coverage-rights
Insurer denial rates, appeal outcomes by treatment and condition, and appeal rights lookups.
Should I use this
Quality & Safety
Findings (1)
- LOWTool 'rank_denial_rates' description lacks action verbin rank_denial_rates
Based on automated analysis of tool definitions and protocol compliance.
Context Cost
This is the approximate number of tokens consumed each time the server's tools are loaded into a model's context. Higher counts reduce the attention available for other tasks.
Install
One-Click Install
Add this to your `claude_desktop_config.json` file:
{
"mcpServers": {
"coverage-rights": {
"url": "https://coverage-rights.com/api/mcp"
}
}
}Remote endpoints
https://coverage-rights.com/api/mcpstreamable-httphttps://www.coverage-rights.com/api/mcpstreamable-httpWhat it can do
Tool inventory
Tools (9)
🟢list_insurers
List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.
Input Schema
{
"type": "object",
"properties": {},
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢get_insurer_metrics(slug)
Get an insurer's verified CY2025 prior-authorization metrics (denial rate, appeal overturn rate, decision times) from its own CMS-0057-F disclosure, plus contract/plan-level rows where collected. Includes source URLs and scope notes.
Input Schema
{
"type": "object",
"properties": {
"slug": {
"type": "string",
"description": "Insurer slug from list_insurers, e.g. 'unitedhealthcare'"
}
},
"required": [
"slug"
],
"additionalProperties": false,
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢rank_denial_rates
Insurer prior-authorization denial rates (CY2025), ranked only within compatible reporting cohorts. Each row includes its cohort, rank within that cohort, exact source scope, calculation method, and source link. Never compare ranks across cohorts.
Input Schema
{
"type": "object",
"properties": {},
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢get_treatment_outcomes(slug)
External-review outcomes for a treatment: how often insurer denials of this treatment/drug/procedure were overturned by independent reviewers (42,749 published CA IMR decisions, 2001–2026). Accepts a category slug (e.g. 'pharmacy') or specific treatment slug (e.g. 'zepbound', 'speech-therapy').
Input Schema
{
"type": "object",
"properties": {
"slug": {
"type": "string",
"description": "Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs."
}
},
"required": [
"slug"
],
"additionalProperties": false,
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢get_condition_outcomes(slug)
External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.
Input Schema
{
"type": "object",
"properties": {
"slug": {
"type": "string",
"description": "Condition slug, e.g. 'obesity', 'autism', 'hepatitis-c'"
}
},
"required": [
"slug"
],
"additionalProperties": false,
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢search_outcomes(query, limit)
Search treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.
Input Schema
{
"type": "object",
"properties": {
"query": {
"type": "string",
"minLength": 2,
"description": "Search text, e.g. 'wegovy', 'back pain', 'imaging'"
},
"limit": {
"type": "integer",
"minimum": 1,
"maximum": 50,
"description": "Max results per type (default 10)"
}
},
"required": [
"query"
],
"additionalProperties": false,
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢get_appeal_rights(program, denial_reason, state, insurer_slug, employer_type, ...)
Deterministically resolve the governing appeal route, missing facts, filing recipient, deadlines, current external-review status, and verified grounds. Distinguishes Original Medicare, Medicare Advantage medical benefits, Part D pharmacy benefits, employer funding/governance, ACA, Medicaid, FEHB, TRICARE, and unknown coverage; unsupported or ambiguous routes fail closed.
Input Schema
{
"type": "object",
"properties": {
"program": {
"type": "string",
"enum": [
"medicare-advantage",
"original-medicare",
"medicare-part-d",
"erisa-employer-plans",
"aca-marketplace",
"medicaid",
"fehb",
"tricare",
"other-unknown"
],
"description": "Plan type"
},
"denial_reason": {
"type": "string",
"enum": [
"medical-necessity",
"experimental-investigational",
"prior-authorization",
"out-of-network",
"not-covered-benefit",
"coding-billing-error",
"prescription-drug"
],
"description": "Denial reason category. Use 'prescription-drug' for medication denials — formulary exclusion, step therapy, quantity limits, or drug prior authorization — which return the formulary-exception grounds and their short decision deadlines."
},
"state": {
"type": "string",
"minLength": 2,
"maxLength": 2,
"description": "Two-letter state code, e.g. 'ca'"
},
"insurer_slug": {
"type": "string",
"description": "Insurer slug for insurer-specific stats"
},
"employer_type": {
"type": "string",
"enum": [
"private",
"government",
"church",
"union",
"unknown"
],
"description": "Required to resolve job-based coverage"
},
"funding_status": {
"type": "string",
"enum": [
"fully-insured",
"self-funded",
"unknown"
],
"description": "Required to resolve job-based state versus federal governance"
},
"drug_channel": {
"type": "string",
"enum": [
"not-a-drug",
"medical-benefit",
"pharmacy-benefit",
"unknown"
],
"description": "For a drug denial, whether the medical or pharmacy benefit applies"
},
"regulatory_marker": {
"type": "string",
"enum": [
"state-regulated",
"federal-or-self-funded",
"unknown"
]
},
"regulatory_state_basis": {
"type": "string",
"enum": [
"denial-letter",
"insurance-card",
"plan-document",
"residence-only",
"unknown"
]
},
"appeal_stage": {
"type": "string",
"enum": [
"initial-denial",
"internal-appeal-filed",
"first-internal-denial",
"final-internal-denial",
"external-review-filed",
"unknown"
]
},
"current_status": {
"type": "string",
"enum": [
"awaiting-service",
"receiving-service",
"service-ended",
"post-service-claim",
"unknown"
]
}
},
"required": [
"program",
"denial_reason"
],
"additionalProperties": false,
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢get_drug_playbook(drug)
Drug-specific denial patterns and appeal strategy for the medications plans fight hardest over: GLP-1s (Wegovy, Zepbound, Mounjaro, Ozempic, Saxenda) and IBD biologics (Humira, Skyrizi, Stelara, Entyvio, Remicade, Rinvoq). Returns FDA-approved indications stated conservatively, why plans deny that specific drug, what winning appeals argue, and the step-therapy exception framing — plus the published external-review record for the drug when the corpus has it. Accepts a brand or generic name.
Input Schema
{
"type": "object",
"properties": {
"drug": {
"type": "string",
"minLength": 2,
"maxLength": 80,
"description": "Brand or generic drug name, e.g. 'Zepbound', 'ustekinumab'"
}
},
"required": [
"drug"
],
"additionalProperties": false,
"$schema": "http://json-schema.org/draft-07/schema#"
}🟢get_state_external_review(state)
How a state's external review process works: filing deadline, regulator contact, and key facts. Verified detail currently covers 10 states (CA, TX, FL, NY, PA, IL, OH, GA, NC, MI); other states return the covered list.
Input Schema
{
"type": "object",
"properties": {
"state": {
"type": "string",
"minLength": 2,
"maxLength": 2,
"description": "Two-letter state code, e.g. 'ca', 'ny', 'fl'"
}
},
"required": [
"state"
],
"additionalProperties": false,
"$schema": "http://json-schema.org/draft-07/schema#"
}Community
Evidence