{"uid":"cap_Z_Z_6xzCNpxOZQvKejcjs","slug":"clearcarepulse-out-of-pocket-cost-calculator-03a7f7c1","name":"ClearCarePulse Out-of-Pocket Cost Calculator","description":"Out-of-pocket cost calculator for healthcare and consumer-health agents. Returns the exact patient cost given deductible, coinsurance, and OOP max for any procedure and plan.","url":"https://clear-care-pulse.vercel.app/api/care/oop","method":"GET","headers":{},"bodySchema":{"type":"object","required":["procedure"],"properties":{"hsa":{"type":"string","description":"Has HSA (true/false)"},"lang":{"type":"string","description":"lang"},"oop_max":{"type":"string","description":"oop_max"},"oop_spent":{"type":"string","description":"OOP already spent this year in USD"},"plan_type":{"type":"string","description":"Plan type (Bronze, Silver, Gold, Platinum, employer)"},"procedure":{"type":"string","description":"procedure"},"deductible":{"type":"string","description":"deductible"},"coinsurance":{"type":"string","description":"coinsurance"},"deductible_met":{"type":"string","description":"deductible_met"},"procedure_cost":{"type":"string","description":"Known procedure cost in USD"}}},"responseSchema":{"type":"json","example":{}},"example":null,"exampleRequest":null,"tags":["x402"],"displayCostAmount":"0.15","displayCostAsset":"USDC","priceDynamic":false,"priceHint":null,"priceStatus":"priced","priceSource":"probe","requiresHandshake":false,"reviewCount":0,"rating":{"score":"0.00","successRate":"0.00","reviews":0,"stars":null,"state":"unrated"},"availabilityStatus":"unknown","priceObserved":null,"sessionDeposit":null,"pricing":{"kind":"static","summary":"$0.15/call","primary":{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.15","per":"call","confidence":"exact"},"accepted":[{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.15","per":"call","confidence":"exact"}]},"paymentMethods":[{"uid":"pm_b_kADto0cjWiAD6QqT7Om","protocol":"x402","methodType":"crypto","chain":"base","mode":"charge","costAmount":"0.15","costPer":"request","priority":0,"asset":"0x833589fCD6eDb6E08f4c7C32D4f71b54bdA02913","unit":"request","depositMicros":null,"planRef":null}],"brandName":null,"brandSlug":null,"brandBaseUrl":null,"brandDocsUrl":null,"whatItDoes":"Calculates the exact patient out-of-pocket cost for a healthcare procedure given their deductible status, coinsurance rate, and out-of-pocket maximum.","exampleAgentPrompt":"How much will I actually owe out of pocket for a knee arthroscopy if my plan has a $2,000 deductible (I've paid $800 so far), 20% coinsurance, and a $6,000 out-of-pocket maximum — and the procedure costs $4,500?","exampleUseCases":[{"title":"Plan out surgery costs before scheduling","prompt":"I'm looking at getting shoulder surgery and my insurance has a $1,500 deductible that I haven't met yet, plus 25% coinsurance. The surgeon quoted me $8,000 for the procedure. Can you tell me exactly what I'd owe out of pocket so I can decide if I should wait until next year when my deductible resets?"},{"title":"Compare dental work across insurance plans","prompt":"My employer is switching insurance providers next month and I need to get a crown soon. My current plan has a $500 deductible with $200 remaining and 15% coinsurance, while the new plan has no deductible but 30% coinsurance. The dentist says the crown will cost $1,200 — which plan would actually save me money?"},{"title":"Understand urgent care visit expenses","prompt":"I think I sprained my ankle and need to go to urgent care, but I want to know my costs first. My plan has a $2,000 deductible that I've already met, 20% coinsurance, and I've paid $3,500 toward my $5,000 out-of-pocket max. The urgent care visit is estimated at $600 — how much will I actually have to pay?"}],"resultDescription":"Returns the exact patient out-of-pocket dollar amount for the procedure after applying deductible remainder, coinsurance rate, and out-of-pocket maximum cap — broken down by each cost component (deductible applied, coinsurance owed, OOP max adjustment).","failureModes":["Missing required plan parameters (deductible, coinsurance, OOP max) returns a 400 error","Invalid or unrecognized procedure code/name returns an error or null cost","OOP max lower than deductible yields a validation error","Negative or out-of-range coinsurance percentage triggers a bad request","Service unavailable or Vercel cold start returns 503"],"whenToPreferThis":"Use this endpoint when you need to compute the precise patient financial responsibility for a specific procedure under a known insurance plan with defined deductible, coinsurance, and OOP max values — especially when the user already knows their plan parameters and wants an exact cost rather than a benchmark range or provider price search.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-09-15T12:33:13.496Z","isFirstParty":false}