AI Tool Helps Patients Appeal Health Insurance Denials

Counterforce Health, founded by Neal Shah, offers a free AI‑driven platform that creates customized insurance appeal letters in minutes. As insurers increasingly rely on AI to reject claims—sometimes denying thousands of requests in weeks—patients face a daunting and time‑consuming appeals process. Counterforce’s system analyzes denial letters, policy language, medical literature, and successful past appeals to produce evidence‑based drafts that users can edit and submit. Backed by grants and venture funding, the tool aims to level the playing field for individuals who cannot afford professional advocates, making the appeals process faster, cheaper, and more accessible.

Rising AI‑Powered Denials in American Health Care

Patients across the United States are encountering a new wave of health‑insurance claim denials driven by artificial‑intelligence algorithms. Major insurers have deployed AI tools that scan medical records, apply coverage rules, and generate denial letters in bulk. Investigations have revealed that Cigna’s AI algorithm denied more than 30,000 claims in just two months in 2022, while UnitedHealth’s AI tool, nH Predict, faced a class‑action lawsuit in 2023 for cutting off care for elderly Medicare patients. These systems can issue denials in seconds, often without a human physician reviewing the files, leaving patients to navigate a complex appeals process that many never attempt.

The Human Cost of Automated Denials

Data from KFF shows that 20% of all claims across Affordable Care Act marketplace plans were denied in 2023, and fewer than 1% of those denials are challenged. Of the tiny fraction that does appeal, only about 40% succeed. The effort required to draft an appeal can take eight hours of research into billing codes, medical journals, and citations—effectively a full‑time job for the average American. As a result, many patients forgo needed treatment, incur debt, or simply accept the denial as final.

Counterforce Health’s AI‑Powered Solution

Neal Shah, who previously founded CareYaya, launched Counterforce Health to flip the script on AI‑driven denials. The free platform lets users upload a denial letter and relevant medical records. Its AI engine then parses the insurer’s rationale, references policy language, and draws on a database of successful appeals and clinical research to generate a tailored draft appeal. Users can edit the letter before submitting it to their insurer. By automating the most labor‑intensive parts of the process, Counterforce reduces the cost per user to literally pennies.

Accessibility and Funding

Counterforce remains free for individuals thanks to grants and venture investment, including a $2.47 million grant from PennAITech. The tool’s low operating cost allows it to serve low‑ and middle‑income patients who cannot afford professional patient advocates, whose rates can range from $80 to $150 per hour. Shah emphasizes that appealing should not be a privilege reserved for the ultra‑rich.

Impact and Reception

Thousands of patients have already used Counterforce’s tools to overturn denials for treatments that would otherwise have been out of reach. Dr. David Casarett of Duke Health, who partners with CareYaya, notes that while some patients “step into the ring with boxing gloves on,” many lack the resources to fight back. Counterforce’s evidence‑based appeals aim to make the insurer’s decision harder to dismiss, offering a more equitable balance between automated denials and human advocacy.

Future Outlook

Shah envisions a future where AI‑generated appeals become trusted arbiters recognized by both patients and insurers. By providing a free, data‑driven alternative to costly advocacy services, Counterforce Health seeks to democratize the appeals process and reduce the systemic inequities amplified by AI‑driven claim denials.