{
  "case_id": "example-video",
  "policy_id": "memorial-2026-05",
  "fpl_pct": "212.3",
  "findings": [
    {
      "kind": "E2",
      "title": "Same service billed twice on sheet 7",
      "detail": "Lines 1 and 2 are the same code 01960 on Feb 11, 2025 for $4,944.00 each. Your insurance statement shows $196.82 for the second one.",
      "amount": "196.82",
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S7",
          "line_no": 1,
          "note": ""
        },
        {
          "doc_id": "S7",
          "line_no": 2,
          "note": ""
        },
        {
          "doc_id": "S1",
          "line_no": 5,
          "note": "also twice here"
        },
        {
          "doc_id": "S1",
          "line_no": 6,
          "note": ""
        }
      ],
      "policy_refs": [],
      "math": {
        "code": "01960",
        "service_date": "2025-02-11",
        "charges": "4944.00",
        "second_patient_responsibility": "196.82",
        "amount_from": "S1"
      },
      "trace": [
        {
          "doc_id": "S1",
          "line_no": 6,
          "field": "patient_responsibility",
          "printed": "196.82",
          "role": "your insurance shows for the second one"
        }
      ],
      "severity": "high",
      "confidence": 1.0,
      "laws": [],
      "explain": "The same service appears twice, same day and same price."
    },
    {
      "kind": "E4",
      "title": "Sheet 13 asks two different amounts",
      "detail": "It says your balance is $0.00 and also asks you to pay $719.03. Do not pay until the office explains which one is right.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S13",
          "line_no": null,
          "note": ""
        }
      ],
      "policy_refs": [],
      "math": {
        "patient_balance": "0.00",
        "amount_due_coupon": "719.03"
      },
      "trace": [],
      "severity": "high",
      "confidence": 1.0,
      "laws": [],
      "explain": "One sheet shows two different amounts to pay. Ask which one is right before paying."
    },
    {
      "kind": "P1",
      "title": "Page 3 of 4 is missing",
      "detail": "This insurance statement has 4 pages; we have 3. Totals may be on a missing page. Find or ask for pages 3.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S1",
          "line_no": null,
          "note": "page 1 of 4"
        },
        {
          "doc_id": "S2",
          "line_no": null,
          "note": "page 2 of 4"
        },
        {
          "doc_id": "S3",
          "line_no": null,
          "note": "page 4 of 4"
        }
      ],
      "policy_refs": [],
      "math": {
        "page_count": "4",
        "missing": "3"
      },
      "trace": [],
      "severity": "high",
      "confidence": 1.0,
      "laws": [],
      "explain": "Some pages of a statement are missing from the pile; totals may be on them."
    },
    {
      "kind": "F1",
      "title": "You likely qualify for financial assistance",
      "detail": "Household of 3, income $58,000: 212.3% of the poverty guideline. The policy gives 90% off at this level. Sheet D1 has no discount yet.",
      "amount": "1399.71",
      "deadline": null,
      "evidence": [
        {
          "doc_id": "D1",
          "line_no": null,
          "note": "no discount"
        }
      ],
      "policy_refs": [
        "memorial-2026-05#scale-mrh",
        "memorial-2026-05#insured-balances"
      ],
      "math": {
        "balance": "1555.23",
        "minus_overcharge": "0",
        "fpl_pct": "212.3",
        "discount_pct": "90",
        "saving": "1399.71"
      },
      "trace": [
        {
          "doc_id": "D2",
          "line_no": null,
          "field": "patient_balance",
          "printed": "1555.23",
          "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."
