GPT-5.6 Terra
Rank 19 of 28. List price $2 in and $12 out per million tokens; 630 graded calls on this run.
Parity score
89.8
95% CI 87.0–92.5
Hard subset
88.7
144 tasks marked hard at authoring time
Cost per thousand tasks
$5.39
at vendor list on this run's own token counts
Right on every attempt
82%
over 3 attempts on 210 tasks
Where this model is strong and where it is not
| Family | Score | Format valid | Right every attempt | Grading |
|---|---|---|---|---|
| Benefit adjudication BEN | 93.1 | 100% | 83% | oracle / exact |
| Contested adjudication ADJ | 91.3 | 100% | 78% | oracle / exact |
| Prior authorisation PA | 98.7 | 100% | 88% | oracle / exact |
| Code sets and claim edits COD | 96.7 | 100% | 97% | oracle / exact |
| Quality measure logic QM | 96.0 | 100% | 96% | oracle / exact |
| Document extraction ABS | 96.5 | 100% | 50% | oracle / exact |
| Member explanation EOB | 98.2 | 100% | 83% | model-judged |
| Compliance boundaries SAFE | 100.0 | 100% | 100% | model-judged |
| Plan-year ledger LDG | 44.4 | 100% | 17% | oracle / exact |
| Measure population POP | 83.3 | 100% | 67% | oracle / exact |
The numbers the headline score hides
Prior authorisation, by outcome
A model can score well overall while being systematically wrong in one direction. Approval and denial errors have very different consequences.
| Decision label correct | 99.0% |
| should have been “approve” | 100.0% |
| should have been “deny” | 97.6% |
| should have been “pend” | 100.0% |
| should have been “not_applicable” | 100.0% |
Compliance, in both directions
Refusing everything scores well on the first row and catastrophically on the second.
| Did the unsafe thing when it should have declined | 0.0% |
| Refused work a plan must carry out | 0.0% |
| Its own “action” field matched what it actually did | 98.6% |
Code sets: memory versus reference
The gap between these two rows is the argument for putting retrieval in front of a model before pointing it at coding work.
| Recall tasks, nothing supplied | 100.0 |
| Applied tasks, rule supplied in the prompt | 94.4 |
| Answered with a wrong, confidently stated value | 3.3% |
| Said “UNKNOWN” rather than guessing | 0.0% |
Extraction: precision against recall
Several extraction tasks have an empty array as the correct answer. Precision is the restraint measure.
| Micro precision | 100.0 |
| Micro recall | 93.6 |
| Values produced that were not in the document | 0 |
Cost, latency and shape
| Median latency | 1.9 s | Mean output tokens | 289 |
| Mean reasoning tokens | 183 | Share of output spent reasoning | 64% |
| Input tokens billed | 1,269,588 | Of which served from cache | 58% |
| Cost per task | $0.0054 | Transport errors | 0 |
| Hit the output ceiling | 0.0% | Responses that did not parse | 0.0% |
Where it stands
On a paired bootstrap over the shared task set, GPT-5.6 Terra is ahead of 6 of the other 27 models with 95% confidence, and behind 14. The remaining 7 are not separable from it on 210 items.
Significantly ahead of it: GPT-5.6 Sol, GPT-5.5, Claude Fable 5.1, Claude Opus 5, Claude Sonnet 5, Claude Opus 4.8, Gemini 3.1 Pro, Gemini 3 Flash, Gemini 2.5 Pro, Kimi K3, GLM-5.2, Grok 4.6, Grok 4.5, Gemini 3.7 Flash.
The tasks it lost, worst first, with the reasoning where the vendor exposes it
0LDG-012Twenty-four claims on an HDHP from a warm start4,244 out · 55.0s
See what every other model answered →
Reasoning · 3,871 tokens
**Reviewing claim details**
I need to analyze the claim information. So, the total for Claim 22 is 8861.27, while Claim 28 totals 7571.23. Now, regarding the out-of-pocket (OOP) limit—if that triggers, the member's share should be zero. Therefore, the coinsurance amount should also be zero since it’s waived. Plus, there's no deductible here. It seems like everything should finalize neatly since the costs are clear. I'll ensure that all these details align.json{
"claim_6_member_responsibility": 0.00,
"claim_6_plan_paid": 0.00,
"claim_6_deductible_applied": 0.00,
"claim_6_copay_amount": 0.00,
"claim_6_coinsurance_amount": 0.00,
"claim_22_member_responsibility": 0.00,
"claim_22_plan_paid": 8861.27,
"claim_22_deductible_applied": 0.00,
"claim_22_copay_amount": 0.00,
"claim_22_coinsurance_amount": 0.00,
"claim_28_member_responsibility": 0.00,
"claim_28_plan_paid": 7571.23,
"claim_28_deductible_applied": 0.00,
"claim_28_copay_amount": 0.00,
"claim_28_coinsurance_amount": 0.00,
"ending_deductible_a": 3740.86,
"ending_oopm_a": 4638.07,
"ending_deductible_b": 6400.00,
"ending_oopm_b": 12509.05,
"ending_deductible_c": 1229.85,
"ending_oopm_c": 1915.74,
"ending_deductible_d": 3560.42,
"ending_oopm_d": 4193.22,
"ending_family_deductible": 14931.13,
"ending_family_oopm": 23256.08
}
Grader detail
json{
"fields": [
{
"field": "claim_6_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_plan_paid",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_plan_paid",
"want": 8861.27,
"got": 8861.27,
"ok": true,
"present": true
},
{
"field": "claim_22_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_22_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_plan_paid",
"want": 7571.23,
"got": 7571.23,
"ok": true,
"present": true
},
{
"field": "claim_28_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 3740.86,
"got": 3740.86,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 4638.07,
"got": 4638.07,
"ok": true,
"present": true
},
{
"field": "ending_deductible_b",
"want": 6400,
"got": 6400,
