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Insurer Denial Profile

insurer_denial_profile
Read-onlyIdempotent

Everything reported for ONE named health insurer: claims received and denied in and out of network, the denial rate, and both internal and external appeal outcomes, for plan year 2026. Use when a caller names a company — "how often does Ambetter deny claims", "Blue Cross denial rate in Texas", "what happens if I appeal with Oscar". Matches on the insurer's name and is forgiving about punctuation, case and partial names; an issuer selling in several states returns one entry per state, since CMS reports these figures per issuer per state. Sourced from the CMS Transparency in Coverage Public Use File; covers HealthCare.gov states only.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
stateNoOptional two-letter state code to narrow a multi-state insurer, e.g. "TX".
insurerYesInsurer name or part of one, e.g. "Ambetter", "Blue Cross Blue Shield of Texas", "oscar".

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.7/5.0
Behavior5/5

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

Beyond the readOnly/idempotent annotations, it discloses matching behavior (forgiving case, punctuation, partial names), the per-state row behavior for multi-state issuers, the data source, the plan year, and the HealthCare.gov coverage limitation. No annotation contradiction found.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness5/5

Is the description appropriately sized, front-loaded, and free of redundancy?

Four dense sentences, each earning its place: what the tool returns, when to use it, matching behavior, and source/scope caveats. The key output is front-loaded in the first sentence.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness5/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

For a tool with no output schema, the description enumerates the return contents and covers matching, state behavior, data source, year, and geographic scope. Nothing critical is missing for an agent to invoke it correctly.

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 100%, so the baseline is 3. The description adds value beyond the schema by explaining partial-name matching, per-state returns, and the optional state parameter's narrowing effect for multi-state insurers.

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?

The description names a specific resource ('ONE named health insurer') and enumerates the exact contents: claims received/denied, denial rate, and appeal outcomes. This clearly distinguishes the profile tool from the sibling tools that focus on only one slice of that data.

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?

It gives explicit use guidance: 'Use when a caller names a company,' with realistic example queries. It does not explicitly mention sibling alternatives like insurer_denial_rates or insurer_appeal_outcomes, but the context is clear enough to route the agent correctly.

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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