    }
  ],
  "no_money": [
    {
      "kind": "NM",
      "title": "Sheet D3: waiting for insurance",
      "detail": "$1,490.25 is due from insurance, not from you, so nothing comes off it yet. If the plan refuses it, ask for the same help on this bill.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "D3",
          "line_no": null,
          "note": ""
        }
      ],
      "policy_refs": [],
      "math": {},
      "trace": [],
      "severity": null,
      "confidence": null,
      "laws": [],
      "explain": null
    },
    {
      "kind": "NM",
      "title": "Doctors' bills are outside the hospital's assistance policy",
      "detail": "BRIGHTWATER HEALTHCORP INC, Little Harbor Pediatrics - PA bill separately. This policy covers the hospital and its own doctors only; ask each office whether it has its own help program.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S5",
          "line_no": null,
          "note": ""
        },
        {
          "doc_id": "S7",
          "line_no": null,
          "note": ""
        },
        {
          "doc_id": "S8",
          "line_no": null,
          "note": ""
        },
        {
          "doc_id": "S10",
          "line_no": null,
          "note": ""
        }
      ],
      "policy_refs": [
        "memorial-2026-05#facilities-only"
      ],
      "math": {},
      "trace": [],
      "severity": null,
      "confidence": null,
      "laws": [],
      "explain": null
    }
  ],
  "held_back": [],
  "total_may_come_off": "1596.53",
  "apply_by": "2026-04-01",
  "worth_asking": [
    {
      "kind": "E3",
      "title": "Check the $40.00 credit stays taken off",
      "detail": "Sheet 12 shows a $40.00 credit. Sheet 13 of the same account asks $719.03, which looks to include it already. Check that it stays there; it is not counted as money back.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S12",
          "line_no": null,
          "note": ""
        },
        {
          "doc_id": "S13",
          "line_no": null,
          "note": ""
        }
      ],
      "policy_refs": [],
      "math": {
        "patient_balance": "-40.00",
        "applied_on": "S13"
      },
      "trace": [
        {
          "doc_id": "S12",
          "line_no": null,
          "field": "patient_balance",
          "printed": "-40.00",
          "role": "balance in your favor"
        }
      ],
      "severity": "borderline",
      "confidence": 0.5,
      "laws": [],
      "explain": "The sum this sheet asks for looks like it already took this credit off, so it is not extra money back."
    },
    {
      "kind": "F2",
      "title": "Apply by Apr 1, 2026",
      "detail": "First bill after discharge: sheet D1, Apr 5, 2025. No sheet says 'first bill', so we used the earliest hospital bill we have. This date is 12 months after Apr 1, 2025 (sheet S4).",
      "amount": null,
      "deadline": "2026-04-01",
      "evidence": [
        {
          "doc_id": "D1",
          "line_no": null,
          "note": "first bill after discharge"
        }
      ],
      "policy_refs": [
        "memorial-2026-05#window",
        "federal-501r#application-period"
      ],
      "math": {
        "policy: one year after service": "2026-02-13",
        "policy: 12 months after last insurance payment": "2026-04-01",
        "federal: 240 days after first bill": "2025-12-01",
        "paid_on": "2025-04-01",
        "paid_sheet": "S4",
        "why_unsure": "no paper prints the payment date: this counts from the date of your plan's statement on S4. 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": "B1",
      "title": "Baby's care is billed under mom's insurance",
      "detail": "Sheet 2 lists newborn care (0170, 99460, 99462) for mom (member [MEMBER_1]). 8 lines for $7,400.00 were denied (reason A27). Ask the insurer and the provider to bill it under the baby, or add the baby to the plan, before the balance moves to you. The hospital already bills the baby's account (file 3) $0.00 due from insurance and shows an insurance credit of $4,946.75 that no insurance statement in your papers explains: ask for the statement behind it.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S2",
          "line_no": 1,
          "note": "A27"
        },
        {
          "doc_id": "S2",
          "line_no": 2,
          "note": "A27"
        },
        {
          "doc_id": "S2",
          "line_no": 3,
          "note": "A27"
        },
        {
          "doc_id": "S2",
          "line_no": 4,
          "note": "A27"
        },
        {
          "doc_id": "S2",
          "line_no": 5,
          "note": "A27"
        },
        {
          "doc_id": "S2",
          "line_no": 6,
          "note": "A27"
        },
        {
          "doc_id": "S2",
          "line_no": 7,
          "note": "A27"
        },
        {
          "doc_id": "S2",
          "line_no": 8,
          "note": "A27"
        },
        {
          "doc_id": "D3",
          "line_no": null,
          "note": "baby's bill"
        }
      ],
      "policy_refs": [],
      "math": {
        "codes": "0170, 99460, 99462",
        "denied_lines": "8",
        "denied_total": "7400.00",
        "baby_bill": "D3",
        "baby_insurance_credit": "4946.75",
        "baby_balance": "0.00",
        "baby_waiting": "yes",
        "why_unsure": "Muse Wonder: D3 shows due_from_insurance $1,490.25, not $0.00; D3 also notes patient_balance printed as both 0.00 and 1490.25, so the $0.00 baby balance is not settled."
      },
      "trace": [],
      "severity": "borderline",
      "confidence": 0.6,
      "laws": [],
      "explain": "The baby's care was billed under mom's insurance ID, so the plan may have refused it."
    }
  ],
  "apply_by_sure": false,
  "not_sent": []
}