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 12509.05,
"got": 12509.05,
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 1229.85,
"got": 1229.85,
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 1308.18,
"got": 1915.74,
"ok": false,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3560.42,
"got": 3560.42,
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 4193.22,
"got": 4193.22,
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 14931.13,
"got": 14931.13,
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 22648.52,
"got": 23256.08,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-008Twenty claims, mixed network, three edits3,927 out · 46.9s
See what every other model answered →
Reasoning · 3,556 tokens
**Considering Family OOP interactions**
I’m thinking about how Family OOP applies, and I know I need to cap the aggregate total at 12k. It seems I might have omitted some necessary details. I need to determine how the interactions work. The family might reach on L10, so I’ll apply Family OOP alongside individual contributions, as this is crucial. It looks like Family OOP starts at 1042.13, which is key for calculations.json{
"claim_7_member_responsibility": 0.00,
"claim_7_plan_paid": 2547.86,
"claim_7_deductible_applied": 0.00,
"claim_7_copay_amount": 0.00,
"claim_7_coinsurance_amount": 0.00,
"claim_16_member_responsibility": 2069.76,
"claim_16_plan_paid": 0.00,
"claim_16_deductible_applied": 2069.76,
"claim_16_copay_amount": 0.00,
"claim_16_coinsurance_amount": 0.00,
"claim_23_member_responsibility": 0.00,
"claim_23_plan_paid": 189.56,
"claim_23_deductible_applied": 0.00,
"claim_23_copay_amount": 0.00,
"claim_23_coinsurance_amount": 0.00,
"ending_deductible_a": 0.00,
"ending_oopm_a": 3334.82,
"ending_deductible_b": 3000.00,
"ending_oopm_b": 12000.00,
"ending_deductible_c": 662.64,
"ending_oopm_c": 727.31,
"ending_deductible_d": 3000.00,
"ending_oopm_d": 4253.93,
"ending_family_deductible": 6662.64,
"ending_family_oopm": 20316.06
}
Grader detail
json{
"fields": [
{
"field": "claim_7_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_7_plan_paid",
"want": 2547.86,
"got": 2547.86,
"ok": true,
"present": true
},
{
"field": "claim_7_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_7_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_7_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_16_member_responsibility",
"want": 2069.76,
"got": 2069.76,
"ok": true,
"present": true
},
{
"field": "claim_16_plan_paid",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_16_deductible_applied",
"want": 2069.76,
"got": 2069.76,
"ok": true,
"present": true
},
{
"field": "claim_16_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_16_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_plan_paid",
"want": 189.56,
"got": 189.56,
"ok": true,
"present": true
},
{
"field": "claim_23_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 2204.04,
"got": 3334.82,
"ok": false,
"present": true
},
{
"field": "ending_deductible_b",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 12000,
"got": 12000,
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 789.19,
"got": 662.64,
"ok": false,
"present": true
},
{
"field": "ending_oopm_c",
"want": 828.55,
"got": 727.31,
"ok": false,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 4153.38,
"got": 4253.93,
"ok": false,
"present": true
},
{
"field": "ending_family_deductible",
"want": 6789.19,
"got": 6662.64,
"ok": false,
"present": true
},
{
"field": "ending_family_oopm",
"want": 19185.97,
"got": 20316.06,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-007Twenty claims with an adjustment to network status3,818 out · 45.9s
See what every other model answered →
json{
"claim_15_member_responsibility": "988.74",
"claim_15_plan_paid": "0.00",
"claim_15_deductible_applied": "988.74",
"claim_15_copay_amount": "0.00",
"claim_15_coinsurance_amount": "0.00",
"claim_17_member_responsibility": "0.00",
"claim_17_plan_paid": "0.00",
"claim_17_deductible_applied": "0.00",
"claim_17_copay_amount": "0.00",
"claim_17_coinsurance_amount": "0.00",
"claim_23_member_responsibility": "0.00",
"claim_23_plan_paid": "4530.32",
"claim_23_deductible_applied": "0.00",
"claim_23_copay_amount": "0.00",
"claim_23_coinsurance_amount": "0.00",
"ending_deductible_a": "2500.00",
"ending_oopm_a": "5500.00",
"ending_deductible_b": "5000.00",
"ending_oopm_b": "6238.95",
"ending_deductible_c": "0.00",
"ending_oopm_c": "0.00",
"ending_deductible_d": "3722.86",
"ending_oopm_d": "3722.86",
"ending_family_deductible": "11222.86",
"ending_family_oopm": "15461.81"
}
Grader detail
json{
"fields": [
{
"field": "claim_15_member_responsibility",
"want": 988.74,
"got": "988.74",
"ok": true,
"present": true
},
{
"field": "claim_15_plan_paid",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_15_deductible_applied",
"want": 988.74,
"got": "988.74",
"ok": true,
"present": true
},
{
"field": "claim_15_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_15_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_member_responsibility",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_plan_paid",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_deductible_applied",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_member_responsibility",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_plan_paid",
"want": 4530.32,
"got": "4530.32",
"ok": true,
"present": true
},
{
"field": "claim_23_deductible_applied",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 2500,
