Counterforce Health is an AI-powered patient advocacy platform designed to help individuals, caregivers, and small medical clinics effectively challenge denied health insurance claims. The company was founded in 2025 with the mission to "flip the script" against the rising trend of insurers using AI to deny claims, providing patients with a powerful counter-tool.
The core of the platform is its sophisticated AI system, which automates the laborious and time-consuming appeal process. Users upload their denial letters and relevant medical records, and the system instantly analyzes the case. It draws on a vast database of information, including insurance policies, medical literature, billing code databases, external review decisions, and legal case filings, to identify the strongest appeal arguments.
The AI then generates a fully drafted, customized appeal letter, complete with relevant medical citations, policy analysis, and legal precedents, which is ready for the user to edit and submit. The platform has demonstrated a high level of success, with media reports indicating an estimated 70% claim reversal rate, which exceeds typical industry averages for appeals.
Key Capabilities
- AI-Driven Appeal Letter Generation: Creates professional, evidence-backed appeal letters in minutes, significantly reducing the time and stress for patients and clinic staff.
- Voice AI Agent (Maxwell): A proprietary voice-controlled agent designed to contact insurance companies on the user's behalf to track appeal status updates and negotiate, eliminating the bureaucratic phone-calling nightmare.
- Evidence-Based Case Building: The system automatically compiles relevant clinical studies, real-world evidence, and guideline recommendations to support medical necessity claims.
- HIPAA-Compliant Infrastructure: The platform is built with HIPAA-compliant infrastructure to securely handle sensitive health information, using encryption and other safeguards.
Target Market & Pricing
The platform is currently provided free of charge to patients, caregivers, and medical clinics, with operational costs supported by grants and donations. While the service is free for individuals, the company has indicated that future monetization may involve subscription fees for clinics for advanced features, as the platform is also being leveraged for prior authorization management by MedTech companies. The service has been used by thousands of patients and several clinics nationwide.