Insurer denial rates, appeal outcomes by treatment and condition, and appeal rights lookups.
Inferred from the transports this listing declares (streamable-http). A client not listed here hasn’t been ruled out — it just isn’t something Forge can confirm.
Verification confirms publisher identity (repo ownership), not code safety. The security scan covers known CVEs and suspicious install scripts.
Read from a real MCP initialize → tools/list handshake against the declared endpoint. No tool was ever invoked — tools/list is the read-only introspection call the protocol defines for this. It reflects what the server advertised at that moment; a hosted endpoint is not pinned to any version and can change without notice.
https://www.coverage-rights.com/api/mcp9 tools · 246mslist_insurersList tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.
No input schema was published for this tool.
get_insurer_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 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.
| Parameter | Type | Description |
|---|---|---|
| slug* | string | Insurer slug from list_insurers, e.g. 'unitedhealthcare' |
rank_denial_ratesInsurer 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.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.
No input schema was published for this tool.
get_treatment_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').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').
| Parameter | Type | Description |
|---|---|---|
| slug* | string | Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs. |
get_condition_outcomesExternal-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.
| Parameter | Type | Description |
|---|---|---|
| slug* | string | Condition slug, e.g. 'obesity', 'autism', 'hepatitis-c' |
search_outcomesSearch treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.Search treatments (categories + specific drugs/procedures) and conditions by name. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.
| Parameter | Type | Description |
|---|---|---|
| query* | string | Search text, e.g. 'wegovy', 'back pain', 'imaging' |
| limit | integer | Max results per type (default 10) |
get_appeal_rightsDeterministically 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, T…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, T…
| Parameter | Type | Description |
|---|---|---|
| program* | string | Plan type |
| denial_reason* | string | Denial reason category. Use 'prescription-drug' for medication denials — formulary exclusion, step therapy, quantity limits, or drug prior authorization — whic… |
| state | string | Two-letter state code, e.g. 'ca' |
| insurer_slug | string | Insurer slug for insurer-specific stats |
| employer_type | string | Required to resolve job-based coverage |
| funding_status | string | Required to resolve job-based state versus federal governance |
| drug_channel | string | For a drug denial, whether the medical or pharmacy benefit applies |
| regulatory_marker | string | — |
| regulatory_state_basis | string | — |
| appeal_stage | string | — |
| current_status | string | — |
get_drug_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…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…
| Parameter | Type | Description |
|---|---|---|
| drug* | string | Brand or generic drug name, e.g. 'Zepbound', 'ustekinumab' |
get_state_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.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.
| Parameter | Type | Description |
|---|---|---|
| state* | string | Two-letter state code, e.g. 'ca', 'ny', 'fl' |
9 of 9 tools published a description.
Tool names and descriptions are written by the publisher and shown verbatim as inert text. They are the strings an MCP client passes to a model, so Forge scans them for prompt-injection patterns — any finding appears with the security scan above. “Privileged” is a keyword match on the tool name, not an audit of what the tool does: a benign-sounding name can still do anything.
Insurer denial rates, appeal outcomes by treatment and condition, and appeal rights lookups.
Linked names open Forge’s index of every entry observed exposing that tool. Browse all indexed tools.
This entry publishes no npm package, so Forge has no dependency tree for it. That is a gap in coverage — not a statement that it has no dependencies.