For Neal Shah, the breaking point came during his wife’s cancer treatment. 

He remembers being overwhelmed, surrounded by stacks of hospital bills, denial notices and insurance statements. When he and his wife tallied everything — from monthly premiums and out-of-pocket costs to uncovered treatments — they realized the shocking truth that over the years, they might have been better off paying entirely out of pocket than carrying health insurance at all.

At first, shah chalked all of the bills and denials up to bad luck. 

“Then, I went down a rabbit hole of research, of just trying to figure out what is going on with health insurance?” he told CNET. “Why are ther so many denials of claims? How many people is it impacting? And then I just got obsessive about it.”

That obsessiveness and frustration became the seed for CareYaya,a North Carolina-based company Shah launched to connect college students entering the health care field with families in need of affordable caregiving.But even as CareYaya grew, Shah kept encountering the all-too-familiar situation of patients, caregivers and students completely overwhelmed by health insurance claim denials.

“I realized I’m not alone and the people using CareYaya are not alone,” Shah said. “There are millions of Americans dealing with this problem. People are drowning in denial claims.”

Last year, Shah launched another startup, Counterforce Health, which offers a free platform that generates customized insurance appeal letters in minutes. 

Counterforce’s platform allows patients or clinics to upload denial letters and

Counterforce Health Fights back Against AI-Driven Insurance Denials

As health insurers increasingly rely on artificial intelligence to automate claims processing, a troubling trend is emerging: more denials. This shift, while touted for efficiency, frequently enough leaves patients facing frustrating hurdles and, eventually, life-altering care is delayed or abandoned altogether.

Flipping the Script

Against this backdrop of rising denials and AI-automated gatekeeping,Counterforce Health is positioning itself as a counterpunch,going lick for lick with big health insurance companies deploying AI to deny claims. Instead of patients drowning in paperwork or giving up,the Counterforce platform arms them with the tools to push back quickly and effectively.

“Right now, insurers are using AI to deny claims in seconds, while patients and doctors spend hours fighting back,” Shah said. “That’s not a fair fight. Our mission is to flip the script and make appeals as easy as one click.”

When a denial letter is uploaded, Counterforce’s system doesn’t just produce boilerplate text; it analyzes the insurer’s rationale and draws on clinical research and other appeals that have succeeded under similar circumstances.The goal is to create tailored, evidence-driven appeals that are hard for insurers to dismiss, while also saving patients and their families hundreds of hours of research and drafting appeal letters.

Many patients simply don’t have the time, energy or resources to fight appeals. As Dr. David Casarett, a professor of medicine at Duke and section chief of palliative care at Duke Health, told CNET, some patients “step into the ring with boxing gloves on,” but many just give up, go into debt or forgo treatment altogether. Casarett works with CareYaya as a partner physician.

Casarett’s mother battled multiple myeloma, a cancer of the blood’s plasma cells, and faced repeated insurance denials for pricey yet necessary medication.because she and her husband had advanced scientific backgrounds, and a son with a medical degree, they meticulously tracked appeals and often won.

“Our appeals where successful,” he said. “But what about everybody else? What prayer does a single mom with two jobs and a high school education have against a multibillion-dollar insurance industry?”

The association has expanded beyond its pilot program at Wilmington Health’s rheumatology clinic in North Carolina to clinics and hospitals around the US,offering free access to patients and caregivers. Shah said thousands of patients have used Counterforce’s tools to overturn denials for treatments that would otherwise have been out of reach.

Shah’s longer-term vision is for tools like Counterforce to become trusted, objective arbiters — where patients and insurers