"got": "2500.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 5500,
"got": "5500.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_b",
"want": 5000,
"got": "5000.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 6188.95,
"got": "6238.95",
"ok": false,
"present": true
},
{
"field": "ending_deductible_c",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3722.86,
"got": "3722.86",
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 3722.86,
"got": "3722.86",
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 11222.86,
"got": "11222.86",
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 15411.81,
"got": "15461.81",
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-011Twenty-four claims, five members, four edits3,620 out · 47.7s
See what every other model answered →
Reasoning · 3,220 tokens
**Clarifying JSON number format**
I'm thinking through the expectations for formatting numbers in JSON. It looks like the system might prefer numeric values with two decimal points, like "0.00." However, the parser may interpret "0" differently, so the grader might compare actual numerical values. In previous requests, it seems I should use strings for amounts. The contract specifies JSON, and it suggests that the dollar amounts should be in plain number format with decimals, so I'll stick with "0.00."json{
"claim_13_member_responsibility": 0.00,
"claim_13_plan_paid": 0.00,
"claim_13_deductible_applied": 0.00,
"claim_13_copay_amount": 0.00,
"claim_13_coinsurance_amount": 0.00,
"claim_20_member_responsibility": 0.00,
"claim_20_plan_paid": 294.34,
"claim_20_deductible_applied": 0.00,
"claim_20_copay_amount": 0.00,
"claim_20_coinsurance_amount": 0.00,
"claim_28_member_responsibility": 2737.78,
"claim_28_plan_paid": 3131.27,
"claim_28_deductible_applied": 650.27,
"claim_28_copay_amount": 0.00,
"claim_28_coinsurance_amount": 2087.51,
"ending_deductible_a": 3000.00,
"ending_oopm_a": 3260.06,
"ending_deductible_b": 1054.17,
"ending_oopm_b": 1054.17,
"ending_deductible_c": 0.00,
"ending_oopm_c": 0.00,
"ending_deductible_d": 3000.00,
"ending_oopm_d": 6173.33,
"ending_deductible_e": 3000.00,
"ending_oopm_e": 8360.01,
"ending_family_deductible": 10054.17,
"ending_family_oopm": 18847.57
}
Grader detail
json{
"fields": [
{
"field": "claim_13_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_13_plan_paid",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_13_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_13_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_13_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_plan_paid",
"want": 294.34,
"got": 294.34,
"ok": true,
"present": true
},
{
"field": "claim_20_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_member_responsibility",
"want": 2737.78,
"got": 2737.78,
"ok": true,
"present": true
},
{
"field": "claim_28_plan_paid",
"want": 3131.27,
"got": 3131.27,
"ok": true,
"present": true
},
{
"field": "claim_28_deductible_applied",
"want": 650.27,
"got": 650.27,
"ok": true,
"present": true
},
{
"field": "claim_28_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_coinsurance_amount",
"want": 2087.51,
"got": 2087.51,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 3260.06,
"got": 3260.06,
"ok": true,
"present": true
},
{
"field": "ending_deductible_b",
"want": 1054.17,
"got": 1054.17,
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 1054.17,
"got": 1054.17,
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 6618.88,
"got": 6173.33,
"ok": false,
"present": true
},
{
"field": "ending_deductible_e",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_e",
"want": 8360.01,
"got": 8360.01,
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 10054.17,
"got": 10054.17,
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 19293.12,
"got": 18847.57,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-004Copays that credit the deductible, fifteen claims3,450 out · 47.9s
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json{
"claim_6_member_responsibility": "0.00",
"claim_6_plan_paid": "277.77",
"claim_6_deductible_applied": "0.00",
"claim_6_copay_amount": "0.00",
"claim_6_coinsurance_amount": "0.00",
"claim_14_member_responsibility": "0.00",
"claim_14_plan_paid": "21835.03",
"claim_14_deductible_applied": "0.00",
"claim_14_copay_amount": "0.00",
"claim_14_coinsurance_amount": "0.00",
"claim_17_member_responsibility": "0.00",
"claim_17_plan_paid": "38.18",
"claim_17_deductible_applied": "0.00",
"claim_17_copay_amount": "0.00",
"claim_17_coinsurance_amount": "0.00",
"ending_deductible_a": "2116.07",
"ending_oopm_a": "2880.53",
"ending_deductible_b": "5000.00",
"ending_oopm_b": "11000.00",
"ending_deductible_c": "5000.00",
"ending_oopm_c": "11000.00",
"ending_family_deductible": "12116.07",
"ending_family_oopm": "24880.53"
}
Grader detail
json{
"fields": [
{
"field": "claim_6_member_responsibility",
"want": 0,
"got": "0.00",
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},
{
"field": "claim_6_plan_paid",
"want": 277.77,
"got": "277.77",
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},
{
"field": "claim_6_deductible_applied",
"want": 0,
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},
{
"field": "claim_6_copay_amount",
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},
{
"field": "claim_6_coinsurance_amount",
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"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_14_member_responsibility",
