Counterforce Health is an American health-technology startup founded in early 2025 in Durham, North Carolina that develops artificial intelligence software to assist patients and clinics in appealing health-insurance claim denials.[1][2]
| Company type | Private |
|---|---|
| Industry | Health technology |
| Founded | 2025 |
| Founders |
|
| Headquarters | Durham, North Carolina, U.S. |
Area served | United States |
Key people | Neal K. Shah (chairman) |
| Products | AI tools for appealing health-insurance claim denials |
| Website | counterforcehealth |
History
editCounterforce Health was co-founded by Neal K. Shah, Gavry Eshet, Riyaa Jadhav and Maggie Xu in January 2025.[3] The idea for the company arose from Shah’s experience contesting insurance denials during his wife’s cancer treatment,[4] which he described as “killing people” due to the added stress.[5] A beta version of the company’s AI-driven appeal letter service was tested in the same year at Wilmington Health’s rheumatology clinic.[6] According to WECT, the tool reduced the time needed to prepare appeals and achieved a higher success rate than typical manual processes.[6]
In May 2025, Counterforce Health received first place and a US$5,000 award at The Launch Place’s tenth IdeaFest pitch competition.[7] Media coverage reported that within months of launch, thousands of patients and several clinics had used the service.[8] GrepBeat noted that the approval rate for appeals submitted through the platform exceeded industry averages.[9] According to ABC11, the tool has achieved an estimated 70% claim reversal rate and has been deployed in rural North Carolina through a mobile outreach unit.[5] NBC News highlighted accounts from individual users who said the tool led to faster resolutions of denied claims.[1][10]
Business model and approach
editCounterforce Health operates a web-based platform that uses artificial intelligence to help patients and clinics contest denied health-insurance claims.[3][11] The system processes denial letters, insurance policies, and relevant medical records, comparing them with medical literature, policy terms, and appeal regulations to generate a customized appeal letter.[12] Its AI models draw on billing code databases, external review decisions, and legal case filings.[8]
The company also develops “Maxwell,” a voice-controlled agent designed to contact insurers for appeal status updates.[8]
The platform is provided free to patients and caregivers, with operational costs covered by CareYaya’s impact fund through grants and donations.[6] The company has indicated that subscription fees for clinics may be introduced for advanced features.[9]
Media outlets have described the product as part of a broader movement toward using artificial intelligence to reduce administrative barriers in health care, aligning with wider adoption of generative artificial intelligence tools in professional settings.[13][14]
See also
editReferences
edit- ^ a b Morgenson, Gretchen (July 18, 2025). "AI is helping patients fight insurance company denials". NBC News. Retrieved August 8, 2025.
- ^ "Some powerful players are taking on the epidemic of medical claim denials". WFAA. July 26, 2025. Retrieved August 10, 2025.
- ^ a b Gentry, Connie (August 8, 2025). "Triangle startup takes on insurance denials with AI". Triangle Business Journal. Retrieved August 16, 2025.
- ^ "Artificial intelligence helps patients appeal health insurance claim denials". 11Alive. August 9, 2025. Retrieved August 16, 2025.
- ^ a b George, Tom (July 25, 2025). "RTP-based company using AI to fight health insurance denials". ABC 11 WTVD. Retrieved August 8, 2025.
- ^ a b c Tarpley, Delaney (July 24, 2025). "Free AI tool that helps patients battle insurance claim denials got its start in Wilmington". WECT. Retrieved August 8, 2025.
- ^ "The Launch Place holds its 10th IdeaFest competition". The Launch Place. April 3, 2025. Retrieved August 8, 2025.
- ^ a b c Casey, Morgan (April 2, 2025). "Counterforce Health uses AI to fight claim denials". CityView. Retrieved August 8, 2025.
- ^ a b Motley, Taylor (May 20, 2025). "Durham-Based Counterforce Health Uses AI to Appeal Insurance Claim Denials". GrepBeat. Retrieved August 8, 2025.
- ^ "AI helping patients fight insurance company denials". Yahoo News. July 18, 2025. Retrieved August 10, 2025.
- ^ "US health insurers using AI to deny care, lawsuits allege". The Guardian. January 25, 2025. Retrieved August 10, 2025.
- ^ "What Are Appeals and How Do I File One?". Everyday Health. Retrieved August 10, 2025.
- ^ "Taking on America's Health Insurance Bureaucracy with AI". Neurology Live. May 2025. Retrieved August 10, 2025.
- ^ "Big insurance uses AI to quickly deny claims – physician fights back with AI app that quickly appeals". Good News Network. May 2025. Retrieved August 10, 2025.