**The Battle Over Health Insurance Denials: How One Man’s Struggle Sparked an AI Revolution in Patient Advocacy**
Neal Shah’s life changed dramatically when his wife was diagnosed with cancer. Like millions of Americans, they found themselves caught in a bewildering and stressful web of hospital bills, insurance denials, and endless paperwork. Despite dutifully paying for health insurance, they faced mounting costs—not just premiums and copays, but also significant out-of-pocket expenses for treatments their insurer refused to cover. After years of this, Shah and his wife made a shocking calculation: they might have been financially better off paying for her care entirely out of pocket rather than carrying insurance at all.
Initially, Shah assumed their experience was unusual, perhaps just a string of bad luck. But as he started researching the insurance system, he realized their ordeal was anything but unique. “I went down a rabbit hole of research, trying to figure out what is going on with health insurance,” Shah recounted. He became obsessed with understanding why so many claims were denied, how many people were affected, and what could be done.
This obsession became the driving force behind Shah’s entrepreneurial ventures. First, he founded CareYaya, a North Carolina-based company that connects college students in healthcare fields with families seeking affordable caregiving. Through CareYaya, Shah was exposed to countless stories of patients and caregivers struggling to navigate the labyrinth of insurance denials. It became clear to him that his family’s struggle was shared by millions of Americans. “People are drowning in denial claims,” Shah observed.
**A Widespread and Growing Crisis**
The numbers tell a grim story. According to data from the Kaiser Family Foundation (KFF), 20% of all claims submitted to Affordable Care Act (ACA) marketplace plans in 2023 were denied. At the start of 2025, these plans covered more than 20 million Americans. Audits of Medicare Advantage, which insures over 30 million people, have found that millions of care requests are wrongly denied or delayed each year.
Yet, despite these staggering numbers, very few patients challenge denials. Less than 1% of ACA plan denials are appealed. “Ninety-nine percent of patients or family caregivers do not appeal,” Shah said. “Of the tiny fraction who do, 40% win. That tells you most people are intimidated, don’t know their rights, or just assume a denial is final. And it also shows how frivolous so many of these denials are.”
The barriers to appealing are daunting: the process is time-consuming, confusing, and emotionally exhausting. “Writing an appeal letter can take eight hours between digging through billing codes, medical journals, and citations,” Shah explained. For most Americans—already struggling with illness or caregiving—challenging a denial feels like a full-time job.
**Enter AI: Insurers’ Double-Edged Sword**
In recent years, the rise of artificial intelligence (AI) in healthcare has deepened the problem. Major insurers have adopted AI-driven systems that rapidly scan medical records, apply coverage rules, and generate denial letters at scale. According to a 2022 ProPublica investigation, Cigna used an algorithm to deny over 30,000 claims in just two months, often without any physician review.
In 2023, UnitedHealth faced a class-action lawsuit alleging its AI tool, nH Predict, prematurely cut off care for elderly Medicare patients, even in direct contradiction to doctors’ recommendations. The use of such technology has fueled criticism that insurers are treating patients as mere data points, prioritizing cost control over patient well-being and ethical care.
Patients are often forced into an exhausting cycle: claims are filed, swiftly denied by algorithms, and then buried under complex appeals procedures. For many, this means delayed or abandoned care, deepening financial and emotional distress.
**Counterforce Health: AI for the People**
Shah saw an opportunity to turn the tide by harnessing AI for the benefit of patients. In 2023, he launched Counterforce Health, a free platform that uses AI to generate customized insurance appeal letters in just minutes. Patients or clinics can upload denial letters and relevant medical records. The system then analyzes the insurer’s policy, reviews medical literature, and draws on a database of successful appeals to produce a draft response. Users can edit the letter before submitting it, but the AI does the heavy lifting—translating dense healthcare jargon and crafting a