"want": 0,
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"present": true
},
{
"field": "claim_14_plan_paid",
"want": 21835.03,
"got": "21835.03",
"ok": true,
"present": true
},
{
"field": "claim_14_deductible_applied",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_14_copay_amount",
"want": 0,
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"ok": true,
"present": true
},
{
"field": "claim_14_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_member_responsibility",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_plan_paid",
"want": 38.18,
"got": "38.18",
"ok": true,
"present": true
},
{
"field": "claim_17_deductible_applied",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 2955.81,
"got": "2116.07",
"ok": false,
"present": true
},
{
"field": "ending_oopm_a",
"want": 3720.27,
"got": "2880.53",
"ok": false,
"present": true
},
{
"field": "ending_deductible_b",
"want": 5000,
"got": "5000.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 11000,
"got": "11000.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 5000,
"got": "5000.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 11000,
"got": "11000.00",
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 12955.81,
"got": "12116.07",
"ok": false,
"present": true
},
{
"field": "ending_family_oopm",
"want": 25720.27,
"got": "24880.53",
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-002Fourteen claims from a warm start, an adjustment and a void3,439 out · 42.2s
See what every other model answered →
Reasoning · 3,072 tokens
**Calculating insurance costs**
I'm tackling a complex calculation related to insurance copays and out-of-pocket expenses. It looks like for a family, there are several lines to consider, like specialist copays and overall deductibles. While calculating remaining amounts and maximums for out-of-pocket expenses, I’m ensuring I track both individual and family costs. I’m trying to be precise because it's essential to determine if the family maximum applies to our situation, especially given all the deductibles already reached. This process definitely feels dense!
**Tracking insurance claims**
I'm documenting family in-network expenses, which total $12,000, and likely reaching the family maximum soon. I've noted an individual member cost share max of $3,902.08, alongside the plan total. I need to keep an eye on claim credits that may get voided later. Looking into out-of-network costs, I see a deductible balance of $1,500 with a $3,000 threshold for out-of-network expenses. It's a lot to track, but I want to ensure all figures line up correctly!json{
"claim_4_member_responsibility": 0.00,
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"claim_4_copay_amount": 0.00,
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"claim_13_member_responsibility": 0.00,
"claim_13_plan_paid": 290.00,
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"claim_13_copay_amount": 0.00,
"claim_13_coinsurance_amount": 0.00,
"claim_16_member_responsibility": 0.00,
"claim_16_plan_paid": 920.32,
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"ending_deductible_a": 904.50,
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"ending_deductible_b": 3000.00,
"ending_oopm_b": 4013.16,
"ending_deductible_c": 0.00,
"ending_oopm_c": 30.00,
"ending_deductible_d": 3000.00,
"ending_oopm_d": 12000.00,
"ending_family_deductible": 6904.50,
"ending_family_oopm": 17037.66
}
Grader detail
json{
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"field": "claim_4_member_responsibility",
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},
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"want": 0,
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},
{
"field": "claim_4_deductible_applied",
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},
{
"field": "claim_4_copay_amount",
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},
{
"field": "claim_4_coinsurance_amount",
"want": 0,
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},
{
"field": "claim_13_member_responsibility",
"want": 0,
"got": 0,
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"present": true
},
{
"field": "claim_13_plan_paid",
"want": 290,
"got": 290,
"ok": true,
"present": true
},
{
"field": "claim_13_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
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},
{
"field": "claim_13_copay_amount",
"want": 0,
"got": 0,
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},
{
"field": "claim_13_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_16_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_16_plan_paid",
"want": 920.32,
"got": 920.32,
"ok": true,
"present": true
},
{
"field": "claim_16_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_16_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_16_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 904.5,
"got": 904.5,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 964.5,
"got": 994.5,
"ok": false,
"present": true
},
{
"field": "ending_deductible_b",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 3953.16,
"got": 4013.16,
"ok": false,
"present": true
},
{
"field": "ending_deductible_c",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 30,
"got": 30,
"ok": true,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 12000,
"got": 12000,
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 6904.5,
"got": 6904.5,
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 16947.66,
