com.coverage-rights/coverage-rights

Measured conclusion: Deep-tested. L2 outcome: tools_ok.

Insurer denial rates, appeal outcomes by treatment and condition, and appeal rights lookups.

Add to your agent

Copy this into your MCP client config:

{
  "mcpServers": {
    "coverage-rights": {
      "url": "https://www.coverage-rights.com/api/mcp",
      "transport": "streamable-http"
    }
  }
}

Measured tools (9)

• list_insurers read-only

  List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• get_insurer_metrics read-only

  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.

  Parameters:

  • slug (required) — string — Insurer slug from list_insurers, e.g. 'unitedhealthcare'

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• rank_denial_rates read-only

  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.

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• get_treatment_outcomes read-only

  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').

  Parameters:

  • slug (required) — string — Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs.

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• get_condition_outcomes read-only

  External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.

  Parameters:

  • slug (required) — string — Condition slug, e.g. 'obesity', 'autism', 'hepatitis-c'

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• search_outcomes read-only

  Search treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.

  Parameters:

  • query (required) — string — Search text, e.g. 'wegovy', 'back pain', 'imaging'
  • limit — integer — Max results per type (default 10)

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• get_appeal_rights read-only

  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.

  Parameters:

  • program (required) — string — Plan type
  • denial_reason (required) — string — 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 — string — Two-letter state code, e.g. 'ca'
  • appeal_stage — string
  • drug_channel — string — For a drug denial, whether the medical or pharmacy benefit applies
  • insurer_slug — string — Insurer slug for insurer-specific stats
  • employer_type — string — Required to resolve job-based coverage
  • current_status — string
  • funding_status — string — Required to resolve job-based state versus federal governance
  • regulatory_marker — string
  • regulatory_state_basis — string

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• get_drug_playbook read-only

  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.

  Parameters:

  • drug (required) — string — Brand or generic drug name, e.g. 'Zepbound', 'ustekinumab'

  Hints: read-only yes · destructive no · idempotent yes · open-world no

• get_state_external_review read-only

  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.

  Parameters:

  • state (required) — string — Two-letter state code, e.g. 'ca', 'ny', 'fl'

  Hints: read-only yes · destructive no · idempotent yes · open-world no

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Measured by MCPYP probing. Untested fields are omitted, never estimated. Listing is always free; MCPYP never proxies calls or stores user tokens.