{
  "case_id": "example",
  "policy_id": "memorial-2026-05",
  "fpl_pct": "212.3",
  "findings": [
    {
      "kind": "E2",
      "title": "Same service billed twice on sheet 10",
      "detail": "Lines 1 and 2 are the same code 01960 on Feb 11, 2025 for $4,944.00 each.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S10",
          "line_no": 1,
          "note": ""
        },
        {
          "doc_id": "S10",
          "line_no": 2,
          "note": ""
        }
      ],
      "policy_refs": [],
      "math": {
        "code": "01960",
        "service_date": "2025-02-11",
        "charges": "4944.00",
        "second_patient_responsibility": "0"
      },
      "severity": "high",
      "confidence": 1.0,
      "laws": [],
      "explain": "The same service appears twice, same day and same price."
    },
    {
      "kind": "E3",
      "title": "You have a $40.00 credit on sheet 12",
      "detail": "The balance is in your favor. Ask for a refund instead of leaving it on the account.",
      "amount": "40.00",
      "deadline": null,
      "evidence": [
        {
          "doc_id": "S12",
          "line_no": null,
          "note": ""
        }
      ],
      "policy_refs": [],
      "math": {
        "patient_balance": "-40.00"
      },
      "severity": "high",
      "confidence": 1.0,
      "laws": [],
      "explain": "There is a credit on your account: money that should come back to you."
    },
    {
      "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"
      },
      "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"
      },
      "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": "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 D3 has no discount yet.",
      "amount": "1341.23",
      "deadline": null,
      "evidence": [
        {
          "doc_id": "D3",
          "line_no": null,
          "note": "no discount"
        }
      ],
      "policy_refs": [
        "memorial-2026-05#scale-mrh",
        "memorial-2026-05#insured-balances"
      ],
      "math": {
        "balance": "1490.25",
        "minus_overcharge": "0",
        "fpl_pct": "212.3",
        "discount_pct": "90",
        "saving": "1341.23"
      },
      "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": "Doctors' bills are outside the hospital's assistance policy",
      "detail": "LITTLE HARBOR PEDIATRICS, Meridian Physician Services 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": "S8",
          "line_no": null,
          "note": ""
        },
        {
          "doc_id": "S9",
          "line_no": null,
          "note": ""
        },
        {
          "doc_id": "S10",
          "line_no": null,
          "note": ""
        },
        {
          "doc_id": "S11",
          "line_no": null,
          "note": ""
        }
      ],
      "policy_refs": [
        "memorial-2026-05#facilities-only"
      ],
      "math": {},
      "severity": null,
      "confidence": null,
      "laws": [],
      "explain": null
    }
  ],
  "held_back": [],
  "total_may_come_off": "2780.94",
  "apply_by": null,
  "worth_asking": [
    {
      "kind": "I1",
      "title": "Ask for the itemized bill",
      "detail": "Sheet D1 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": "D1",
          "line_no": null,
          "note": "no itemized bill"
        }
      ],
      "policy_refs": [
        "fl-395-301#itemized-on-request",
        "fl-395-301#itemized-7-days"
      ],
      "math": {
        "letter": "itemized"
      },
      "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."
    },
    {
      "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",
        "why_unsure": "Nemotron-3-Ultra-550b-a55b: No document S13 exists in the case; the claim references a missing sheet."
      },
      "severity": "borderline",
      "confidence": 0.6,
      "laws": [],
      "explain": "One sheet shows two different amounts to pay. Ask which one is right before paying."
    },
    {
      "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]). 3 line(s) were denied. 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.",
      "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": 7,
          "note": "A27"
        }
      ],
      "policy_refs": [],
      "math": {
        "codes": "0170, 99460, 99462",
        "denied_lines": "3",
        "why_unsure": "Nemotron-3-Ultra-550b-a55b: S2 lines 1,2,7 have codes 99460, 0170, 99462 with denial A27, but descriptions are empty so \"newborn care\" is not supported by the provided text."
      },
      "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."
    },
    {
      "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 D2 has no discount yet.",
      "amount": null,
      "deadline": null,
      "evidence": [
        {
          "doc_id": "D2",
          "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",
        "why_unsure": "Nemotron-3-Ultra-550b-a55b: Amount 1399.71 does not derive from D2 (patient_balance 393.64; 90% = 354.28) or any other sheet balance shown.",
        "amount_if_confirmed": "1399.71"
      },
      "severity": "borderline",
      "confidence": 0.6,
      "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": "F2",
      "title": "Apply by Apr 01, 2026",
      "detail": "First bill after discharge: sheet S12, Mar 18, 2025. No sheet says 'first bill', so we used the earliest statement. 345 days left.",
      "amount": null,
      "deadline": "2026-04-01",
      "evidence": [
        {
          "doc_id": "S12",
          "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": "2025-11-13",
        "days_left": "345",
        "why_unsure": "Nemotron-3-Ultra-550b-a55b: Deadline 2026-04-01 conflicts with quoted policy: 240 days after first post-discharge statement (S12 2025-03-18) is 2025-11-13; 1 year after service (2025-02-11) is 2026-02-11. The later is 2026-02-11, not 2026-04-01."
      },
      "severity": "borderline",
      "confidence": 0.6,
      "laws": [
        "federal-501r#application-period"
      ],
      "explain": "The last day to apply for the hospital's financial assistance."
    }
  ]
}