Connection check
verified live · 20h ago
coverage-rights
Insurer denial rates, appeal outcomes by treatment and condition, and appeal rights lookups.
Tools
9
GitHub stars
—
Installs / wk
—
Licence
—
Transport
streamable-http
Last checked
20h ago
Tools & capabilities
9 toolsRead from the running server on 20h ago.
get_appeal_rights
read-only
stateprogram*appeal_stagedrug_channelinsurer_slugdenial_reason*
+5
Deterministically resolve the governing appeal route, missing facts, filing recipient, deadlines, current external-review status, and verified grounds. Distinguishes Original Medic… 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.
get_condition_outcomes
read-only
slug*
External-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.
get_drug_playbook
read-only
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, Sky… 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.
get_insurer_metrics
read-only
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 w… 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.
get_state_external_review
read-only
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);… 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.
get_treatment_outcomes
read-only
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, 20… 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').
list_insurers
read-only
List 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.
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, calcu… 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.
search_outcomes
read-only
limitquery*