coverage-rights

Tools

Token cost is the o200k count of the tools list JSON, including schemas, before any tool is called.

• list_insurers

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

• get_insurer_metrics

  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. Incl

• rank_denial_rates

  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 s

• get_treatment_outcomes

  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

• get_condition_outcomes

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

• search_outcomes

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

• get_appeal_rights

  Deterministically resolve the governing appeal route, missing facts, filing recipient, deadlines, current external-review status, and verified grounds. Distinguishes Original Medicare, Medicare Advant

• get_drug_playbook

  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, Entyv

• get_state_external_review

  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