# Rufous — Insurance Navigation

> *Part of the Circuit Forge LLC "AI for the tasks you hate most" suite.*

**Status:** Backlog — not yet started. Peregrine must prove the model first.

## What it does

Rufous handles the full insurance fight: prior authorization tracking, claim dispute drafting, EOB (Explanation of Benefits) reconciliation, internal and external appeal letters, and state insurance commissioner complaints.

## Why it is hard

Insurance disputes are engineered to be abandoned:
- Prior auth processes have no standard timeline or format across insurers
- EOBs are intentionally opaque — reconciling them against bills requires expertise
- Appeal deadlines are short (30–60 days internal, 4 months external)
- The regulatory landscape is complex: state insurance codes, ACA requirements, ERISA for employer plans

## Core pipeline

```
Log claim / denial / prior auth request
→ AI analyzes EOB + denial reason → Drafts appeal with clinical rationale
→ Human review + attach supporting docs → Submit appeal
→ Track deadline + escalation windows → External appeal / commissioner complaint if needed
```

## Product code (license key)

`CFG-RFUS-XXXX-XXXX-XXXX`

## License

Discovery pipeline: **MIT**. AI assist features: **BSL 1.1** (free for personal non-commercial self-hosting; converts to MIT after 4 years).