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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. For requests like "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_typeNoPlan type: marketplace, 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. Changed1 schema field changed
    • changedInput schema / properties / plan_type / description
      Previous value: -"marketplace, 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."New value: +"Plan type: marketplace, 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."
  2. First observed

TDQS

A4/5.0
Behavior4/5

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

Annotations already declare readOnlyHint=true, idempotentHint=true, destructiveHint=false and openWorldHint=true, so the safety profile is covered; the description still adds value by disclosing what the call returns (decision-maker, appeal steps, deadlines, free help) and the default behavior when plan_type is omitted. No rate limits or data-freshness caveats are mentioned, but nothing is contradicted.

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?

Four sentences, front-loaded with purpose, then trigger examples, then return contents, then the optional-parameter rule. The opening restatement of the display name is slightly redundant, but the rest is dense with useful information and free of filler.

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 correctly carries the job of enumerating what comes back (who decides, steps across appeal tracks, deadlines, free help including the state insurance department) and how to call it with zero required parameters. The only gap is that it never clarifies how it relates to the deadline-focused sibling, which an agent choosing between the two would want.

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 description coverage is 100%, so the baseline is 3, but the description adds real semantics on top: omitting plan_type yields the rules for most private plans, which reinforces and clarifies the schema's stated default. State is not elaborated beyond the schema, and both parameters are optional per the schema.

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 clear verb (get) plus the resource (appeal rights, steps and free help) scoped by plan type and state, and the example questions make the intent unmistakable. It does not, however, differentiate itself from the sibling appealmyclaim_get_appeal_deadlines, even though it lists deadlines among its own outputs, leaving a small routing ambiguity.

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?

The quoted example requests ("what are my appeal rights in California?", "my insurer denied my claim, what can I do?") give an agent concrete trigger conditions, and the closing note tells it what to do when plan type is unknown. There is no explicit statement of when NOT to use it or which sibling to prefer instead.

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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