On behalf of Neil Shah, the breaking point came during his wife’s cancer treatment.
He recalled that he was supposed to be overwhelmed, surrounded by hospital bills, refusal notifications and insurance statements. When he and his wife had made everything long-from the expense of the Masik Premium and the cost of the pocket to exposed treatment-they realized that for years, it was better to pay from the pocket perfectly than carrying health insurance.
At first, Shah unfortunately removed all bills and denial.
“Then, I went down into a rabbit hole in the research, trying to determine what’s going on with health insurance?” He told CNET. “Why so many of the claims of claims? How many people are it affecting? And then I just became emotional about it.”
That became the seeds of induction and frustration CaravaA North Carolina -based company Shah launched the college students entering the healthcare field with families in need of affordable care. However, as the Keraiya grows, Shah begins to face all familiar conditions of patients, careful and students who are completely overwhelmed by the denying the health insurance claim.
Shah said, “I realized that I was not alone and the people used in Kerala were not alone,” said Shah. “Millions of Americans are working with this problem. People are drowning in demanding.”
Last year Shah introduced another start, HealthWhich provides a free platform that produces customized insurance appeals letters within minutes.
The counterforce platform allows patients or clinics to upload the denying characters and relevant medical records. The system analyzes insurance principles, reviews treatment literature and draws from a successful appeal to create a draft response. Users can edit before submitting the letter, but the AI equipment lifts heavy health care policies and clinical arguments and structured a heavy application.
Disappointment comes to an important moment with the agency’s arrival as to debate nationwide climbing and ramp up to use moral AI. Health insurers are rising towards AI to review the demands, resulting in further rejection and disappointment for patients seeking assistance. The counterforce script is trying to flip, not to block the coverage using AI but to help patients win it again.
Basically, AI is fighting AI.
Don’t miss our neutral technical content and lab-based reviews. Add CNET As the desired Google source in Chrome.
Denial on the rise of nationwide
Health insurance denies have become a defined feature of the American Healthcare system. Patients provide growing premiums, discounts and copies, only insurers often refuse to cover the treatment that their physicians recommend to find it.
The numbers tell their own tragic stories.
According to KFF data, 20% of all claims Affordable Care Law Market plans were denied in 2023. ACA plans are covered more than this 20 million Americans At the beginning of 2025. Audits have shown that insurers delay or delay millions of requests for care every year in Medicare Advantage, which cover more than 30 million Americans.
Yet the appeal is rare. Less than 1% ACA plan denial is challenged.
Shah said, “Heaters do not apply to patients or family care.” “The miniature fraction that does, 40% won. It tells you that most people have scared, their rights do not know their rights or just denying the final. And it also shows how much of these disobedients are.”
In recent years, AI has enhanced this imbalance. The chief insurers have turned into AI equipment that scan medical records, apply coverage rules and produce a lot of denial letters. Investigations have made some algorithms near-underestimated disobedience even after the treatment provider offers care.
In 2022, Investigate a prophetic It has been published that Signa used an AI-powered algorithm to deny more than 30,000 claims in just two months, often a human physician never reviews files.
Next year, A class-action suit United Heloth has been accused of deploying its AI equipment, known as NH forecasts, to premature care for veteran Medicare patients regardless of their physicians’ recommendations. The case was filed a year before the assassination of the then UNIGH CEO Brian Thompson in 2021, which the insurance giants rejected the cost of controlling the national investigation.
Critics like Shah say that these systems reduce patient data points, giving priority to the cost rather than ethics.
“An appeal may take eight hours in excavation through billing codes, medical journals and quotes,” said Shah. “For the average Americans, it’s like a full -time job at the top of the things they’re working with” ”
When dealing with the health care system, patients are often to enter a nausea loop: Claims are filed, claims are denied by machine, appeal processes are buried and in the end, life-changing care is delayed or completely abandoned.
The script turned upside down
Against this background of increasing rejection and AI-atomated gatekeeping, Counterforce Health is identifying itself as a replica, the AI deployed to deny the claim is about to lick with large health insurance companies. Instead of sinking or quit in patients with papers, the counterforce platform gives them weapons with the equipment to push the back quickly and effectively.
Shah said, “Now, the insurers are using the AI to deny the claim within a few seconds, while patients and physicians spend several hours in the back fight,” Shah said. “This is not fairly fighting. Our goal is to flip the script and make it easy to appeal just like one click.”
When a disobedience letter is uploaded, the Counterforce system does not just produce boilerplate text; It analyzes the insurer’s argument and draws clinical research and other appeals that have succeeded in the same situation. The goal is to create a suitable, proof-driven appeal that is tough to dismiss the insurers, as well as to save patients and their families for several hours of research and appeal letters to draft.
Many patients do not have time, energy or resources to fight appeal. As Dr. David CassarateDuke’s Medicine Professor and Duke Health’s Playive Care Department Chief, CNET said that some patients launched “Boxing Gloves” entered the ring, “but many only give up on the debt or quit their treatment.
Casaret’s mother fought multiple melloma, a cancer of blood plasma cells and still faces insurance denial for the necessary drugs. Since she and her husband had an advanced scientific background and had a medical degree, they caution tracked the appeals and won often.
“Our petitions were successful,” he said. “But what will everyone else happen? With two jobs and a high school education, a single mother prayed against the insurance industry of a million dollars?”
The company has also extended out of its pilot program at the Rheumatology Clinic in North Carolina, offering free access to patients and caring to clinics and hospitals in the United States. Shah said that thousands of patients have used counterforce equipment to reversed the denying treatment, which otherwise be out of reach.
Shah’s long-term view is for equipment to be a loyal, purposeful arbitrator-where patients and insurers recognize their application as valid, reliable and proof-based.
To reduce the expenditure barrier with AI
Why was asked why AI was chosen as a Go-Tool, the cost was a big warning. A. may use the counterforce because of the investment of several grants and initiative partners in the initiative Grants of $ 2.47 million from PennetchThe research center at the University of Pennsylvania is developing AI and technology to support aging and independence.
Shah said that keeping this tool is accessible was a priority to give more people the opportunity to apply. Patient Advocates have options for disobedience and appeal formation, but they can be expensive, depending on the set rate of the advocate, from $ 80 to $ 150 per hour.
According to a 2025 report From the KFF, the average pocket cost for healthcare services reached $ 1,425 per person per year by 2022.
Adding an additional $ 300 to $ 1000 to give help to write the application is probably not possible for many lower-income or middle-class Americans.
Shah said, “Now, applying is truly for the rich, or I will even say very rich,” Shah said. “To solve this problem, [we had] This is to find any way to do it for free or dirt cheap because people do not have $ 300 to spend on the patient’s advocate when they do not carry their critically required Medicine. We thought that AI would be in perfect use because the ongoing cost of the user is literally penny. ”
At present, Shah said that the counterforce wants to be free for people.
How to start with Counterforce Health
You should always consider privacy before starting a service that collects sensitive health information. Counterforce Health collects personal and health-related data-such as to generate your insurance details, denying letters and treatment background-ups. The company said It does not sell this information, it uses encryption and other protection to protect the protection and only shares data with a trusted service provider or third party under privacy and legal consent requirements.
To start with Counter Force Health, you can View homepageClick “Start Appeals” and you will be requested to fill in a short questionnaire of information, such as preliminary information about why you are visiting the website and your insurance denying. From there, you will provide your refusal letter and insurance details and produce a complete draft, editable application prepared for submission of the system AI.