When insurers started using AI to scan medical records and generate denial letters in bulk, patients suddenly faced automated roadblocks that left them drowning in paperwork. A North‑Carolina startup, Counterforce Health, flipped the script by building its own AI that reads denial letters, pulls relevant policy details, and drafts evidence‑backed appeal letters in minutes. The system doesn’t just spit out boilerplate; it matches the insurer’s rationale with clinical research and past successful appeals, giving patients a tailored, hard‑to‑dismiss argument .
The platform lets anyone—patient or clinic—upload a denial notice and supporting records. Within seconds, the AI parses the insurer’s rules, cross‑references medical literature, and produces a fully editable appeal ready for submission. Because the tool is free, funded by grants and venture partners, it removes the cost barrier that once made appeals a luxury only the wealthy could afford. Users report saving hundreds of hours of research and paperwork, and the success rate for overturned denials has climbed dramatically .
Behind the scenes, the AI follows a rigorous process: it extracts key data with OCR, identifies denial reasons, retrieves payer policies and clinical guidelines, then structures a letter that cites specific evidence and meets each insurer’s submission requirements. This automation not only speeds up the appeal but also ensures compliance with filing deadlines and reduces the “hallucination” risk by grounding every claim in verifiable sources .
Early results show thousands of patients have already used the service to win back coverage for critical treatments. By democratizing access to expert‑level appeal drafting, AI is turning a once‑intimidating bureaucratic battle into a one‑click fight, forcing insurers to rethink their automated denial pipelines and giving patients a fairer chance at the care they need .
