`insurer_appeal_outcomes`

Pack: insurance-denials · Endpoint: https://gateway.pipeworx.io/insurance-denials/mcp

Does appealing a denied health-insurance claim work? Marketplace issuers ranked by the share of appeals that were OVERTURNED in the patient’s favour, plan year ${PLAN_YEAR}. Answers “is it worth appealing a denied claim”, “what percentage of insurance appeals succeed”, “how often does reverse a denial”, and which insurer most often changes its mind. Returns internal appeals (decided by the insurer itself) and external appeals (decided by an independent reviewer) separately, with how many were filed, how many were overturned, and the overturn percentage — the two differ a lot and the external number is the independent one. Sourced from the CMS Transparency in Coverage Public Use File; covers HealthCare.gov states only, so state-run exchanges such as California and New York are not present.

Parameters

Name	Type	Required	Description
`state`	string	no	Two-letter US state code to filter by, e.g. “TX”. Omit for all states.
`market`	string	no	”medical” / “QHP”, “dental” / “SADP”, or “SHOP”. Omit for all.
`appeal_type`	string	no	”internal” (default, decided by the insurer) or “external” (decided by an independent reviewer).
`order`	string	no	”highest” (default) ranks the most-overturned first; “lowest” ranks the least.
`limit`	number	no	How many issuers to return (default 20, max 200).

Example call

Arguments

{
  "appeal_type": "external",
  "limit": 3
}

curl

curl -X POST https://gateway.pipeworx.io/insurance-denials/mcp \
  -H 'Content-Type: application/json' \
  -d '{"jsonrpc":"2.0","id":1,"method":"tools/call","params":{"name":"insurer_appeal_outcomes","arguments":{"appeal_type":"external","limit":3}}}'

TypeScript (@pipeworx/sdk)

import { Pipeworx } from '@pipeworx/sdk';
const pipeworx = new Pipeworx();

const result = await pipeworx.call('insurer_appeal_outcomes', {
  "appeal_type": "external",
  "limit": 3
});

More examples

{
  "state": "FL"
}

Connect

Add this to your MCP client config, or use one-click install buttons:

{
  "mcpServers": {
    "insurance-denials": {
      "url": "https://gateway.pipeworx.io/insurance-denials/mcp"
    }
  }
}

See Getting Started for client-specific install steps.

insurer_appeal_outcomes