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Appeal My Claim

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

get_appeal_rights
Read-onlyIdempotent

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 declare readOnly/idempotent/non-destructive, so the bar is low. The description adds substantive behavioral context by enumerating the returned content (decision-maker, internal appeal vs. external review vs. Medicare levels vs. Medicaid fair hearing, deadlines, free help including the state insurance department), which is not in the annotations.

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-loaded with purpose, then examples, return contents, and a default-behavior note. Mostly efficient, though the example queries consume space for what is already a clear purpose.

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 read-only, two-optional-param tool with no output schema, the description does the work of explaining return contents, when to use it, and default behavior. Nothing essential to correct invocation is missing, though sibling differentiation is the one remaining gap.

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% and the plan_type schema entry already states 'Default: most private plans.' The description's note to leave plan_type out to get most-private-plan rules largely restates that default rather than adding new syntax or constraints, 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?

The description states a specific verb+resource ('Appeal rights, steps and free help for a plan type and state') and details what comes back (who decides, steps, deadlines, free help). It does not, however, explicitly distinguish itself from the sibling get_appeal_deadlines, whose topic it partly covers, leaving some ambiguity about which to pick.

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?

Three concrete example queries ('what are my appeal rights in California?', 'my insurer denied my claim, what can I do?', 'how do Medicare appeals work?') give clear usage context, and the closing note tells the agent to omit plan_type when unknown. It stops short of naming when NOT to use it or routing to sibling tools.

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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