coverage-rights

get_treatment_outcomes

Read-onlyIdempotent

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').

Tool call template

Replace each placeholder with a value matching the input schema. Only required parameters are included; add optional parameters as needed.

{
  "id": 1,
  "jsonrpc": "2.0",
  "method": "tools/call",
  "params": {
    "arguments": {
      "slug": "<slug>"
    },
    "name": "get_treatment_outcomes"
  }
}

Input Schema

Name	Required	Description	Default
`slug`	Yes	Treatment slug, e.g. 'zepbound', 'pharmacy', 'speech-therapy'. Use search_outcomes to find slugs.

Output Schema

Name	Required	Description
`page`	No	Existing free information page when a matching record is available.
`type`	No
`_note`	Yes
`error`	No	Lookup error text when _coverage.status is not_found or unsupported.
`source`	No
`_coverage`	Yes
`decisions`	No
`treatment`	No
`overturned`	No
`by_condition`	No
`subcategories`	No
`by_denial_reason`	No
`overturn_rate_pct`	No

Schema Changelog

Changes observed during successful MCP inspections.

Changed56 schema fields changedNov 10, 2026
- changedInput schema / $schema
```
Previous value: -"http://json-schema.org/draft-07/schema#"New value: +"https://json-schema.org/draft/2020-12/schema"
```
- removedInput schema / additionalProperties
```
Removed value: -false
```
- changedOutput schema / $schema
```
Previous value: -"http://json-schema.org/draft-07/schema#"New value: +"https://json-schema.org/draft/2020-12/schema"
```
- changedOutput schema / additionalProperties
```
Previous value: -trueNew value: +{}
```
- changedOutput schema / properties / _coverage / properties / content_reviewed_at / anyOf
```
Previous value: -[
-  {
-    "format": "date",
-    "type": "string"
-  },
-  {
-    "type": "null"
-  }
-]New value: +[
+  {
+    "format": "date",
+    "pattern": "^(?:(?:\\d\\d[2468][048]|\\d\\d[13579][26]|\\d\\d0[48]|[02468][048]00|[13579][26]00)-02-29|\\d{4}-(?:(?:0[13578]|1[02])-(?:0[1-9]|[12]\\d|3[01])|(?:0[469]|11)-(?:0[1-9]|[12]\\d|30)|(?:02)-(?:0[1-9]|1\\d|2[0-8])))$",
+    "type": "string"
+  },
+  {
+    "type": "null"
+  }
+]
```
- removedOutput schema / properties / _coverage / properties / continuation / properties / url / $ref
```
Removed value: -"#/properties/_coverage/properties/sources/items/properties/url"
```
- addedOutput schema / properties / _coverage / properties / continuation / properties / url / format
```
Added value: +"uri"
```
- addedOutput schema / properties / _coverage / properties / continuation / properties / url / type
```
Added value: +"string"
```
- changedOutput schema / properties / _coverage / properties / sources / items / additionalProperties
```
Previous value: -trueNew value: +{}
```
- changedOutput schema / properties / by_condition / items / additionalProperties
```
Previous value: -trueNew value: +{}
```
- removedOutput schema / properties / by_condition / items / properties / overturned / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / by_condition / items / properties / overturned / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / by_condition / items / properties / overturned / minimum
```
Added value: +0
```
- addedOutput schema / properties / by_condition / items / properties / overturned / type
```
Added value: +"integer"
```
- removedOutput schema / properties / by_condition / items / properties / total / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / by_condition / items / properties / total / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / by_condition / items / properties / total / minimum
```
Added value: +0
```
- addedOutput schema / properties / by_condition / items / properties / total / type
```
Added value: +"integer"
```
- changedOutput schema / properties / by_denial_reason / items / additionalProperties
```
Previous value: -trueNew value: +{}
```
- removedOutput schema / properties / by_denial_reason / items / properties / overturn_rate_pct / $ref
```
Removed value: -"#/properties/overturn_rate_pct"
```
- addedOutput schema / properties / by_denial_reason / items / properties / overturn_rate_pct / anyOf
```
Added value: +[
+  {
+    "maximum": 100,
+    "minimum": 0,
+    "type": "number"
+  },
+  {
+    "type": "null"
+  }
+]
```
- removedOutput schema / properties / by_denial_reason / items / properties / overturned / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / by_denial_reason / items / properties / overturned / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / by_denial_reason / items / properties / overturned / minimum
```
Added value: +0
```
- addedOutput schema / properties / by_denial_reason / items / properties / overturned / type
```
Added value: +"integer"
```
- removedOutput schema / properties / by_denial_reason / items / properties / total / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / by_denial_reason / items / properties / total / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / by_denial_reason / items / properties / total / minimum
```
Added value: +0
```
- addedOutput schema / properties / by_denial_reason / items / properties / total / type
```
Added value: +"integer"
```
- addedOutput schema / properties / decisions / maximum
```
Added value: +9007199254740991
```
- removedOutput schema / properties / overturned / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / overturned / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / overturned / minimum
```
Added value: +0
```
- addedOutput schema / properties / overturned / type
```
Added value: +"integer"
```
- removedOutput schema / properties / page / $ref
```
Removed value: -"#/properties/_coverage/properties/sources/items/properties/url"
```
- addedOutput schema / properties / page / format
```
Added value: +"uri"
```
- addedOutput schema / properties / page / type
```
Added value: +"string"
```
- changedOutput schema / properties / source / additionalProperties
```
Previous value: -trueNew value: +{}
```
- removedOutput schema / properties / source / properties / records / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / source / properties / records / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / source / properties / records / minimum
```
Added value: +0
```
- addedOutput schema / properties / source / properties / records / type
```
Added value: +"integer"
```
- removedOutput schema / properties / source / properties / url / $ref
```
Removed value: -"#/properties/_coverage/properties/sources/items/properties/url"
```
- addedOutput schema / properties / source / properties / url / format
```
Added value: +"uri"
```
- addedOutput schema / properties / source / properties / url / type
```
Added value: +"string"
```
- changedOutput schema / properties / subcategories / items / additionalProperties
```
Previous value: -trueNew value: +{}
```
- removedOutput schema / properties / subcategories / items / properties / overturn_rate_pct / $ref
```
Removed value: -"#/properties/overturn_rate_pct"
```
- addedOutput schema / properties / subcategories / items / properties / overturn_rate_pct / anyOf
```
Added value: +[
+  {
+    "maximum": 100,
+    "minimum": 0,
+    "type": "number"
+  },
+  {
+    "type": "null"
+  }
+]
```
- removedOutput schema / properties / subcategories / items / properties / overturned / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / subcategories / items / properties / overturned / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / subcategories / items / properties / overturned / minimum
```
Added value: +0
```
- addedOutput schema / properties / subcategories / items / properties / overturned / type
```
Added value: +"integer"
```
- removedOutput schema / properties / subcategories / items / properties / total / $ref
```
Removed value: -"#/properties/decisions"
```
- addedOutput schema / properties / subcategories / items / properties / total / maximum
```
Added value: +9007199254740991
```
- addedOutput schema / properties / subcategories / items / properties / total / minimum
```
Added value: +0
```
- addedOutput schema / properties / subcategories / items / properties / total / type
```
Added value: +"integer"
```

