Company:Counterforce Health

From HandWiki
Counterforce Health
TypePrivate
IndustryHealth technology
Founded2025
Headquarters
Durham, North Carolina
,
United States
ProductsAI tools for appealing health-insurance claim denials
Websitewww.counterforcehealth.org

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]

History

Counterforce 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.[10]

Business model and approach

Counterforce 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

References

  1. ↑ "Some powerful players are taking on the epidemic of medical claim denials". WFAA. July 26, 2025. https://www.wfaa.com/article/money/business/right-on-the-money/some-powerful-players-taking-on-epidemic-medical-claim-denials/287-c97dd6c5-8559-47f1-8d25-a37d50b546c2. 
  2. ↑ Eanes, Zachery (2025-08-20). "RTP startup uses AI to fight health insurance denials" (in en). https://www.axios.com/local/raleigh/2025/08/20/using-ai-to-fight-back-against-insurance-denials-counteforce. 
  3. ↑ 3.0 3.1 Gentry, Connie (August 8, 2025). "Triangle startup takes on insurance denials with AI". Triangle Business Journal. https://www.bizjournals.com/triangle/news/2025/08/08/counterforce-health-ai-health-insurance-claims.html. 
  4. ↑ "Artificial intelligence helps patients appeal health insurance claim denials". 11Alive. August 9, 2025. https://www.11alive.com/article/news/health/artificial-intelligence-helps-patients-appeal-health-insurance-claim-denials/85-45e2959e-008d-4535-aa4c-6a62db58f71d. 
  5. ↑ 5.0 5.1 George, Tom (July 25, 2025). "RTP-based company using AI to fight health insurance denials". ABC 11 WTVD. https://abc11.com/post/rtp-based-company-using-ai-fight-health-insurance-denials/17283588/. 
  6. ↑ 6.0 6.1 6.2 Tarpley, Delaney (July 24, 2025). "Free AI tool that helps patients battle insurance claim denials got its start in Wilmington". WECT. https://www.wect.com/2025/07/25/ai-tool-that-helps-patients-battle-insurance-claim-denials-got-its-start-wilmingon/. 
  7. ↑ "The Launch Place holds its 10th IdeaFest competition". The Launch Place. April 3, 2025. https://www.thelaunchplace.org/news/details/id/254/the-launch-place-holds-its-10th-ideafest. 
  8. ↑ 8.0 8.1 8.2 Casey, Morgan (April 2, 2025). "Counterforce Health uses AI to fight claim denials". CityView. https://www.cityviewnc.com/stories/counterforce-health-an-nc-based-company-uses-ai-to-fight-health-insurance-denials/. 
  9. ↑ 9.0 9.1 Motley, Taylor (May 20, 2025). "Durham-Based Counterforce Health Uses AI to Appeal Insurance Claim Denials". GrepBeat. https://grepbeat.com/2025/05/20/durham-based-counterforce-health-uses-ai-to-appeal-insurance-claim-denials/. 
  10. ↑ Morgenson, Gretchen (July 18, 2025). "AI is helping patients fight insurance company denials". NBC News. https://www.nbcnews.com/news/us-news/ai-helping-patients-fight-insurance-company-denials-wild-rcna219008. 
  11. ↑ "US health insurers using AI to deny care, lawsuits allege". The Guardian. January 25, 2025. https://www.theguardian.com/us-news/2025/jan/25/health-insurers-ai. 
  12. ↑ "What Are Appeals and How Do I File One?". https://www.everydayhealth.com/general-health/what-are-appeals-and-how-do-i-file-one/. 
  13. ↑ "Taking on America's Health Insurance Bureaucracy with AI". Neurology Live. May 2025. https://www.neurologylive.com/view/taking-america-health-insurance-bureaucracy-with-ai. 
  14. ↑ "Big insurance uses AI to quickly deny claims – physician fights back with AI app that quickly appeals". Good News Network. May 2025. https://www.goodnewsnetwork.org/big-insurance-uses-ai-to-quickly-deny-claims-physican-fights-back-with-ai-app-that-quickly-appeals/. 



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