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    "canonical_url": "https://registry.modelcontextprotocol.io/v0.1/servers/coverage-rights/versions/1.1.0",
    "name": "coverage-rights",
    "summary_en": "Insurer denial rates, appeal outcomes by treatment and condition, and appeal rights lookups.",
    "summary_zh": "查询美国保险拒赔率、按治疗与病症分类的上诉结果，并确定适用的申诉途径。",
    "description_en": "This MCP server provides verified U.S. health insurer prior-authorization denial metrics, external-review overturn rates by treatment and condition, and deterministic appeal-rights lookups. Use it when researching insurer denial patterns or guiding patients through appeals. Access is open without authentication, but detailed state external-review data covers only 10 states.",
    "description_zh": "该MCP服务器提供经核实的美国健康保险公司预先授权拒绝率、按治疗和病症分类的外部审查推翻率，以及确定性的申诉权利查询。适用于研究保险公司拒绝模式或指导患者进行申诉。无需认证即可访问，但州级外部审查详细信息仅覆盖10个州。",
    "provider_name": "com.coverage-rights",
    "homepage_url": "https://www.coverage-rights.com/mcp",
    "endpoint_url": "https://www.coverage-rights.com/api/mcp",
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    "capabilities": [
      "health.insurer-metrics",
      "health.appeal-rights",
      "health.outcomes-research"
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      "search-research"
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    "industries": [
      "health"
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    "protocols": [
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        "integrations": [],
        "use_cases": {
          "en": [
            "Compare insurer denial rates and appeal overturn rates",
            "Look up appeal rights and deadlines for a specific denial",
            "Research treatment or condition denial outcomes"
          ],
          "zh": [
            "比较保险公司的拒绝率和上诉推翻率",
            "查询特定拒绝的申诉权利和截止日期",
            "研究治疗或病症的拒绝结果"
          ]
        },
        "categories": [
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        "industries": [
          "health"
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      "evidence_strength": "protocol_inspected",
      "use_readiness": "ready_for_guidance",
      "reviewed_at": "2026-09-04T03:51:38.156Z"
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    "first_seen_at": "2026-09-03T14:02:46.117Z",
    "last_seen_at": "2026-09-04T03:51:37.361Z",
    "published_at": "2026-09-03T14:02:46.117Z",
    "created_at": "2026-09-03T14:02:46.117Z",
    "updated_at": "2026-09-04T03:51:38.156Z",
    "api_url": "https://aiworkshub.io/api/v1/resources/RES_0539C9C4EF5A",
    "reviews_url": "https://aiworkshub.io/api/v1/resources/RES_0539C9C4EF5A/reviews",
    "public_url": "https://aiworkshub.io/resources/RES_0539C9C4EF5A",
    "distribution": {
      "canonical_identity": "https://registry.modelcontextprotocol.io/v0.1/servers/coverage-rights/versions/1.1.0",
      "syndicatable": true,
      "origins": [
        {
          "registry_url": "https://registry.modelcontextprotocol.io/",
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          "upstream_record_url": "https://registry.modelcontextprotocol.io/v0.1/servers/coverage-rights/versions/1.1.0",
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    "tools": [
      {
        "name": "get_appeal_rights",
        "title_en": "Appeal rights lookup",
        "title_zh": "申诉权利查询",
        "description_en": "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.",
        "description_zh": "确定性地解析适用的申诉途径、缺失事实、提交对象、截止日期、当前外部审查状态和经核实的理由。区分原始Medicare、Medicare Advantage医疗福利、Part D药房福利、雇主资助/治理、ACA、Medicaid、FEHB、TRICARE和未知覆盖；不支持或模糊的途径将安全失败。",
        "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,
          "$schema": "http://json-schema.org/draft-07/schema#"
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "get_condition_outcomes",
        "title_en": "Condition denial outcomes",
        "title_zh": "病症拒绝结果",
        "description_en": "External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.",
        "description_zh": "医疗病症的外部审查结果：涉及该病症的保险拒绝被推翻的频率，以及最常争议的治疗方法。",
        "input_schema": {
          "type": "object",
          "properties": {
            "slug": {
              "type": "string",
              "description": "Condition slug, e.g. 'obesity', 'autism', 'hepatitis-c'"
            }
          },
          "required": [
            "slug"
          ],
          "additionalProperties": false,
          "$schema": "http://json-schema.org/draft-07/schema#"
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "get_drug_playbook",
        "title_en": "Drug denial playbook",
        "title_zh": "药物拒绝策略",
        "description_en": "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.",
        "description_zh": "针对计划最难争议的药物（GLP-1类药物：Wegovy、Zepbound、Mounjaro、Ozempic、Saxenda；IBD生物制剂：Humira、Skyrizi、Stelara、Entyvio、Remicade、Rinvoq）的药物特定拒绝模式和申诉策略。返回保守陈述的FDA批准适应症、计划拒绝该特定药物的原因、成功申诉的论点以及阶梯疗法例外框架——如果语料库中有该药物的已发布外部审查记录，也会返回。接受品牌或通用名。",
        "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,
          "$schema": "http://json-schema.org/draft-07/schema#"
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "get_insurer_metrics",
        "title_en": "Insurer denial metrics",
        "title_zh": "保险公司拒绝指标",
        "description_en": "Get an insurer's verified CY2025 prior-authorization metrics (denial rate, appeal overturn rate, decision times) from its own CMS-0057-F disclosure, plus contract/plan-level rows where collected. Includes source URLs and scope notes.",
