Millions of Americans face a hidden crisis within the healthcare system: rising insurance claim denials. Increasingly, these rejections aren’t due to simple errors, but to sophisticated artificial intelligence (AI) algorithms deployed by insurers to cut costs. Now, a new startup, Counterforce Health, is fighting back – using AI to help patients win their appeals.
The Silent Epidemic of Denials
For Neal Shah, the reality hit when his wife battled cancer. Buried under bills and denials, he discovered a disturbing trend: often, people are better off paying out-of-pocket than dealing with insurance at all. This isn’t an isolated case. Data from KFF shows 20% of Affordable Care Act claims were denied in 2023, while Medicare Advantage plans wrongly deny or delay millions of requests annually. Yet, less than 1% of denials are appealed, largely because patients are intimidated, unaware of their rights, or simply give up.
The problem is getting worse. Insurers are leaning heavily into AI to automate claim reviews, leading to faster denials and increased frustration. Investigations have revealed insurers using AI to deny claims without human oversight, sometimes even against doctors’ recommendations. One lawsuit accused UnitedHealth of deploying an AI tool to prematurely cut off care for elderly patients, a practice that intensified scrutiny after the death of the company’s CEO.
Counterforce: AI vs. AI
Counterforce Health, born from this frustration, offers a free platform that generates customized insurance appeal letters in minutes. Users upload denial letters and medical records, and the AI analyzes policies, reviews research, and drafts a response. The tool doesn’t replace human review, but it drastically reduces the time and effort required to fight back.
The core issue: Writing an effective appeal can take hours of research, a luxury most patients don’t have. Counterforce levels the playing field, providing evidence-driven appeals that insurers find harder to dismiss.
Why This Matters Now
The rise of AI in healthcare is reshaping the power dynamic. Insurers are using algorithms to maximize profits, often at the expense of patient care. Counterforce is a direct response, demonstrating how AI can also be used to empower individuals.
Dr. David Casarett of Duke Health highlights the disparity: some patients have the resources to fight back, but many are left with no choice but to accept denials, go into debt, or forgo treatment altogether. Counterforce aims to bridge that gap, making appeals accessible to everyone.
Funding and Future Outlook
Counterforce remains free thanks to grants and venture funding, including a $2.47 million grant from PennAITech. This commitment to accessibility is crucial, as traditional patient advocacy services can cost hundreds of dollars per hour – a barrier for many low-income families.
Shah’s long-term vision is to establish Counterforce as a trusted, objective arbiter, where AI-generated appeals are recognized as valid and reliable by insurers. The company’s expansion beyond its pilot program suggests growing demand for this service.
In a system where AI increasingly dictates access to care, Counterforce Health represents a critical counterforce: a tool that puts the power back in the hands of patients.
