The Daily Populous Friday August 1st, 2025 evening edition
Authored by abc11.com and submitted by isolated_monk1

RTP-based company using AI to fight health insurance denials

At Research Triangle Park, companies are leading the way with artificial intelligence and trying to harness their powers for the greater good.

RALEIGH, N.C. (WTVD) -- At Research Triangle Park (RTP), companies are leading the way with artificial intelligence and trying to harness their powers for the greater good.

Nearly 1 in 5 Americans with health insurance have had a healthcare claim denied, and a new app developed at RTP is hoping to make it easier for people to challenge it.

It still hurts thinking about the darkest time in Neal Shah's life, as his wife was battling cancer.

"Chemotherapy wasn't working, she'd lost all her hair, it was really touch and go on what's going to happen," he said.

At the same time, his wife was fighting cancer, Shah was fighting their insurance company, which was denying claims even when she needed help in the ICU.

"I remember specific times when somebody's extremely ill and worried about dying, that you are spending 4 or 5 hours arguing on the phone with the insurance company," he said. "The amount of stress it adds to your life right when somebody's already sick, I literally think it's killing people."

Thankfully, Shah's wife has been in remission for years, but he never forgot what happened.

"When I was going through that with my wife's care, I just thought it was just us, I thought maybe we just had bad luck," Shah said.

He said many in the same situation don't realize they can challenge claim denials or know how to go about that process.

"If you write a robust appeal and then send it immediately, you will get a notice and the decision reversed pretty quickly," Shah said.

But that requires a lot of medical knowledge, and now with AI, insurance companies can stop your claim in seconds.

"Before you used to have a reason you would deny it, and you used to have a doctor review or a nurse review it, but once AI rolled out, they could just have AI deny it," he explained.

It's why Shah decided to use the same AI technology to turn the tables. He brought in Riyaa Jadhav, who worked with patients at Johns Hopkins in Baltimore, to the Triangle to help fight back.

"I think my first instinct is to just listen to them and then hop on to what can we do next," Jadhav said.

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She's now the co-founder of Counterforce Health. Their AI app helps people fight their claims.

They say they have a 70% success rate, but some cases are harder, including a patient denied an $18,000 a month cancer drug.

"It was really heartbreaking because they had so much evidence backing their case, they have a lot of doctors telling them that this is the only drug that can help you, still the insurance company keeps denying it," Jadhav said.

Jadhav showed ABC11 how it works. The app lets you upload your long insurance coverage document along with your denial letter and combines them to create a medically-based analysis that you can print and send.

So far, thousands have logged on, and the company has even taken it on the road to parts of rural North Carolina with limited internet access.

Hoping an AI solution can solve a human problem and a broken system.

"Sometimes when enough people get loud, enough people put pressure, then I think all of a sudden society wakes up, so I really feel like it's really about to click," Shah said.

Counterforce is free for anyone to use online. They said typically their responses can get those responses from insurance companies within a few days.

zenjabba on August 1st, 2025 at 12:21 UTC »

https://www.counterforcehealth.org maybe it was my foggy brain but took me a while to find the link so posting it here

IAmInTheBasement on August 1st, 2025 at 12:15 UTC »

And you know the insurance companies are going to use AI to write denial letters.

clovisx on August 1st, 2025 at 11:51 UTC »

It’s sad that we’re in this position but nice to see someone turning the tables. I hope their product continues to help people and remains effective.