`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; the market filter selects which ISSUERS to include, since CMS publishes these counts per issuer rather than per market. 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	Restrict to issuers participating in a market: “medical” / “QHP”, “dental” / “SADP” for standalone dental, or “SHOP” for small-group. Selects issuers; it does not split an issuer’s claim counts, which CMS reports per issuer. 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