For several years, Neal Shah served as a caregiver for his wife and grandfather as they lived with serious illnesses. Driven by his experience navigating the complexities of the healthcare industry, Shah ultimately set out to use technology to find ways to improve patient and caregiver experiences. His latest venture is Counterforce Health, a startup utilizing AI to help users easily appeal insurance claim denials.
Traditionally, an appeal letter for an insurance claim can take hours to write. Using Counterforce Health, patients, caregivers and clinicians alike can use AI to draft appeal letters for those denied claims. And they can do it for free.
On Counterforce Health’s website, users can upload their insurance claim denial letter, insurance coverage policy, and any supporting documents—such as letters from primary care providers—and the AI will instantaneously draft a letter of appeal that users can download and send to their insurance company.
The total addressable market of denied insurance claims is an estimated $1 trillion, with over 850 million denials being issued each year. However, only 1% of denied claims are ever appealed, largely due to the stress surrounding the current appeal process, Shah said.
Out of the denied claims that are appealed, 40% of them are approved. When denied claims are appealed using Counterforce Health’s tools and letters of appeal, however, the approval rate jumps to over 50%.
Although some other companies are experimenting with AI in the healthcare insurance space, Counterforce Health sets itself apart by targeting its AI solutions towards patients and small clinics, rather than large hospitals.
Monetizing free-to-use tools
Prior to co-founding Counterforce Health, Shah co-founded CareYaya with Gavry Eshet, and currently serves as the startup’s CEO. CareYaya is an online platform that connects older adults with vetted premed college students who provide affordable caregiving services. Building CareYaya—which has received funding from the National Institutes of Health and was named one of LinkedIn’s top 50 startups of 2024—gave Shah the confidence that he could build a successful startup without charging users.
“It has validated that you can build a sustainable and scalable and valuable business, even if you are making massive social impact and not charging fees, because there are other elegant ways to monetize,” Shah said.
Although Counterforce Health’s tools are currently free for both individuals and clinics to use, the startup plans to monetize its software by charging clinics a monthly subscription fee to use the tools. The subscription model would charge clinics a monthly fee per physician at their practice based on the total amount of revenue they are able to regain through Counterforce Health.
Clinics currently using Counterforce Health’s AI-generated letters of appeals often generate tens of letters every day. With the startup’s tools, clinics can improve their revenue cycle management by recapturing thousands of dollars monthly that the clinics may not recuperate if insurance does not cover the costs.
Shah also plans to continue to seek funding for Counterforce Health through grants. The startup was recently awarded 1st place and $5,000 at The Launch Place’s IdeaFest pitch competition. (Shah will also be pitching the startup at Grep-a-Palooza for a chance at another $5,000 grand prize.)
Expanding tools and access
Counterforce Health is actively working to expand its range of AI-powered tools. Its latest is Maxwell, an AI insurance agent that can call users’ insurance companies on their behalf, and which is currently available in beta.
“Our goal is that your AI agent does the fighting for you, where it knows all your information and in real time has access to the internet, so it can pull all of these citations,” Shah said. “While you’re arguing with the insurance rep, you can navigate the stuff they’re asking for and what they’re saying and make a much more compelling case to get your claim paid.”
QUICK BITS
Startup: Counterforce Health
Co-Founders: Neal Shah, Gavry Eshet, Saraswati Sridhar
Founded: 2025
Team size: 5
Location: Durham
Website: www.counterforcehealth.org
As Counterforce Health works to expand their range of tools, they are also expanding their user base. The startup is currently in discussion with national health organizations and regional hospitals to implement and promote their tools for both patients and physicians.
“I just want this to solve the problem, and I want people to realize they have rights,” Shah said.
Patients, caregivers, and other interested parties can “join the movement” at the startup’s website.
