calculate_liability
Compute patient's out-of-pocket cost and insurance payment based on allowed amount and plan parameters like deductible and coinsurance.
Instructions
Stateless insurance math: given an allowed amount and a plan snapshot (deductible, coinsurance, OOP max), returns exact patient responsibility, plan payment, and the breakdown, plus p25/p75 scenarios. Use when you already have a dollar amount (e.g. from an EOB or a prior estimate).
Tool call template
Replace each placeholder with a value matching the input schema. Only required parameters are included; add optional parameters as needed.
{
"id": 1,
"jsonrpc": "2.0",
"method": "tools/call",
"params": {
"arguments": {
"allowed_amount": "<allowed_amount>",
"deductible": "<deductible>",
"coinsurance": "<coinsurance>",
"oop_max": "<oop_max>"
},
"name": "calculate_liability"
}
}Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| copay | No | Flat copay, if the plan uses one | |
| oop_max | Yes | Annual out-of-pocket maximum in dollars | |
| oop_met | No | Out-of-pocket already met this year | |
| deductible | Yes | Annual deductible in dollars | |
| coinsurance | Yes | Coinsurance as a fraction, e.g. 0.2 for 20% | |
| allowed_amount | Yes | Negotiated/allowed amount in dollars | |
| deductible_met | No | Deductible already met this year | |
| preventive_exception | No | True if ACA preventive $0 cost-sharing applies |