# Coverage Rights

> Coverage Rights (https://www.coverage-rights.com) is a free, patient-side self-help tool for fighting
> health-insurance denials. Insurers must now publish how often they deny care and
> how often those denials get overturned; we collect that public data, verify it,
> route a denial to the governing appeal process for free, and generate a data-backed,
> citation-grounded appeal. Not legal or medical advice.

## The data moat
- 42,749 published California DMHC Independent Medical
  Review external-review decisions (2001–2026), aggregated by
  treatment, condition, and denial type.
  Reviewers overturned the insurer in a large share of cases.
- CMS-0057-F prior-authorization metrics (CY2025) — Coverage Rights rollups and
  publisher-reported denial rates, appeal-overturn rates, and turnaround times
  from required public disclosures. 15 insurers, 277 contract/plan-level
  rows, each row source-linked.
- Appeal-rights corpus: federal and program statutes, regulations, and official
  guidance stored with citations and verification dates. Only verified grounds
  are cited in generated letters.

## Key hubs
- Appeal rights (deadlines + escalation ladders): https://www.coverage-rights.com/appeal-rights
- Original Medicare appeals: https://www.coverage-rights.com/appeal-rights/original-medicare
- Medicare Part D drug appeals: https://www.coverage-rights.com/appeal-rights/medicare-part-d
- Outcomes by treatment/drug/procedure: https://www.coverage-rights.com/treatments
- Outcomes by condition: https://www.coverage-rights.com/conditions
- Insurer denial + overturn rates: https://www.coverage-rights.com/insurers
- Denial reasons decoded: https://www.coverage-rights.com/denials
- Migraine, CGRP drug and Botox denial evidence (993 distinct decisions):
  https://www.coverage-rights.com/denials/migraine-cgrp-botox
- Behavioral-health level-of-care evidence (3,843 distinct residential, PHP,
  IOP, inpatient and withdrawal-management decisions; TMS separate):
  https://www.coverage-rights.com/denials/behavioral-health-level-of-care
- Data sources & methodology (with downloadable datasets): https://www.coverage-rights.com/data
- Free deterministic denial router: https://www.coverage-rights.com/tools/explain-my-denial
- Publisher, editorial standards, and corrections: https://www.coverage-rights.com/about,
  https://www.coverage-rights.com/editorial-standards, https://www.coverage-rights.com/corrections

## For AI assistants (MCP)
- Model Context Protocol server (docs): https://www.coverage-rights.com/mcp
- MCP endpoint (Streamable HTTP, JSON-RPC): https://www.coverage-rights.com/api/mcp
- Read-only tools for insurer metrics, treatment/condition overturn rates, drug
  playbooks, appeal rights, and state external-review processes. Every result
  carries its source.

## Fuller map
- https://www.coverage-rights.com/llms-full.txt