**AI insurance appeal automation** uses artificial intelligence to generate medically-grounded challenges to denied healthcare claims. Counterforce Health, a Research Triangle Park startup founded in 2024, applies this technology to fight insurance denials with a reported 70% success rate.
At Research Triangle Park, companies lead artificial intelligence innovation—but Neal Shah uses AI to fight back against a system he says is "killing people.".
Nearly 1 in 5 Americans with health insurance have had a healthcare claim denied. Shah experienced this firsthand during the darkest period of his life. His wife was battling cancer, chemotherapy wasn't working, and she had lost all her hair. "It was really touch and go on what's going to happen," he recalls.
At the same time, Shah was fighting their insurance company. "I remember specific times when somebody's extremely ill and worried about dying, that you are spending 4 or 5 hours arguing on the phone with the insurance company," he said. "The amount of stress it adds to your life right when somebody's already sick, I literally think it's killing people."
Thankfully, Shah's wife has been in remission for years. But he never forgot what happened. Many in the same situation don't realize they can challenge claim denials or know how to navigate the appeals process. "If you write a robust appeal and then send it immediately, you will get a notice and the decision reversed pretty quickly," Shah explains. But that requires medical knowledge most patients don't have.
Before AI, insurance companies had doctors or nurses review denials. Now, Shah explains, "they could just have AI deny it." It's why he decided to use the same technology to turn the tables.
Shah brought in Riyaa Jadhav, who worked with patients at Johns Hopkins in Baltimore, to the Triangle to help fight back. She's now the co-founder of Counterforce Health. Their AI app helps people fight denied claims by combining their insurance coverage documents with denial letters to create medically-based analysis they can print and send.
The app is free to use online. They report a 70% success rate, though some cases remain heartbreaking. Jadhav describes a patient denied an $18,000 a month cancer drug: "It was really heartbreaking because they had so much evidence backing their case, they have a lot of doctors telling them that this is the only drug that can help you, still the insurance company keeps denying it."
The company has taken its platform on the road to rural North Carolina with limited internet access. Thousands have already logged on, with responses from insurance companies typically arriving within days.
"Sometimes when enough people get loud, enough people put pressure, then I think all of a sudden society wakes up," Shah says. Counterforce Health represents a growing cohort of Triangle startups using AI not just for efficiency, but for advocacy—harnessing technology to solve human problems in a broken system.