Changed1 schema field changedNov 4, 2026

changedOutput schema / (root)

Previous value: -nullNew value: +{
+  "$schema": "http://json-schema.org/draft-07/schema#",
+  "additionalProperties": true,
+  "properties": {
+    "_coverage": {
+      "additionalProperties": false,
+      "properties": {
+        "applicability": {
+          "additionalProperties": false,
+          "properties": {
+            "jurisdiction": {
+              "type": "string"
+            },
+            "personal_deadline_calculated": {
+              "const": false,
+              "type": "boolean"
+            },
+            "scope": {
+              "type": "string"
+            }
+          },
+          "required": [
+            "jurisdiction",
+            "scope",
+            "personal_deadline_calculated"
+          ],
+          "type": "object"
+        },
+        "content_reviewed_at": {
+          "anyOf": [
+            {
+              "format": "date",
+              "type": "string"
+            },
+            {
+              "type": "null"
+            }
+          ],
+          "description": "YYYY-MM-DD only when this specific content has an existing review date; null means no response-wide review date is asserted."
+        },
+        "continuation": {
+          "additionalProperties": false,
+          "properties": {
+            "label": {
+              "type": "string"
+            },
+            "url": {
+              "$ref": "#/properties/_coverage/properties/sources/items/properties/url"
+            }
+          },
+          "required": [
+            "label",
+            "url"
+          ],
+          "type": "object"
+        },
+        "limitations": {
+          "items": {
+            "type": "string"
+          },
+          "type": "array"
+        },
+        "schema_version": {
+          "const": "1.0",
+          "type": "string"
+        },
+        "sources": {
+          "items": {
+            "additionalProperties": true,
+            "properties": {
+              "label": {
+                "type": "string"
+              },
+              "role": {
+                "enum": [
+                  "primary_source",
+                  "publisher_data",
+                  "curated_guidance",
+                  "methodology"
+                ],
+                "type": "string"
+              },
+              "url": {
+                "format": "uri",
+                "type": "string"
+              }
+            },
+            "required": [
+              "label",
+              "url",
+              "role"
+            ],
+            "type": "object"
+          },
+          "type": "array"
+        },
+        "status": {
+          "enum": [
+            "ok",
+            "no_matches",
+            "not_found",
+            "needs_context",
+            "unsupported"
+          ],
+          "type": "string"
+        },
+        "summary": {
+          "type": "string"
+        },
+        "tool": {
+          "type": "string"
+        }
+      },
+      "required": [
+        "schema_version",
+        "tool",
+        "content_reviewed_at",
+        "status",
+        "summary",
+        "applicability",
+        "sources",
+        "continuation",
+        "limitations"
+      ],
+      "type": "object"
+    },
+    "_note": {
+      "type": "string"
+    },
+    "by_condition": {
+      "items": {
+        "additionalProperties": true,
+        "properties": {
+          "overturned": {
+            "$ref": "#/properties/decisions"
+          },
+          "total": {
+            "$ref": "#/properties/decisions"
+          }
+        },
+        "required": [
+          "total",
+          "overturned"
+        ],
+        "type": "object"
+      },
+      "type": "array"
+    },
+    "by_denial_reason": {
+      "items": {
+        "additionalProperties": true,
+        "properties": {
+          "denial_type": {
+            "type": "string"
+          },
+          "overturn_rate_pct": {
+            "$ref": "#/properties/overturn_rate_pct"
+          },
+          "overturned": {
+            "$ref": "#/properties/decisions"
+          },
+          "total": {
+            "$ref": "#/properties/decisions"
+          }
+        },
+        "required": [
+          "denial_type",
+          "total",
+          "overturned",
+          "overturn_rate_pct"
+        ],
+        "type": "object"
+      },
+      "type": "array"
+    },
+    "decisions": {
+      "minimum": 0,
+      "type": "integer"
+    },
+    "error": {
+      "description": "Lookup error text when _coverage.status is not_found or unsupported.",
+      "type": "string"
+    },
+    "overturn_rate_pct": {
+      "anyOf": [
+        {
+          "maximum": 100,
