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Appeal My Claim

Draft an appeal letter for the user to review and send

draft_appeal_letter
Read-onlyIdempotent

Draft an appeal letter for the user to review and send. Use for "my insurer denied my MRI as not medically necessary, help me appeal" or "write an appeal letter for an out-of-network denial". Returns a letter as plain text with [brackets] for anything not given, a checklist of what to attach (denial notice, doctor's letter of medical necessity, records), and tips. It never sends or files anything.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
dateNoDate of service.
nameNoMember's name.
planNoInsurer or plan name.
claimNoClaim or reference number.
doctorNoTreating doctor's name.
reasonNoWhy the claim was denied: medical_necessity, emergency (said it wasn't an emergency), experimental, out_of_network, prior_auth, coding or generic. Plain words work too. Required unless denial_code is given.
urgentNoyes to ask for an expedited review.
detailsNoA sentence or two in the user's words on why the care should be covered.
serviceNoThe care that was denied, like "MRI of the right knee".
providerNoHospital, clinic or provider name.
member_idNoMember ID or Medicare number.
plan_typeNoSame values as /v1/rights. Changes the wording for Medicare.
denial_codeNoThe reason code on the notice, like CO-50 or PR-197. Picks the reason when reason is left out, and is quoted in the letter.
denial_dateNoDate on the denial notice.

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.1/5.0
Behavior4/5

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

Annotations already declare readOnlyHint/idempotent/destructiveHint=false, but the description goes further by describing the actual return payload (plain-text letter with [bracket] placeholders, attachment checklist, tips) and confirming 'It never sends or files anything.' No output schema exists, so this return-shape disclosure is genuinely additive, though it doesn't cover auth or rate constraints.

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?

Three tight sentences with the core purpose front-loaded, followed by usage triggers, then return format and a safety note. No filler, though the trigger examples add length that is justified by their routing value.

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 14-parameter, zero-required tool with no output schema, the description covers purpose, triggers, return shape, and the no-side-effect guarantee. The main remaining gap is that omitted fields are only vaguely explained rather than tied to the placeholder behavior per parameter.

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 description coverage is 100% for all 14 parameters, so the schema already documents each field, the reason enum, and the reason/denial_code interaction. The description adds only a light note that unspecified values are left as [brackets] placeholders. Baseline 3 is appropriate when the schema carries the load.

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

Purpose5/5

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

Specific verb+resource ('Draft an appeal letter') with an explicit scope qualifier ('for the user to review and send'). Sibling tools (explain_denial_code, get_appeal_deadlines, get_appeal_rights) are all read/explain operations, so the drafting action is unambiguous without opening any schema.

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 utterances ('my insurer denied my MRI as not medically necessary, help me appeal'; 'write an appeal letter for an out-of-network denial'), which make the intended use case clear. It stops short of naming when NOT to use it or explicitly routing to the sibling rights/deadline tools as prerequisites.

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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