        "description_zh": "获取保险公司经核实的CY2025预先授权指标（拒绝率、上诉推翻率、决策时间），数据来自其CMS-0057-F披露，并包含合同/计划级别的行（如收集）。包括来源URL和范围说明。",
        "input_schema": {
          "type": "object",
          "properties": {
            "slug": {
              "type": "string",
              "description": "Insurer slug from list_insurers, e.g. 'unitedhealthcare'"
            }
          },
          "required": [
            "slug"
          ],
          "additionalProperties": false,
          "$schema": "http://json-schema.org/draft-07/schema#"
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "get_state_external_review",
        "title_en": "State external review",
        "title_zh": "州外部审查",
        "description_en": "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.",
        "description_zh": "州外部审查流程如何运作：提交截止日期、监管机构联系方式和关键事实。目前经核实的详细信息覆盖10个州（CA、TX、FL、NY、PA、IL、OH、GA、NC、MI）；其他州返回已覆盖列表。",
        "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,
          "$schema": "http://json-schema.org/draft-07/schema#"
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "get_treatment_outcomes",
        "title_en": "Treatment denial outcomes",
        "title_zh": "治疗拒绝结果",
        "description_en": "External-review outcomes for a treatment: how often insurer denials of this treatment/drug/procedure were overturned by independent reviewers (42,749 published CA IMR decisions, 2001–2026). Accepts a category slug (e.g. 'pharmacy') or specific treatment slug (e.g. 'zepbound', 'speech-therapy').",
        "description_zh": "治疗的外部审查结果：独立审查员推翻保险公司对该治疗/药物/程序的拒绝的频率（42,749个已发布的CA IMR决定，2001-2026）。接受类别slug（如'pharmacy'）或特定治疗slug（如'zepbound'、'speech-therapy'）。",
        "input_schema": {
          "type": "object",
          "properties": {
            "slug": {
              "type": "string",
              "description": "Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs."
            }
          },
          "required": [
            "slug"
          ],
          "additionalProperties": false,
          "$schema": "http://json-schema.org/draft-07/schema#"
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "list_insurers",
        "title_en": "List insurers",
        "title_zh": "列出保险公司",
        "description_en": "List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.",
        "description_zh": "列出跟踪的美国健康保险公司，并显示每家是否有经核实的CMS-0057-F预先授权指标。",
        "input_schema": {
          "$schema": "http://json-schema.org/draft-07/schema#",
          "type": "object",
          "properties": {}
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "rank_denial_rates",
        "title_en": "Denial rates ranked",
        "title_zh": "拒绝率排名",
        "description_en": "Insurer prior-authorization denial rates (CY2025), ranked only within compatible reporting cohorts. Each row includes its cohort, rank within that cohort, exact source scope, calculation method, and source link. Never compare ranks across cohorts.",
        "description_zh": "保险公司预先授权拒绝率（CY2025），仅在兼容的报告队列内排名。每行包括其队列、队列内排名、确切来源范围、计算方法和来源链接。切勿跨队列比较排名。",
        "input_schema": {
          "$schema": "http://json-schema.org/draft-07/schema#",
          "type": "object",
          "properties": {}
        },
        "output_schema": {},
        "unit_kind": "mcp_tool",
        "effect": "read",
        "open_world": false,
        "idempotency": "idempotent",
        "confirmation": "explicit policy",
        "evidence_ids": [
          "protocol-tools"
        ],
        "runtime_auth": {},
        "pricing": {},
        "metadata": {}
      },
      {
        "name": "search_outcomes",
        "title_en": "Search outcomes",
        "title_zh": "搜索结果",
        "description_en": "Search treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.",
        "description_zh": "按名称搜索治疗（类别+特定药物/程序）和病症。返回用于get_treatment_outcomes / get_condition_outcomes的slug以及主要推翻率。",
        "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)"
            }
          },
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            "query"
          ],
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          "$schema": "http://json-schema.org/draft-07/schema#"
        },
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        "evidence_ids": [
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        "integrations": [],
        "use_cases": {
          "en": [
            "Compare insurer denial rates and appeal overturn rates",
            "Look up appeal rights and deadlines for a specific denial",
            "Research treatment or condition denial outcomes"
          ],
          "zh": [
            "比较保险公司的拒绝率和上诉推翻率",
            "查询特定拒绝的申诉权利和截止日期",
            "研究治疗或病症的拒绝结果"
          ]
        }
      },
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          "output_contract": "typed",
          "accepts": [],
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        },
        {
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          "confirmation": "explicit policy",
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          "output_contract": "typed",
          "accepts": [
            "insurer slug"
          ],
          "produces": [
            "denial metrics"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        },
        {
          "id": "tool:rank_denial_rates",
          "kind": "mcp_tool",
          "capability_id": "health.insurer-metrics",
          "effect": "read",
          "open_world": false,
          "idempotency": "idempotent",
          "confirmation": "explicit policy",
          "input_contract": "typed",
          "output_contract": "typed",
