AI-Powered Platform Helps Patients Appeal Health‑Insurance Denials
Key Points
- Counterforce Health provides a free AI‑generated appeal letter for denied health‑insurance claims.
- Founder Neal Shah created the platform after experiencing insurance denials during his wife's cancer treatment.
- The AI analyzes denial letters, insurance policies, and medical literature to produce customized drafts.
- Insurers increasingly use AI to deny claims quickly, leaving patients with limited recourse.
- Thousands of users have successfully used the tool to overturn denials, saving extensive time and effort.
- The service is funded by grants and venture partners, keeping it free for individual users.
- Healthcare experts note the platform helps level the playing field for patients lacking advocacy resources.
Counterforce Health, founded by Neal Shah, offers a free AI‑driven service that creates customized appeal letters for denied health‑insurance claims. The platform analyzes denial letters, insurance policies and medical literature to produce evidence‑based drafts that patients can edit and submit. It aims to level the playing field as insurers increasingly rely on AI to reject claims quickly. By providing a cost‑free tool, Counterforce seeks to empower individuals who might otherwise lack the resources to fight complex denials, addressing a growing frustration in the U.S. healthcare system.
Background and Founder
Neal Shah, who previously launched CareYaya to connect health‑care students with families needing caregiving, observed the widespread difficulty patients face when insurance claims are denied. His experience with his wife’s cancer treatment highlighted how overwhelming denial notices can be. Seeking a solution, Shah created Counterforce Health, a free platform that generates tailored appeal letters for denied claims.
The Rise of AI in Insurance Denials
Insurers have turned to AI tools that scan medical records, apply coverage rules and issue denial letters in seconds. Investigations have shown that such algorithms can deny tens of thousands of claims without human physician review. This rapid, automated denial process leaves patients with limited time and expertise to contest decisions.
How Counterforce Health Works
The service lets users upload a denial letter and relevant medical records. The AI analyzes the insurer’s rationale, cross‑references policy language, and draws on successful appeal examples and medical literature to draft a customized response. Users can edit the generated letter before submitting it to their insurer. The platform is offered at no cost, funded by grants and venture investments, keeping the per‑user expense to pennies.
Impact and Reception
Thousands of patients have used Counterforce to overturn denials, saving hours of research and drafting work. By providing a free, evidence‑driven tool, the platform addresses the disparity where only a small fraction of denied claims are appealed—fewer than 1%—and where about 40% of those appeals succeed. Healthcare professionals, such as Dr. David Casarett of Duke, have highlighted the tool’s potential to help patients who lack the resources to fight complex denials.
Future Outlook
Shah envisions Counterforce becoming a trusted, objective arbiter that insurers recognize as valid. The platform’s continued free access aims to keep appeal assistance affordable for low‑ and middle‑income Americans, counterbalancing the growing use of AI by insurers to reduce costs.