MCP SERVER
https://www.coverage-rights.com/api/mcpSUMMARY
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.
USE CASES
CAPABILITIES
Evidence-backed capability profile
TOOLS IN THIS MCP SERVER
get_appeal_rightsAppeal rights lookupDeterministically 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.
get_condition_outcomesCondition denial outcomesExternal-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.
get_drug_playbookDrug denial playbookDrug-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.
get_insurer_metricsInsurer denial metricsGet 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.
get_state_external_reviewState external reviewHow 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.
get_treatment_outcomesTreatment denial outcomesExternal-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').
list_insurersList insurersList tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.
rank_denial_ratesDenial rates rankedInsurer 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.
search_outcomesSearch outcomesSearch treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.
MACHINE-READABLE ENDPOINTS
ACCESS
USAGE OBSERVATIONS