`insurer_denial_rates`

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

Which health insurers deny the most claims — US marketplace issuers ranked by the share of in-network claims they denied, for plan year ${PLAN_YEAR}. Answers “what percentage of claims does my insurance company deny”, “which insurer denies the most”, “how often does deny claims”, and comparisons between insurers in a state. Returns each issuer with claims received, claims denied, the denial rate as a percentage, and how many marketplace plans it offers. Filter by state (two-letter code) or by market — medical plans (Individual QHP), standalone dental (Individual SADP, which denies at much higher rates than medical), or small-group SHOP. Sourced from the CMS Transparency in Coverage Public Use File, which insurers report into under federal rule; covers HealthCare.gov states only, so issuers on 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”, “FL”. Omit for all states.
`market`	string	no	Which market: “medical” / “QHP” for medical plans, “dental” / “SADP” for standalone dental, “SHOP” for small-group. Omit for all three.
`order`	string	no	”highest” (default) ranks the biggest deniers first; “lowest” ranks the smallest.
`limit`	number	no	How many issuers to return (default 20, max 200).

Example call

Arguments

{
  "market": "medical",
  "limit": 5
}

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_denial_rates","arguments":{"market":"medical","limit":5}}}'

TypeScript (@pipeworx/sdk)

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

const result = await pipeworx.call('insurer_denial_rates', {
  "market": "medical",
  "limit": 5
});

More examples

{
  "state": "TX",
  "market": "medical"
}

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_denial_rates