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Big Insurance Uses AI to Quickly Deny Claims, One Man Fights Back with AI App That Quickly Appeals
Key Excerpts from Article on Website of Good News Network
Posted: August 23rd, 2025
https://www.goodnewsnetwork.org/big-insurance-uses-ai-to-qui...
The idea that American health insurance companies are using AI to analyze and adjudicate claims for approval or denial sounds terrifying, but one North Carolinian is using AI to fight back. When Raleigh resident Neal Shah had a claim denied for his wife’s chemotherapy drugs, he thought it was rare, that he was the only one, that it was just bad luck. Litigating his case on phone calls that lasted for hours changed the husband and father, and he set about creating a sophisticated app that uses artificial intelligence to compare claims denial forms against health insurance contracts, before automatically drafting an appeal letter. “For a doctor to write this, it’s not rocket science, but it still takes hours,” Shah told ABC News 11, adding that a well-written appeal letter, sent in immediately, can sometimes get denials reversed within days or weeks, but most people either don’t know they can appeal, or don’t know on what grounds they can appeal. In fact, according to Shah’s research, 850 million claims denials occur every year, and less than 1% are ever appealed. That’s where Counterforce Health comes in, a startup that’s created a free-to-use app for claims denials. For Counterforce Health, Shah brought onboard Riyaa Jadhav, a Jill of all trades who has helped grow and expand the undertaking. Together, they’ve built Counterforce to the point where it boasts a 70% success rate in appealing claims.
Note: Explore more positive stories like this on technology for good.
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