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costkits

costkits-mcp

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by costkits

get_coverage

Retrieve insurance coverage rules for a procedure and carrier, including summary, prior authorization, cost-sharing, frequency, and billing triggers.

Instructions

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'
Behavior3/5

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

No annotations are provided, so the description carries the full burden. It adds behavioral context by describing each aspect (e.g., 'triggers' for Pro plan billing events). However, it does not disclose other behaviors like authentication, rate limits, or error handling.

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?

The description is concise, consisting of one sentence plus a parenthetical enumeration. However, the enumeration is a bit dense; a list format might improve readability. It efficiently uses space without redundancy.

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

Completeness3/5

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

Given the absence of an output schema, the description does not explain return values or structure, which is a gap. It adequately covers the tool's purpose and parameters but lacks completeness in explaining what the agent can expect as a result.

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?

The schema description coverage is 75%, but the description adds significant value for the 'aspect' parameter by explaining each enum value. For 'procedure' and 'carrier', the description reiterates schema info without much additional detail. Overall, it enriches parameter understanding.

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 clearly states the tool's purpose: retrieving insurance coverage rules for a specific procedure/carrier combination. It lists the available aspects, which distinguishes it from sibling tools like 'estimate_procedure_cost' (cost) or 'find_providers' (providers).

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 description explains what aspects are available and hints at when to use each, but it does not explicitly contrast with alternatives or specify when not to use this tool. Usage context is implied rather than stated.

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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