Why every reserved act has a flat fee
A fee that grows with the claim pays someone to move the number. A flat fee, fixed before the work starts, does not.
In short
Each reserved act on api.insure carries a flat fee, fixed when you post the work and visible before it starts. It never scales with the size of the claim, so the price of a decision never depends on its outcome. The meter releases once per act, on a fact: an issued decision or a bound policy.
Claims work has long been priced in ways that tie the fee to the file: a share of the loss, a fee schedule that climbs with severity, a meter that runs on hours. Each one puts a thumb on the scale. When the person deciding is paid more as the number grows, the number has a reason to grow.
Flat, and fixed at post
Every reserved act on api.insure carries one flat fee:
- Flat per act. The fee never scales with the size of the claim or the reserve.
- Fixed at post. It is set when you post the work, before anyone starts, and you can see it up front.
- Your ceiling. You set a hard spend cap. A call that would pass it answers a typed
OFFERinstead of charging.
No decision, no charge
The meter releases once per act, on a fact the system can prove:
| Act | Outcome | Meter |
|---|---|---|
| adjust | Approved | Billed |
| adjust | Denied | Billed |
| adjust | Sent back | No charge |
| bind | Bound | Billed |
| bind | Not bound | No charge |
A denial is a decision, so it is billed like one. A send-back is not a decision: the file goes back for more, and nothing is charged until a decision issues.
What a flat fee protects
The adjuster's fee is flat too, and it never moves with the outcome. That is an incentive firewall: nothing about the price of the work rewards a bigger or a smaller number. A decision your regulator can trust is a decision your product can ship.
Questions
How is api.insure priced?
Each reserved act carries a flat fee, fixed when you post the work. The meter releases once per act, on an issued decision or a bound policy.
Is a denied claim billed?
Yes. A denial is a decision, and the meter treats it as one.
Is a send-back billed?
No. A send-back returns the file for more work, and nothing is charged until a decision issues.
Can spending run past a limit I set?
No. You set a hard spend ceiling, and a call that would pass it answers a typed OFFER instead of charging.