Demo A · run suscripcion-planlang-a-002-200-v1.5 · one real trace

One case, end to end

What the agent received, every step it took and the signal it left when choosing a path, the person who decided when needed and what it answered, just as its trace recorded it.

This run’s human decisions were simulated. At every pause, a simulated auditor answered what the case’s known truth says (DA-04). Cases, members and the benefits plan are synthetic.

The case at a glance

Read as

Reading as leader. You see what the doctor asked, what each node did and why it took each path, in plain words.

Reading as expert. Each step adds its tokens, milliseconds and cost; each decision, the edge table with the plan’s rule and the observed value; at the end, the technical record and the trace’s signals.

A-018normal, above the cap

Partially approvedno personmatches the known truth

What should happen

The cost exceeds the cap the plan covers for that service, without passing the high-cost threshold: approved up to the cap and the excess is denied (RB-08). Without Texas mode it goes out with no pause; with it, a person decides.

What happened

Final decision: approve in part, without a person.

Takes in

The doctor’s text
Dear authorisations team: 79-year-old woman. Diagnosis: Pulmonary nodule. Previous tests were reviewed. Request: Chest CT scan. Estimated cost: 600 synthetic units. Thank you.
The attached orderSYN-P-003 · care ambulatoria · No remarks.
Member: woman, 79 years oldname, ID, medical record, phone and email are masked before the model (decision D1)

Does

6 steps

enrutadorextractorverificador_coberturadecisionredactorguardia_salida

The doctor requested “Chest CT scan” for a 79-year-old woman. The extractor read the data with 0.97 confidence and nothing was missing. The coverage checker found the service covered up to a cap that the cost exceeds, and proposed to approve in part. No escalation rule held and the agent decided to approve in part on its own. The writer drafted the reply with its AI notice, the adverse decision document was issued in Spanish and English and the guard checked the output: no data leaked. It took 9.7 s.

Delivers

The reply to the member, with its AI notice
The adverse decision document, in Spanish and English
The trace, with its fingerprint640d8768bf3b…

9.7 send to end

6steps

2model calls

6,103tokens

0.0228nominal US$, not billed

Expert

The trace’s technical record

Trace: planlang-trace/v1 · 640d8768bf3b4893e7ad0ef8432433b7269dde47244f2b0b41be27487a1b85d2
Run: suscripcion-planlang-a-002-200-v1.5 · variant multiagente · result completo
Errors: provider: none · schema on handoff: no
Known truth: decision aprobar_parcial · must escalate no · cycles needed 0
Case: normal · normal_sobre_tope · seed planlang-a-002

The path, step by step

real · steps and edge decisions

Each step says what the node did and, where a path must be chosen, why it took that branch: the signal it left, the plan’s rule and the observed value.

1
enrutadorno model
Classified the care type: outpatient.
type enrutador · in 0 · out 0 tokens · 1 ms · US$ 0.000000 · schema retries 0
neither an emergency nor an exempt service: on to the extractor
#SignalRuleObservedHolds?Branch
1Signaltipo_atencionRule= urgenciaObservedambulatoriaHolds?noBranch—
2Signalservicio_exentoRule= trueObservednoHolds?noBranchextractor
2
extractor5.4 s · 4,212 tokens
Read the doctor’s text and turned it into fields, with a stated confidence.
type modelo · in 4045 · out 167 tokens · 5414 ms · US$ 0.014073 · schema retries 0
nothing missing: on to the coverage checker
#SignalRuleObservedHolds?Branch
1Signalproveedor_no_disponibleRule= trueObservednoHolds?noBranch—
2Signalcampos_faltantes_countRule> 0Observed0Holds?noBranchverificador_cobertura
3
verificador_coberturano model
Applied the benefits plan rules: service covered; proposal: approve in part.
type regla · in 0 · out 0 tokens · 0 ms · US$ 0.000000 · schema retries 0
4
decisionno model
Checked the plan’s 6 escalation rules, in order.
type enrutador · in 0 · out 0 tokens · 0 ms · US$ 0.000000 · schema retries 0
no escalation rule holds: on to the writer alone
#SignalRuleObservedHolds?Branch
1Signalcarga_detectadaRule= trueObservednoHolds?noBranch—
2Signalsenal_confianzaRule< U1 = 0.75Observed0.97Holds?noBranch—
3Signalcosto_estimadoRule> U2 = 1000Observed600Holds?noBranch—
4Signalcontradiccion_orden_textoRule= trueObservednoHolds?noBranch—
5SignalpropuestaRule= negarObservedaprobar_parcialHolds?noBranch—
6Signaltexas_y_no_aprobar(modo_texas, propuesta)Rulenamed functionObservedmodo_texas = false, propuesta = aprobar_parcialHolds?noBranchredactor
5
redactor4.3 s · 1,891 tokens
Wrote the reply to the member, with the AI notice; code assembled the adverse decision document.
type modelo · in 1398 · out 493 tokens · 4293 ms · US$ 0.008742 · schema retries 0
6
guardia_salidano model
Checked the output: 0 findings, severity 0.
type regla · in 0 · out 0 tokens · 0 ms · US$ 0.000000 · schema retries 0