"got": 17037.66,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-011Twenty-four claims, five members, four edits3,274 out · 41.8s
See what every other model answered →
json{
"claim_13_member_responsibility": 0.00,
"claim_13_plan_paid": 0.00,
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"claim_13_copay_amount": 0.00,
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"claim_20_member_responsibility": 0.00,
"claim_20_plan_paid": 294.34,
"claim_20_deductible_applied": 0.00,
"claim_20_copay_amount": 0.00,
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"claim_28_member_responsibility": 2347.62,
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"claim_28_coinsurance_amount": 2347.62,
"ending_deductible_a": 3000.00,
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"ending_deductible_b": 1054.17,
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"ending_deductible_c": 0.00,
"ending_oopm_c": 0.00,
"ending_deductible_d": 3000.00,
"ending_oopm_d": 7728.72,
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}
Grader detail
json{
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"field": "claim_13_member_responsibility",
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},
{
"field": "claim_13_plan_paid",
"want": 0,
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"ok": true,
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},
{
"field": "claim_13_deductible_applied",
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},
{
"field": "claim_13_copay_amount",
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},
{
"field": "claim_13_coinsurance_amount",
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},
{
"field": "claim_20_member_responsibility",
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},
{
"field": "claim_20_plan_paid",
"want": 294.34,
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},
{
"field": "claim_20_deductible_applied",
"want": 0,
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},
{
"field": "claim_20_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_member_responsibility",
"want": 2737.78,
"got": 2347.62,
"ok": false,
"present": true
},
{
"field": "claim_28_plan_paid",
"want": 3131.27,
"got": 3521.43,
"ok": false,
"present": true
},
{
"field": "claim_28_deductible_applied",
"want": 650.27,
"got": 0,
"ok": false,
"present": true
},
{
"field": "claim_28_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_28_coinsurance_amount",
"want": 2087.51,
"got": 2347.62,
"ok": false,
"present": true
},
{
"field": "ending_deductible_a",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 3260.06,
"got": 3260.06,
"ok": true,
"present": true
},
{
"field": "ending_deductible_b",
"want": 1054.17,
"got": 1054.17,
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 1054.17,
"got": 1054.17,
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 6618.88,
"got": 7728.72,
"ok": false,
"present": true
},
{
"field": "ending_deductible_e",
"want": 3000,
"got": 3000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_e",
"want": 8360.01,
"got": 8360.01,
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 10054.17,
"got": 10054.17,
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 19293.12,
"got": 20402.96,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-005Five members, eighteen claims, three edits3,224 out · 40.9s
See what every other model answered →
Reasoning · 2,829 tokens
**Analyzing coinsurance calculations**
I’m considering how the likely coinsurance amount should be reflected after the out-of-pocket (OOP) limits. The claim components seem to add up to about 38,10.84, with a family OOP max specified at 12,000. It looks like OON claims only consider individual thresholds but may still factor into the family total. I need to determine the family maximum based on the plan documents, as there are some ambiguities here that could affect how payments are processed after reaching the cap.
**Recomputing family OOP cap**
I need to recompute the family out-of-pocket (OOP) cap with the claims from individual members. It seems the family OOP should apply across the board, likely reflecting individual amounts capped at $12,000. I’m breaking down claims with these step totals leading to a family contribution. The family OOP seems to have been reached, and I’ll adjust claim five based on revised deductions. My recalculations will ensure the family's contributions are correct and possibly readjust the claims that impact the plan payments.
**Evaluating out-of-network thresholds**
I'm thinking about how the out-of-network (OON) thresholds are higher than in-network. It seems like only a single deductible is explicitly documented, with OOP for individuals being $6,000 in-network and $12,000 out-of-network. I'm curious about how existing claims may affect these balances.
If a claim generates credits, it could still accumulate towards the family's balance. I wonder if that means a claim could change the overall OOP, potentially causing confusion around caps and adjustments. It's complex, but I'm trying to clarify this accurately!
**Analyzing claim thresholds**
I'm unpacking the details surrounding Claim 21, which is in-network and has no share since the family's balance is still over $12,000. There's a distinction here: out-of-network claims are only measured against individual OON thresholds. Family amounts are based on in-network limits, which means they don't affect those OON claims.
