com.coverage-rights/coverage-rights

Deterministically resolve the governing appeal route, missing facts, filing recipient, deadlines, current external-review status, and verified grounds. Distinguishes Original Medicare, Medicare Advantage medical benefits, Part D pharmacy benefits, employer funding/governance, ACA, Medicaid, FEHB, TRICARE, and unknown coverage; unsupported or ambiguous routes fail closed.

External-review outcomes for a medical condition: how often insurance denials involving this condition were overturned, plus the most-fought treatments for it.

Curated medication background, common denial patterns, preparation considerations, and available historical California review outcomes for covered GLP-1 and IBD drugs. Accepts a brand or generic name. Confirm current labeling, the actual benefit channel and plan criteria; the guide does not establish current coverage, an exception entitlement, an individual outcome, or an applicable deadline.

Get an insurer's verified CY2025 prior-authorization metrics (denial rate, appeal overturn rate, decision times) from its own CMS-0057-F disclosure, plus contract/plan-level rows where collected. Includes source URLs and scope notes.

How a state's external review process works: filing deadline, regulator contact, and key facts. Verified detail currently covers 10 states (CA, TX, FL, NY, PA, IL, OH, GA, NC, MI); other states return the covered list.

External-review outcomes for a treatment: how often insurer denials of this treatment/drug/procedure were overturned by independent reviewers (42,749 published CA IMR decisions, 2001–2026). Accepts a category slug (e.g. 'pharmacy') or specific treatment slug (e.g. 'zepbound', 'speech-therapy').

List tracked U.S. health insurers with whether verified CMS-0057-F prior-authorization metrics are available for each.

Prepare a free, category-level evidence checklist for a knee osteoarthritis hyaluronic-acid injection denial using routing facts, injection-series status, and record availability categories. Reuses the existing knee denial preparation kit. Does not inspect records or verify an insurer's specific criteria, provide clinical recommendations, draft an appeal, calculate deadlines, or estimate success. Send only the schema's bounded categories; never send names, identifiers, record text, or uploaded documents. Missing routing facts and unsupported routes remain explicit holds.

Insurer prior-authorization denial rates (CY2025), ranked only within compatible reporting cohorts. Each row includes its cohort, rank within that cohort, exact source scope, calculation method, and source link. Never compare ranks across cohorts.

Search treatments (categories + specific drugs/procedures) and conditions by the names used in the published data. The query must appear in a name as a whole word or phrase (e.g. 'wegovy', 'back pain', 'ct scan'); generic names, abbreviations and drug classes are not translated, so search the brand or the specific treatment. Returns slugs for get_treatment_outcomes / get_condition_outcomes plus headline overturn rates.