          "accepts": [],
          "produces": [
            "ranked denial rates"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        },
        {
          "id": "tool:get_treatment_outcomes",
          "kind": "mcp_tool",
          "capability_id": "health.outcomes-research",
          "effect": "read",
          "open_world": false,
          "idempotency": "idempotent",
          "confirmation": "explicit policy",
          "input_contract": "typed",
          "output_contract": "typed",
          "accepts": [
            "treatment slug"
          ],
          "produces": [
            "overturn rates"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        },
        {
          "id": "tool:get_condition_outcomes",
          "kind": "mcp_tool",
          "capability_id": "health.outcomes-research",
          "effect": "read",
          "open_world": false,
          "idempotency": "idempotent",
          "confirmation": "explicit policy",
          "input_contract": "typed",
          "output_contract": "typed",
          "accepts": [
            "condition slug"
          ],
          "produces": [
            "overturn rates"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        },
        {
          "id": "tool:search_outcomes",
          "kind": "mcp_tool",
          "capability_id": "health.outcomes-research",
          "effect": "read",
          "open_world": false,
          "idempotency": "idempotent",
          "confirmation": "explicit policy",
          "input_contract": "typed",
          "output_contract": "typed",
          "accepts": [
            "search query"
          ],
          "produces": [
            "matching treatments and conditions"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        },
        {
          "id": "tool:get_appeal_rights",
          "kind": "mcp_tool",
          "capability_id": "health.appeal-rights",
          "effect": "read",
          "open_world": false,
          "idempotency": "idempotent",
          "confirmation": "explicit policy",
          "input_contract": "typed",
          "output_contract": "typed",
          "accepts": [
            "program",
            "denial reason",
            "state",
            "insurer slug",
            "employer type",
            "funding status",
            "drug channel",
            "regulatory marker",
            "regulatory state basis",
            "appeal stage",
            "current status"
          ],
          "produces": [
            "appeal route and deadlines"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        },
        {
          "id": "tool:get_drug_playbook",
          "kind": "mcp_tool",
          "capability_id": "health.appeal-rights",
          "effect": "read",
          "open_world": false,
          "idempotency": "idempotent",
          "confirmation": "explicit policy",
          "input_contract": "typed",
          "output_contract": "typed",
          "accepts": [
            "drug name"
          ],
          "produces": [
            "denial patterns and appeal strategy"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        },
        {
          "id": "tool:get_state_external_review",
          "kind": "mcp_tool",
          "capability_id": "health.appeal-rights",
          "effect": "read",
          "open_world": false,
          "idempotency": "idempotent",
          "confirmation": "explicit policy",
          "input_contract": "typed",
          "output_contract": "typed",
          "accepts": [
            "state code"
          ],
          "produces": [
            "external review process details"
          ],
          "runtime_auth": {},
          "pricing": {},
          "evidence_ids": [
            "protocol-tools"
          ],
          "metadata": {}
        }
      ],
      "access": {},
      "operational_flags": [],
      "trust": {
        "signal": "none",
        "evidence_ids": [],
        "reason": null
      },
      "fit": {
        "good_for": [
          "Researching insurer denial rates and appeal outcomes",
          "Guiding patients through insurance appeals",
          "Understanding denial patterns for specific treatments or conditions"
        ],
        "not_for": [
          "Legal advice or guaranteed appeal success",
          "Coverage decisions outside the U.S. health system"
        ]
      },
      "evidence": [
        {
          "id": "source-record",
          "type": "registry_record",
          "source": "https://registry.modelcontextprotocol.io/v0.1/servers/coverage-rights/versions/1.1.0",
          "observation": "MCP source record for coverage-rights; version 1.1.0.",
          "observed_at": null,
          "payload": {}
        },
        {
          "id": "protocol-tools",
          "type": "protocol_observation",
          "source": "https://www.coverage-rights.com/api/mcp#tools/list",
          "observation": "9 tools were returned by MCP discovery; 9 were retained for review.",
          "observed_at": "2026-09-04T03:51:19.237Z",
          "payload": {}
        }
      ],
      "unknowns": [
        "Pricing model",
        "Authentication requirements",
        "Data update frequency",
        "Coverage of state external review details beyond 10 states"
      ],
      "id": "REV_C72E652B9CD9",
      "resource_id": "RES_0539C9C4EF5A",
      "evaluator_type": "platform_ai",
      "provider": "deepseek",
      "model": "deepseek-v4-flash",
      "review_scope": "protocol-inspected-mcp",
      "created_at": "2026-09-04T03:51:38.156Z"
    }
  }
}