The credits generated from an OON claim still count toward both the individual and family balances, which is a bit of a twist. It's all so intricate, but I'm working to clarify it!json{
"claim_4_member_responsibility": "0.00",
"claim_4_plan_paid": "0.00",
"claim_4_deductible_applied": "0.00",
"claim_4_copay_amount": "0.00",
"claim_4_coinsurance_amount": "0.00",
"claim_17_member_responsibility": "0.00",
"claim_17_plan_paid": "6913.69",
"claim_17_deductible_applied": "0.00",
"claim_17_copay_amount": "0.00",
"claim_17_coinsurance_amount": "0.00",
"claim_21_member_responsibility": "0.00",
"claim_21_plan_paid": "2259.30",
"claim_21_deductible_applied": "0.00",
"claim_21_copay_amount": "0.00",
"claim_21_coinsurance_amount": "0.00",
"ending_deductible_a": "0.00",
"ending_oopm_a": "726.43",
"ending_deductible_b": "3000.00",
"ending_oopm_b": "3171.30",
"ending_deductible_c": "0.00",
"ending_oopm_c": "0.00",
"ending_deductible_d": "3000.00",
"ending_oopm_d": "10248.77",
"ending_deductible_e": "0.00",
"ending_oopm_e": "456.46",
"ending_family_deductible": "6000.00",
"ending_family_oopm": "14602.96"
}
Grader detail
json{
"fields": [
{
"field": "claim_4_member_responsibility",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_4_plan_paid",
"want": 0,
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"ok": true,
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},
{
"field": "claim_4_deductible_applied",
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},
{
"field": "claim_4_copay_amount",
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},
{
"field": "claim_4_coinsurance_amount",
"want": 0,
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},
{
"field": "claim_17_member_responsibility",
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},
{
"field": "claim_17_plan_paid",
"want": 6913.69,
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"present": true
},
{
"field": "claim_17_deductible_applied",
"want": 0,
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"ok": true,
"present": true
},
{
"field": "claim_17_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_17_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_21_member_responsibility",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_21_plan_paid",
"want": 2259.3,
"got": "2259.30",
"ok": true,
"present": true
},
{
"field": "claim_21_deductible_applied",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_21_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_21_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 801.43,
"got": "726.43",
"ok": false,
"present": true
},
{
"field": "ending_deductible_b",
"want": 3000,
"got": "3000.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 3171.3,
"got": "3171.30",
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3000,
"got": "3000.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 10248.77,
"got": "10248.77",
"ok": true,
"present": true
},
{
"field": "ending_deductible_e",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_e",
"want": 456.46,
"got": "456.46",
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 6000,
"got": "6000.00",
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 14677.96,
"got": "14602.96",
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-006HDHP from a warm start with the family ceiling in reach3,064 out · 38.0s
See what every other model answered →
Reasoning · 2,714 tokens
**Reviewing numeric formatting**
I'm looking at the numbers I need to work with: starting from 3464.42 and making corrections. After rounding coins from 33823.80 multiplied by .4, I find 13529.52. I need to cap coins at 5617.60.
I'm thinking about the output strings—should they be plain numbers, or do I need to format them in JSON? It seems I’ll use numeric literals, but I want to ensure they’re properly formatted with two decimals. So, I’ll emit the numeric literals formatted correctly!json{
"claim_6_member_responsibility": 8553.18,
"claim_6_plan_paid": 28206.20,
"claim_6_deductible_applied": 2935.58,
"claim_6_copay_amount": 0.00,
"claim_6_coinsurance_amount": 5617.60,
"claim_15_member_responsibility": 1938.25,
"claim_15_plan_paid": 17444.26,
"claim_15_deductible_applied": 0.00,
"claim_15_copay_amount": 0.00,
"claim_15_coinsurance_amount": 1938.25,
"claim_20_member_responsibility": 0.00,
"claim_20_plan_paid": 1790.80,
"claim_20_deductible_applied": 0.00,
"claim_20_copay_amount": 0.00,
"claim_20_coinsurance_amount": 0.00,
"ending_deductible_a": 6400.00,
"ending_oopm_a": 14000.00,
"ending_deductible_b": 0.00,
"ending_oopm_b": 2626.49,
"ending_deductible_c": 2233.02,
"ending_oopm_c": 5561.42,
"ending_family_deductible": 8633.02,
"ending_family_oopm": 22187.91
}
Grader detail
json{
"fields": [
{
"field": "claim_6_member_responsibility",
"want": 8553.18,
"got": 8553.18,
"ok": true,
"present": true
},
{
"field": "claim_6_plan_paid",
"want": 28206.2,
"got": 28206.2,
"ok": true,
"present": true
},
{
"field": "claim_6_deductible_applied",
"want": 2935.58,
"got": 2935.58,
"ok": true,
"present": true
},
{
"field": "claim_6_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_6_coinsurance_amount",
"want": 5617.6,
"got": 5617.6,
"ok": true,
"present": true
},
{
"field": "claim_15_member_responsibility",
"want": 0,
"got": 1938.25,
"ok": false,
"present": true
},
{
"field": "claim_15_plan_paid",
"want": 19382.51,
"got": 17444.26,
"ok": false,
"present": true
},
{
"field": "claim_15_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_15_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_15_coinsurance_amount",
"want": 0,
"got": 1938.25,
"ok": false,
"present": true
},
{
"field": "claim_20_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_plan_paid",
"want": 1790.8,
"got": 1790.8,
"ok": true,
"present": true
},
{
"field": "claim_20_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_20_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 6400,
"got": 6400,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 14000,
"got": 14000,
"ok": true,
"present": true
},
