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get_coverage

Read-only

Insurance coverage rules for a procedure/carrier combination. aspect: 'summary' (status + plain English), 'prior-auth', 'cost-sharing' (deductible/coinsurance/ACA preventive), 'frequency' (how often covered, age rules), or 'triggers' (Pro plan: billing events that flip a $0 preventive claim to diagnostic — the highest-signal aspect).

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
aspectNoDefault 'summary'
carrierYesCarrier key, e.g. 'aetna', 'cigna', 'bcbs', 'medicare' — see list_carriers
plan_typeNo
procedureYesProcedure slug, e.g. 'colonoscopy'

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A3.6/5.0
Behavior3/5

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

Annotations already declare readOnlyHint=true and destructiveHint=false, so the safety profile is covered. The description adds nothing beyond that about behavior — no note on rate limits, coverage gaps for unknown carriers, or whether missing data returns an empty result. The 'triggers' explanation is output semantics rather than behavioral disclosure.

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?

One dense sentence that front-loads the purpose before enumerating aspects; every clause carries information. The embedded parentheticals are slightly heavy but readable and justified.

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 and 75% schema coverage, the description covers the most ambiguous input (aspect) well and clarifies the two non-required params implicitly. plan_type's effect on results is the main unexplained gap, leaving it just short of fully complete.

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 75% and the schema only labels 'aspect' with 'Default summary'. The description expands each enum value into what it actually returns (status+plain English, deductible/coinsurance/ACA preventive, age rules, billing-event triggers), which is genuine meaning beyond the schema. plan_type receives no description-level explanation, so not a 5.

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 resource ('insurance coverage rules') and its scope ('for a procedure/carrier combination'), which cleanly separates it from cost-estimation siblings like estimate_procedure_cost or calculate_liability. It does not name any sibling explicitly, so it stops short of a 5.

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 aspect list implicitly guides how to pick a mode, and 'triggers' is flagged as 'the highest-signal aspect', which is useful routing advice. However, there is no statement of when to prefer this tool over full_estimate / estimate_procedure_cost, nor any exclusion or prerequisite (e.g., carrier must come from list_carriers).

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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