: {% if verification.authorization.referral_required %}Yes{% else %}No{% endif %}

Pre-certification Required: {% if verification.authorization.pre_certification_required %}Yes{% else %}No{% endif %}

Prescription:

Dental:

Vision:

{{ verification.contact_info.customer_service }}

{{ verification.contact_info.provider_services }}

{% elif verification.status == 'not_found' %}

{% elif verification.status == 'expired' %}

Policy Holder:	{{ verification.policy_holder.name }}
Member ID:	`{{ verification.policy_holder.member_id }}`
Expired Date:	{{ verification.expiration_details.expired_date }}
Days Expired:	{{ verification.expiration_details.days_expired }} days

{% elif verification.status == 'suspended' %}

Reason: {{ verification.suspension_details.reason }}

Suspended Date: {{ verification.suspension_details.suspended_date }}

Reinstatement Required: {% if verification.suspension_details.reinstatement_required %} Yes {% else %} No {% endif %}

Contact Provider: {% if verification.suspension_details.contact_required %} Required {% else %} Not Required {% endif %}

{% elif verification.status == 'pending' %}

Reason: {{ verification.pending_details.reason }}

Expected Resolution: {{ verification.pending_details.expected_resolution }}

Reference Number: {{ verification.pending_details.reference_number }}

{% endif %}

{% if verification.status == 'verified' %} {% endif %}