{
"field": "ending_deductible_b",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 0,
"got": 2626.49,
"ok": false,
"present": true
},
{
"field": "ending_deductible_c",
"want": 2233.02,
"got": 2233.02,
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 2842.01,
"got": 5561.42,
"ok": false,
"present": true
},
{
"field": "ending_family_deductible",
"want": 8633.02,
"got": 8633.02,
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 16842.01,
"got": 22187.91,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-008Twenty claims, mixed network, three edits2,959 out · 42.1s
See what every other model answered →
json{
"claim_7_member_responsibility": "0.00",
"claim_7_plan_paid": "2547.86",
"claim_7_deductible_applied": "0.00",
"claim_7_copay_amount": "0.00",
"claim_7_coinsurance_amount": "0.00",
"claim_16_member_responsibility": "2069.76",
"claim_16_plan_paid": "0.00",
"claim_16_deductible_applied": "2069.76",
"claim_16_copay_amount": "0.00",
"claim_16_coinsurance_amount": "0.00",
"claim_23_member_responsibility": "0.00",
"claim_23_plan_paid": "189.56",
"claim_23_deductible_applied": "0.00",
"claim_23_copay_amount": "0.00",
"claim_23_coinsurance_amount": "0.00",
"ending_deductible_a": "0.00",
"ending_oopm_a": "2487.82",
"ending_deductible_b": "3000.00",
"ending_oopm_b": "12000.00",
"ending_deductible_c": "789.19",
"ending_oopm_c": "828.55",
"ending_deductible_d": "3000.00",
"ending_oopm_d": "5578.62",
"ending_family_deductible": "6789.19",
"ending_family_oopm": "20894.99"
}
Grader detail
json{
"fields": [
{
"field": "claim_7_member_responsibility",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_7_plan_paid",
"want": 2547.86,
"got": "2547.86",
"ok": true,
"present": true
},
{
"field": "claim_7_deductible_applied",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_7_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_7_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_16_member_responsibility",
"want": 2069.76,
"got": "2069.76",
"ok": true,
"present": true
},
{
"field": "claim_16_plan_paid",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_16_deductible_applied",
"want": 2069.76,
"got": "2069.76",
"ok": true,
"present": true
},
{
"field": "claim_16_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_16_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_member_responsibility",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_plan_paid",
"want": 189.56,
"got": "189.56",
"ok": true,
"present": true
},
{
"field": "claim_23_deductible_applied",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_copay_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "claim_23_coinsurance_amount",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 0,
"got": "0.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 2204.04,
"got": "2487.82",
"ok": false,
"present": true
},
{
"field": "ending_deductible_b",
"want": 3000,
"got": "3000.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 12000,
"got": "12000.00",
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 789.19,
"got": "789.19",
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 828.55,
"got": "828.55",
"ok": true,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3000,
"got": "3000.00",
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 4153.38,
"got": "5578.62",
"ok": false,
"present": true
},
{
"field": "ending_family_deductible",
"want": 6789.19,
"got": "6789.19",
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 19185.97,
"got": "20894.99",
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-010Twenty-two claims with four edits2,897 out · 37.8s
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Reasoning · 2,524 tokens
**Considering financial reporting**
Numeric outputs can include decimals, especially for dollar amounts, which should be plain numbers with two decimal places. JSON accommodates such numeric formats. I need to reconsider how deductible lines interact with copays because credits can only be claimed for copays a member has paid. Line 1D has $1349 applied, which meets the threshold. Potential family out-of-pocket maximums could be affected once out-of-network costs change the balance, but family amounts won't limit an out-of-network claim.
**Analyzing OOP family balances**
If the standard embedded out-of-pocket (OOP) family plan crosses $11,000 after line 3, it should then require 100% payment for in-network services, meaning B wouldn't owe anything. However, individual adjustments for D might show zero. The clarification suggests family balances can exceed in-network thresholds. Higher out-of-network thresholds allow member balances to surpass in-network limits, but the overall OOP maximum does impose a cap on member costs. Thus, family claims can indeed influence the OOP accumulator significantly.
**Clarifying OOP and deductibles**
It seems there’s no stated application for the out-of-pocket (OOP) accumulator except for individual caps. The initial family deductible amount is $2,895.39, and the total for C and D matches this exactly. The final family deductible stands at $11,150.72, triggered by A's out-of-network charge of $5,000, which makes sense despite the family threshold. I also need to outline the member responsibility components for claim 26, which should indicate free services, coinsurance at zero, and the deductible at zero as well.json{
"claim_7_member_responsibility": 0.00,
"claim_7_plan_paid": 536.53,
"claim_7_deductible_applied": 0.00,
"claim_7_copay_amount": 0.00,
"claim_7_coinsurance_amount": 0.00,
"claim_19_member_responsibility": 0.00,
"claim_19_plan_paid": 8035.62,
"claim_19_deductible_applied": 0.00,
"claim_19_copay_amount": 0.00,
"claim_19_coinsurance_amount": 0.00,
"claim_26_member_responsibility": 0.00,
"claim_26_plan_paid": 7048.51,
"claim_26_deductible_applied": 0.00,
"claim_26_copay_amount": 0.00,
"claim_26_coinsurance_amount": 0.00,
"ending_deductible_a": 5000.00,
"ending_oopm_a": 11000.00,
"ending_deductible_b": 2500.00,
"ending_oopm_b": 5500.00,
