How an RTP Company is Harnessing AI to Combat Health Insurance Denials and Enhance Your Coverage

At Research Triangle Park (RTP), innovations in artificial intelligence (AI) are making waves. These advances aim to help people navigate challenges in healthcare. In fact, almost one in five insured Americans has faced the frustration of having a claim denied. A new app, developed at RTP, seeks to simplify the process of challenging these denials.

Neal Shah experienced this struggle firsthand when his wife battled cancer. “Chemotherapy wasn’t working, and she was in a tough spot,” he recalled. While she fought for her health, Shah found himself grappling with their insurance company, which repeatedly denied vital claims. “Imagine arguing on the phone for hours when someone you love is critically ill. It’s incredibly stressful,” he said. Thankfully, his wife is in remission today, but the emotional toll of that experience stuck with him.

Shah learned that many others in similar situations don’t realize they can contest claim denials. “If you send a solid appeal, many times, decisions get reversed quickly,” he explained. However, understanding the intricacies of medical jargon can be daunting, especially when AI enables insurance companies to reject claims almost instantly. “Before, there was often a reason for the denial and a healthcare professional would review it. Now, AI can deny claims in seconds,” Shah noted.

To turn the tide, Shah joined forces with Riyaa Jadhav, who previously worked with patients at Johns Hopkins University. Together, they launched Counterforce, an AI-driven app designed to assist users in fighting claims. Jadhav emphasized the importance of listening to patients. “My instinct is to support them and strategize the next steps,” she shared.

Counterforce claims a 70% success rate in helping users challenge denials—though some cases remain tough. For instance, they encountered a patient denied coverage for an $18,000-per-month cancer drug, despite strong medical backing. “It was heartbreaking,” Jadhav said. The app allows users to upload their insurance documents and denial letters, combining them for a medically-informed appeal that can be printed and submitted.

So far, thousands have taken advantage of Counterforce, including outreach to rural North Carolina areas where internet access is limited. The goal is clear: harness AI to tackle real human problems within a flawed system.

As Shah expressed, “Sometimes, if enough people raise their voices, society begins to notice. I feel like we’re on the brink of change.” Counterforce is available for free online, promising quick responses that can help users regain access to necessary treatments.

In today’s world, where healthcare and insurance systems can feel overwhelming, tools like Counterforce offer hope and empowerment. By making the appeal process more accessible, they aim to bridge gaps that many have faced for years.



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