The rapid adoption of a new artificial intelligence tool designed to help patients fight health insurance denials is casting a harsh spotlight on the deep-rooted problems plaguing the U.S. health insurance system.
As more Americans turn to technology to challenge denied claims, experts warn that the surge in appeals could further strain an already overburdened and crisis-ridden system.
Counterforce Health, a startup based in North Carolina’s Research Triangle Park, has launched an AI-powered platform that automates the process of appealing insurance denials. The tool allows patients to upload their insurance documents and denial letters, then generates personalized, evidence-based appeal letters that cite both policy language and relevant clinical research. In some cases, the AI can even make calls to insurers on the patient’s behalf .
The popularity of Counterforce’s tool is a direct response to the staggering rate of insurance denials in the U.S. As payment denial rates climb to record highs—driven in part by AI-powered algorithms—health systems and patients are increasingly fighting back .
Over 60% of doctors say unregulated AI tools systematically deny patients coverage for necessary care, according to the American Medical Association . Yet, despite these high numbers, the vast majority of denied claims go uncontested by consumers with the Kaiser Family Foundation reporting that less than 1 percent of denials from policies secured on the ACA Marketplace are challenged.
That low number is perhaps understandable: the appeals process is notoriously complex and time-consuming, often requiring patients to navigate dense policy documents and strict deadlines while already dealing with health challenges.
“It is a little scary, because people honestly don’t really know what they have,” said Karen Pollitz, a senior fellow at the KFF. “If you set up the decision tree with an A: yes, B: no, or C: not sure, you’ll find a lot of people clicking not sure”.
“It’s a huge problem. It usually takes multiple attempts. We have to play this horrible, horrible game, and the patients are in the middle,” said Dr. Christianne Heck, a neurologist at Keck Medicine of USC.
The administrative burden is so great that some practices are built around shielding patients from the process entirely. “People who are sick just cannot deal with insurance companies. This is not possible,” said Dr. Barbara McAneny, former president of the American Medical Association.
By automating appeals, Counterforce and similar AI tools are lowering the barrier for patients to challenge denials, potentially leading to a dramatic increase in the number of appeals filed. This could put significant pressure on insurers, who may be forced to justify more of their decisions and process a higher volume of high-quality, data-driven appeals.
Experts warn that if the adoption of AI tools like Counterforce continues to accelerate, insurers could face administrative overload, legal challenges, and increased regulatory scrutiny. Class-action lawsuits have already alleged that algorithms turn down claims in seconds, and critics say reform is needed for lasting change.
The crisis in health insurance denials and the complexity of appeals are also fueling interest in alternatives such as healthshare programs.
Unlike traditional insurance, healthshare programs are community-based arrangements where members contribute funds to help pay for each other’s medical expenses. These programs, which are not regulated as insurance, often have lower monthly costs but differ from traditional insurance in terms of coverage.
As more patients fight back against denials, the resulting pressure may force insurers and policymakers to confront longstanding issues of transparency, fairness, and access. Meanwhile, the search for alternatives such as healthshare programs offers a different way for Americans to approach their healthcare.