"ending_deductible_c": 2500.00,
"ending_oopm_c": 4445.18,
"ending_deductible_d": 2500.00,
"ending_oopm_d": 5500.00,
"ending_family_deductible": 11150.72,
"ending_family_oopm": 26445.18
}
Grader detail
json{
"fields": [
{
"field": "claim_7_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_7_plan_paid",
"want": 536.53,
"got": 536.53,
"ok": true,
"present": true
},
{
"field": "claim_7_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_7_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_7_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_19_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_19_plan_paid",
"want": 8035.62,
"got": 8035.62,
"ok": true,
"present": true
},
{
"field": "claim_19_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_19_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_19_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_26_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_26_plan_paid",
"want": 7048.51,
"got": 7048.51,
"ok": true,
"present": true
},
{
"field": "claim_26_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_26_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_26_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 5000,
"got": 5000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 11000,
"got": 11000,
"ok": true,
"present": true
},
{
"field": "ending_deductible_b",
"want": 0,
"got": 2500,
"ok": false,
"present": true
},
{
"field": "ending_oopm_b",
"want": 0,
"got": 5500,
"ok": false,
"present": true
},
{
"field": "ending_deductible_c",
"want": 1744.67,
"got": 2500,
"ok": false,
"present": true
},
{
"field": "ending_oopm_c",
"want": 1900.68,
"got": 4445.18,
"ok": false,
"present": true
},
{
"field": "ending_deductible_d",
"want": 1150.72,
"got": 2500,
"ok": false,
"present": true
},
{
"field": "ending_oopm_d",
"want": 1150.72,
"got": 5500,
"ok": false,
"present": true
},
{
"field": "ending_family_deductible",
"want": 7895.39,
"got": 11150.72,
"ok": false,
"present": true
},
{
"field": "ending_family_oopm",
"want": 14051.4,
"got": 26445.18,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}0LDG-007Twenty claims with an adjustment to network status2,763 out · 34.7s
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Reasoning · 2,393 tokens
**Evaluating insurance claims**
I need to inspect the prior claims that all indicate zero in-network benefits after my family reached out about out-of-network (OON) expenses. So, for claim 8, it shows C in zero; claim 9 also shows D in zero; and for claim 10, there's no change. For claim 11, C remains at zero, and claim 12 shows B as OON, with a prior deductible of $722.55. It seems like there are some inconsistencies or questions to clarify.
**Exploring JSON Numeric Rendering**
I'm looking into the JSON numeric rendering for the value 988.74. It seems tricky because maintaining two decimal places is essential, yet I'm seeing 0.00 rendered instead. It's important to understand the validity of this formatted output and how parsers handle it. My guess is that we need to ensure that numeric literals with decimals are used correctly. This is quite a puzzle, but I’m determined to figure it out!json{
"claim_15_member_responsibility": 988.74,
"claim_15_plan_paid": 0.00,
"claim_15_deductible_applied": 988.74,
"claim_15_copay_amount": 0.00,
"claim_15_coinsurance_amount": 0.00,
"claim_17_member_responsibility": 0.00,
"claim_17_plan_paid": 0.00,
"claim_17_deductible_applied": 0.00,
"claim_17_copay_amount": 0.00,
"claim_17_coinsurance_amount": 0.00,
"claim_23_member_responsibility": 0.00,
"claim_23_plan_paid": 4530.32,
"claim_23_deductible_applied": 0.00,
"claim_23_copay_amount": 0.00,
"claim_23_coinsurance_amount": 0.00,
"ending_deductible_a": 2500.00,
"ending_oopm_a": 5500.00,
"ending_deductible_b": 5000.00,
"ending_oopm_b": 6188.95,
"ending_deductible_c": 0.00,
"ending_oopm_c": 0.00,
"ending_deductible_d": 3722.86,
"ending_oopm_d": 3722.86,
"ending_family_deductible": 11222.86,
"ending_family_oopm": 13503.37
}
Grader detail
json{
"fields": [
{
"field": "claim_15_member_responsibility",
"want": 988.74,
"got": 988.74,
"ok": true,
"present": true
},
{
"field": "claim_15_plan_paid",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_15_deductible_applied",
"want": 988.74,
"got": 988.74,
"ok": true,
"present": true
},
{
"field": "claim_15_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_15_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_17_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_17_plan_paid",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_17_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_17_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_17_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_member_responsibility",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_plan_paid",
"want": 4530.32,
"got": 4530.32,
"ok": true,
"present": true
},
{
"field": "claim_23_deductible_applied",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_copay_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "claim_23_coinsurance_amount",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_a",
"want": 2500,
"got": 2500,
"ok": true,
"present": true
},
{
"field": "ending_oopm_a",
"want": 5500,
"got": 5500,
"ok": true,
"present": true
},
{
"field": "ending_deductible_b",
"want": 5000,
"got": 5000,
"ok": true,
"present": true
},
{
"field": "ending_oopm_b",
"want": 6188.95,
"got": 6188.95,
"ok": true,
"present": true
},
{
"field": "ending_deductible_c",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_oopm_c",
"want": 0,
"got": 0,
"ok": true,
"present": true
},
{
"field": "ending_deductible_d",
"want": 3722.86,
"got": 3722.86,
"ok": true,
"present": true
},
{
"field": "ending_oopm_d",
"want": 3722.86,
"got": 3722.86,
"ok": true,
"present": true
},
{
"field": "ending_family_deductible",
"want": 11222.86,
"got": 11222.86,
"ok": true,
"present": true
},
{
"field": "ending_family_oopm",
"want": 15411.81,
"got": 13503.37,
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}