How Counterforce Health Uses AI to Help Patients Win Insurance Claim Appeals

Durham Startup Counterforce Health Uses AI to Appeal Insurance Claim Denials

Neal Shah, co-founder of Counterforce Health, draws on personal caregiving experience to simplify the insurance claim appeal process using AI technology. After years of managing health insurance claims for his ill family members, Shah saw an opportunity to ease the burden for patients, caregivers, and clinicians facing denied insurance claims.

Counterforce Health offers a free AI tool that drafts appeal letters quickly and accurately. Users upload their denial letters, insurance policies, and supporting documents like physician letters. The AI then generates a ready-to-send appeal letter instantly, saving hours of manual work.

Addressing a Massive Market Gap

Each year, over 850 million insurance claims are denied, representing a $1 trillion market. Yet only about 1% of these denials are appealed, mainly due to the stress and complexity involved. Traditionally, 40% of appealed claims are approved, but with Counterforce Health’s AI-generated appeals, approval rates exceed 50%.

Unlike solutions aimed at large hospitals, Counterforce Health focuses on patients and small clinics, delivering accessible tools that improve appeal success rates and financial recovery.

Monetizing Free Tools Through Clinic Subscriptions

Before Counterforce Health, Shah co-founded CareYaya, a platform connecting seniors with affordable caregiving. This experience showed him that startups can operate sustainably without charging users directly.

Counterforce Health currently offers its appeal letter service for free. The plan is to charge clinics a monthly subscription based on revenue recovered through the AI tools, with fees calculated per physician. Clinics using the service often generate dozens of appeal letters daily, recapturing thousands of dollars monthly that might otherwise be lost.

The startup has also secured funding through grants and recently won $5,000 at The Launch Place’s IdeaFest competition. Shah will pitch again for additional funding soon.

Expanding AI Tools for Insurance Claims

Counterforce Health is developing Maxwell, an AI insurance agent in beta that can interact directly with insurance companies on users’ behalf. This agent accesses real-time information and documentation to handle calls and disputes, aiming to make the appeals process even more effective and less stressful.

Quick Facts

• Startup: Counterforce Health
• Co-Founders: Neal Shah, Gavry Eshet, Saraswati Sridhar
• Founded: 2025
• Team Size: 5
• Location: Durham
• Website: www.counterforcehealth.org

Counterforce Health is in talks with national health organizations and regional hospitals to broaden access to their tools. The goal is to empower patients and healthcare providers with resources to effectively challenge claim denials.

For insurance professionals looking to understand how AI is enhancing claims management and appeals, Counterforce Health offers a practical example of technology improving outcomes for patients and clinics alike.