Plan rule mismatch
The plan said the service was covered at $0. The invoice still showed a balance.
The deductible was already met and the plan rule for the service showed no patient cost. The provider invoice still requested payment.
Plan share after deductible$0
Invoice balance$95
Deductible statusMet
What happened
1
The plan rule was clear
The coverage data showed the service carried 0% coinsurance once the deductible was met.
2
The deductible condition was satisfied
Earlier claims showed the deductible remaining had already reached $0 in the same coverage period.
3
The invoice did not match the rule
Insured Guard flagged the $95 invoice balance because both required conditions pointed to a $0 patient share.
When the plan rule and deductible status both say zero, a balance needs support.
How do we know
It combines plan rules with the current coverage state.
The app does not rely on the invoice alone. It evaluates the service category against the plan rule, then applies the current deductible status before deciding whether a patient balance is supported.