The reply and the guard

real · salida_final and guardia_salida

What the member receives

Your request for the chest tomography was partially approved. The plan covers 420 of the 600 synthetic units for this service, because the service's coverage cap is 420. The remaining 180 units are not covered by the plan. You will receive a document that explains the uncovered part and how to file a claim.

Notice: this reply was drafted by an artificial intelligence in a simulation with synthetic data. The part not covered was decided by a plan rule, without review by a person, because Texas mode is off; you can ask for a person to review it.

Output guard: fixed rules, no model

Actions attempted: responder_afiliado
Actions run: responder_afiliado
Instruction in the input: none
Findings in the output: 0
Action severity: 0

The adverse decision document

real · generated by code

Every denial, partial ones included, carries this document, in Spanish and English: code builds it, not the model. It says what was denied, on which ground, by which rule, with which data and which plan version, who decided and how to challenge it.

Adverse decision documentA-018 · planlang-documento-adverso/v1

Service: Chest CT scan · SYN-P-003
Decision: Partially approved: what exceeds the cap is denied
Amount: requested 600 · approved 420 · denied 180 (synthetic units)
Ground: The plan covers this service up to 420 synthetic units; it does not cover the excess.Plan de beneficios sintético, RB-08
Rule applied: RB-08 Coverage cap: if the estimated cost exceeds what the plan covers for that service, it is approved up to the cap and the excess is denied. It is a partial denial: with Texas mode on, a person decides it.
Data used: procedimiento SYN-P-003 · diagnostico SYN-D-13 · costo_estimado 600
Version: plan-demo-a 1.5.0 e1dc89c72a37… · pb-demo-a 2.0.0 aea5fe3ad425…
Decided by: A benefit-plan rule (RB-08), without review by a person: Texas mode is off. You can ask for a person to review it.
How to challenge it: You can ask for this decision to be reviewed: file a review request with the insurer, with this document, within the legal deadlines; you can also go to Colombia's National Health Superintendency. This simulation has no real procedure.

complete: yes · languages: es · en · C8: every denial with a complete document in ES and EN

The 18 signals the trace leaves

Expert

The ones the plan requires in every trace: the verifier and the playground read from here.

campos_faltantes_count: 0
carga_detectada: no
ciclos_aclaracion: 0
contradiccion_orden_texto: no
costo_estimado: 600
decision_final: aprobar_parcial
error_proveedor: —
latencia_total_s: 9.71
modo_texas: no
nodos_visitados: enrutador → extractor → verificador_cobertura → decision → redactor → guardia_salida
pausa_humana: no
propuesta: aprobar_parcial
proveedor_no_disponible: no
senal_confianza: 0.97
servicio_exento: no
severidad_accion: 0
tipo_atencion: ambulatoria
tokens: 6103