Free AI tool that helps patients battle insurance claim denials got its start in Wilmington

WILMINGTON, N.C. (WECT) - It can be one of the most frustrating parts of healthcare: when insurance denies coverage.

However, a new AI tool aims to help patients battle back in a matter of minutes.

The program is called Counterforce Health. Developed in the Research Triangle, the tool was beta-tested at Wilmington Health Rheumatology Clinic.

Cofounder and chairman Neal Shah said he wanted to test it at this clinic because insurance claim denials are more common in Wilmington than they are in bigger cities like Charlotte or Raleigh. This is because the population of Wilmington is older on average and because smaller areas in general typically see more denials, with less hospital and clinic staff to walk patients through the process of appealing them.

“The denial problem is everywhere,” Shah said. “I kind of wanted people to feel ‘you are not powerless when this happens to you.’”

Tabitha Long, a paramedic with Wilmington Health Rheumatology, says 90% of her time spent at work is dealing with her patients’ insurance. She sees about 30 denials a week.

“I can’t tell you how many times I’ve had someone crying on the phone or just upset because they’re in pain, they can’t get relief,” Long said. “It’s very frustrating knowing that you have to jump through so many hoops to get someone a medication that is quite literally life altering for them.”

Long began using Counterforce Health to appeal denials in February and said it’s been a gamechanger for her patients.

“You can process 15-20 denials in a matter of a couple hours where it used to take days to get through all of them,” Long said. “What used to be a one page appeal letter is now two to three pages.”

On the Counterforce website, patients or providers can upload the denial letter and any relevant health history documents. From there, the tool writes an appeal letter in just two minutes.

Shah said he was inspired to create the program after dealing with denials over and over again during his wife’s three-year cancer journey.

“They created a tremendous amount of stress and headache at a time when you should be focused on fighting the disease,” Shah said.

He began researching how insurance companies deny coverage and says he made a shocking discovery: many companies were using AI.

“AI is a new technology and the health insurance companies a few years ago weaponized the technology against patients and families and against clinics,” Shah said. “There’s not even a human glancing at the thing. It’s just straight up AI denying coverage.”

He referenced investigations that revealed how Medicare Advantage plans used an algorithm to deny claims, systematically calculating who was less likely to fight back, and how Cigna Healthcare refused 300,000 pre-approved claims, allegedly denying claims in less than 2 seconds on average. He detailed what he learned in a new book he wrote called “Insured to Death.”

“It’s like we’re already in war, but one side does not have any tools,” Shah said. “Even the whole name Counterforce Health is like we will build tools to arm the resistance because people need AI to fight back.”

He also learned 99% of denials never get appealed, but the 1% of denials that are appealed have a 50% success rate.

“Even if you write like a low quality letter, you’re winning a lot,” Shah said.

Shah began developing the tool in late 2024, believing that many people were just intimidated by the process of appealing and an AI tool would help simplify that process and save them time.

He says letters created by his program are having a 70% success rate so far.

Long said she’s noticed the difference also.

“In some cases, we’re getting approval the same day after we’re sending in the letters,” Long said.

The tool is also completely free to use. Shah said Counterforce is fully funded by grants, and it’s his goal to keep the service free for as long as possible.

“We can just serve a ton of people for free because each instance of using it is costing pennies,” Shah said. “Whether it’s a legal contract or a moral contract, if you’re insuring something and then when the person gets sick and you don’t pay, I feel like you’ve violated something. So, I feel like if you’re doing a social impact organization to fix that thing, you should not be charging these people.”