🔍 What’s happening behind the scenes

This demo connects a custom Python FastAPI service to structured Healthcare.gov plan data and large language models.

When you click Ask, the system performs the following steps:

1) Plan data ingestion (offline)

Healthcare.gov plan documents are collected and processed ahead of time:

• Summary of Benefits (SBC) PDFs
• Drug formularies
• Plan brochures

These documents are:

• Parsed into structured JSON
• Chunked into small, searchable excerpts
• Stored in PostgreSQL with vector embeddings
• Scored using a configurable weighted ranking system

This allows the system to reason over real plan documents — not summaries or guesses.

2) Plan ranking (deterministic)

Before any AI is involved, plans are ranked using a transparent scoring model.

The ranking system:

• Penalizes high deductibles and out-of-pocket maximums
• Penalizes missing or unclear benefits
• Can be tuned for different health profiles (e.g. diabetes, cardiac risk, prenatal care)

This step ensures the AI only looks at the most relevant plans.

3) Retrieval (RAG mode)

When a question is asked:

• The system searches the top-ranked plans
• Relevant document excerpts are retrieved
• Only those excerpts are passed to the language model

The AI cannot use outside knowledge — it answers strictly from cited plan text.

4) Answer generation with citations

The response you see is:

• Generated from real plan excerpts
• Grouped by plan ID
• Cited down to the exact PDF and page number
• Explicit about differences between plans

If the answer varies by plan, the system will say:

“It depends by plan.”

If the information is not present, it will say so.

5) Why this matters

Most plan comparison tools:

• Hide their scoring logic
• Don’t show citations
• Can’t answer nuanced questions

This demo is built to show:

• Transparency
• Auditability
• Custom health-specific decision making

It’s a foundation for user-defined weighting, personalized recommendations, and explainable AI in healthcare plan selection.

⚠️ Important note

This is an experimental demo, not medical or financial advice.
Always verify coverage details with the insurer.