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Appeal My Claim: Appeal rights, steps and free help for a plan type and state

appealmyclaim_get_appeal_rights
Read-onlyIdempotent

Appeal My Claim. Appeal rights, steps and free help for a plan type and state. Use for "what are my appeal rights in California?", "my insurer denied my claim, what can I do?" or "how do Medicare appeals work?". Returns who decides, the steps (internal appeal, external review, Medicare levels or Medicaid fair hearing), deadlines, and where to get free help, including the state insurance department. If the plan type is not known, leave it out to get the rules for most private plans

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
stateNoUS state name or two-letter code, like California or CA. Puerto Rico works too.
plan_typeNomarketplace, employer, employer_insured, employer_self_funded, medicare, medicare_advantage, part_d or medicaid. Everyday words work too, like "job", "Obamacare" or "Medi-Cal". Default: most private plans.

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A3.9/5.0
Behavior4/5

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

Annotations already establish the safe read-only, idempotent, closed-world profile, so the bar is lower; the description adds real value by enumerating what is returned (who decides, the appeal steps, deadlines, and where to get free help). The fallback behavior when plan_type is omitted is also disclosed, though no rate limits or data-freshness notes are given.

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?

Front-loads the purpose and packs example phrasings into a single compact block, and each sentence serves a routing or fallback function. The opening 'Appeal My Claim. Appeal rights, steps and free help for a plan type and state' restates the title verbatim, a minor redundancy.

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?

With no output schema, the description carries the return-shape burden and does so by listing the categories of information returned. Combined with the handling of the optional plan_type and state inputs, it is essentially complete for calling the tool correctly, missing only any note on coverage limits or data recency.

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

Parameters3/5

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

Schema coverage is 100%, so both parameters are already documented, including the state format and the plan_type default. The description reinforces the default ('leave it out to get the rules for most private plans'), which slightly clarifies behavior but largely restates the schema, so baseline 3 is appropriate.

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?

States a specific verb and resource (get appeal rights, steps and free help) scoped by plan type and state, and the example queries make the intent unambiguous. It does not explicitly name or differentiate from its siblings (get_appeal_deadlines, draft_appeal_letter), so sibling routing is left implicit.

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

Usage Guidelines4/5

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

Provides concrete trigger phrasings ('what are my appeal rights in California?', 'my insurer denied my claim, what can I do?') and a fallback for the unknown-plan-type case, which is strong usage context. However, it does not say when to prefer this over appealmyclaim_get_appeal_deadlines or appealmyclaim_draft_appeal_letter, despite overlapping on the deadlines content.

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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