+          "minimum": 0,
+          "type": "number"
+        },
+        {
+          "type": "null"
+        }
+      ]
+    },
+    "overturned": {
+      "$ref": "#/properties/decisions"
+    },
+    "page": {
+      "$ref": "#/properties/_coverage/properties/sources/items/properties/url",
+      "description": "Existing free information page when a matching record is available."
+    },
+    "source": {
+      "additionalProperties": true,
+      "properties": {
+        "name": {
+          "type": "string"
+        },
+        "records": {
+          "$ref": "#/properties/decisions"
+        },
+        "url": {
+          "$ref": "#/properties/_coverage/properties/sources/items/properties/url"
+        },
+        "yearsCovered": {
+          "type": "string"
+        }
+      },
+      "required": [
+        "name",
+        "url",
+        "records",
+        "yearsCovered"
+      ],
+      "type": "object"
+    },
+    "subcategories": {
+      "items": {
+        "additionalProperties": true,
+        "properties": {
+          "label": {
+            "type": "string"
+          },
+          "overturn_rate_pct": {
+            "$ref": "#/properties/overturn_rate_pct"
+          },
+          "overturned": {
+            "$ref": "#/properties/decisions"
+          },
+          "total": {
+            "$ref": "#/properties/decisions"
+          }
+        },
+        "required": [
+          "label",
+          "total",
+          "overturned",
+          "overturn_rate_pct"
+        ],
+        "type": "object"
+      },
+      "type": "array"
+    },
+    "treatment": {
+      "type": "string"
+    },
+    "type": {
+      "enum": [
+        "category",
+        "specific"
+      ],
+      "type": "string"
+    }
+  },
+  "required": [
+    "_note",
+    "_coverage"
+  ],
+  "type": "object"
+}

First observedJul 19, 2026

TDQS

A3.8/5.0

Behavior4/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

Annotations already establish this as a safe, idempotent, closed-world read, so the description's added value is the data provenance: 42,749 published CA IMR decisions spanning 2001–2026. That quietly signals a California-only coverage boundary an agent would otherwise not know. It does not discuss aggregation level or rate limits, but the output schema covers the return shape.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness4/5

Is the description appropriately sized, front-loaded, and free of redundancy?

Two sentences, tightly front-loaded with the core metric before the dataset metadata and the input-shape note. The long parenthetical is dense but each element (corpus size, jurisdiction, year range) carries information. Minor awkwardness from packing both a definition and a scope note into one sentence.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness4/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

For a single-parameter read tool with full schema coverage, an output schema, and rich annotations, the description supplies the essential semantics plus data provenance. The remaining gap is routing: it never states how this differs from get_condition_outcomes or when to prefer get_state_external_review.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters4/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema coverage is 100%, so baseline would be 3, but the description adds real meaning: the single slug parameter accepts either a broad category or a specific treatment, which the schema alone only hints at through its mixed examples. That distinction materially affects how an agent picks a value.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose4/5

Does the description clearly state what the tool does and how it differs from similar tools?

Names a concrete resource and metric: external-review outcomes for a treatment, specifically how often insurer denials were overturned by independent reviewers. That is far more specific than a restatement of the name. It stops short of differentiating itself from near-neighbors like get_condition_outcomes or get_state_external_review, so an agent must infer that this one is keyed on treatments/drugs rather than conditions or states.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines3/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

The description clarifies the accepted input shape (category slug such as 'pharmacy' or a specific treatment slug such as 'zepbound'), which implies when the tool applies. However, it gives no explicit when-to-use/when-not-to-use guidance against siblings, and the useful pointer to search_outcomes for discovering slugs lives only in the schema, not the description.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

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