{
  "case_id": "example-appeal",
  "policy_id": "memorial-2026-05",
  "fpl_pct": "223.3",
  "findings": [
    {
      "kind": "F1",
      "title": "You likely qualify for financial assistance",
      "detail": "Household of 3, income $61,000: 223.3% of the poverty guideline. The policy gives 90% off at this level. Sheet S1 has no discount yet.",
      "amount": "6527.07",
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S1",
          "line_no": null,
          "note": "no discount"
        }
      ],
      "policy_refs": [
        "memorial-2026-05#scale-mrh",
        "memorial-2026-05#insured-balances"
      ],
      "math": {
        "balance": "7252.30",
        "minus_overcharge": "0",
        "fpl_pct": "223.3",
        "discount_pct": "90",
        "saving": "6527.07"
      },
      "trace": [
        {
          "doc_id": "S1",
          "line_no": null,
          "field": "patient_balance",
          "printed": "7252.30",
          "role": "what the papers ask"
        }
      ],
      "severity": "high",
      "confidence": 1.0,
      "laws": [
        "federal-501r-5#agb-limit",
        "federal-501r-6#refund-overpaid",
        "federal-501r-6#reverse-eca"
      ],
      "explain": "Your income fits the hospital's financial assistance policy, but no discount is on the bill."
    },
    {
      "kind": "A1",
      "title": "Appeal the denial by Apr 13, 2027",
      "detail": "Insurance statement S2 (Oct 15, 2026) paid nothing on 1 line (code P31). An employer health plan must give you at least 180 days to appeal.",
      "amount": null,
      "deadline": "2027-04-13",
      "evidence": [
        {
          "doc_id": "S2",
          "line_no": 1,
          "note": "denied"
        }
      ],
      "policy_refs": [
        "erisa-2560-503-1#appeal-180-days"
      ],
      "math": {
        "notice_date": "2026-10-15",
        "days": "180"
      },
      "trace": [],
      "severity": "high",
      "confidence": 1.0,
      "laws": [
        "erisa-2560-503-1#appeal-180-days",
        "erisa-2560-503-1#decide-post-service-60"
      ],
      "explain": "This is the last day to appeal what your insurance refused to pay."
    }
  ],
  "no_money": [
    {
      "kind": "NM",
      "title": "Sheet 1 line 2 matches your insurance statement",
      "detail": "Both say $412.30. Nothing to dispute here.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S1",
          "line_no": 2,
          "note": ""
        },
        {
          "doc_id": "S2",
          "line_no": 2,
          "note": ""
        }
      ],
      "policy_refs": [],
      "math": {
        "bill_patient_responsibility": "412.30",
        "eob_patient_responsibility": "412.30",
        "difference": "0.00"
      },
      "trace": [],
      "severity": null,
      "confidence": null,
      "laws": [],
      "explain": null
    }
  ],
  "held_back": [],
  "total_may_come_off": "6527.07",
  "apply_by": "2027-10-15",
  "worth_asking": [
    {
      "kind": "F2",
      "title": "Apply by Oct 15, 2027",
      "detail": "First bill after discharge: sheet S1, Oct 20, 2026. No sheet says 'first bill', so we used the earliest hospital bill we have. This date is 12 months after Oct 15, 2026 (sheet S2).",
      "amount": null,
      "deadline": "2027-10-15",
      "evidence": [
        {
          "doc_id": "S1",
          "line_no": null,
          "note": "first bill after discharge"
        }
      ],
      "policy_refs": [
        "memorial-2026-05#window",
        "federal-501r#application-period"
      ],
      "math": {
        "policy: one year after service": "2027-07-16",
        "policy: 12 months after last insurance payment": "2027-10-15",
        "federal: 240 days after first bill": "2027-06-17",
        "paid_on": "2026-10-15",
        "paid_sheet": "S2",
        "why_unsure": "no paper prints the payment date: this counts from the date of your plan's statement on S2. Check the date with the hospital"
      },
      "trace": [],
      "severity": "borderline",
      "confidence": 0.5,
      "laws": [
        "federal-501r#application-period"
      ],
      "explain": "This is the last day to apply for the hospital's financial assistance."
    },
    {
      "kind": "I1",
      "title": "Ask for the itemized bill",
      "detail": "Sheet S1 shows a total without every charge. Line-by-line errors can hide there. A Florida hospital must send the itemized bill within 7 days of your request.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S1",
          "line_no": null,
          "note": "no itemized bill"
        }
      ],
      "policy_refs": [
        "fl-395-301#itemized-on-request",
        "fl-395-301#itemized-7-days"
      ],
      "math": {
        "letter": "itemized"
      },
      "trace": [],
      "severity": "borderline",
      "confidence": 0.5,
      "laws": [
        "fl-395-301#itemized-on-request",
        "fl-395-301#itemized-7-days"
      ],
      "explain": "Ask for the itemized bill to see every charge; errors often hide in the total."
    }
  ],
  "apply_by_sure": false,
  "not_sent": []
}