How does Counterclaim generate an insurance appeal letter?

Counterclaim uses a 5-agent AI pipeline. The Reader extracts claim data from your document. The Researcher identifies applicable state insurance law. The Writer drafts a formal appeal letter. The Adversary identifies weaknesses. The Editor rewrites the letter to eliminate all weaknesses. The final letter is ready to print and mail in minutes.

Is Counterclaim free to use?

Yes - Counterclaim is free during the launch period. Upload your denial letter and receive a complete adversary-tested appeal letter at no cost. No account required.

What types of insurance denials can Counterclaim handle?

Counterclaim handles all major denial types: medical necessity (CO-50), prior authorization (CO-11), experimental treatment (PR-1), fee schedule (CO-45), timely filing (PR-27), not covered (CO-4), step therapy (PR-50), and missing information (CO-16).

What file formats does Counterclaim accept?

Counterclaim accepts PDF files, JPG and PNG photos, and scanned documents of your denial letter or Explanation of Benefits (EOB).

Does Counterclaim provide legal advice?

No. Counterclaim generates appeal letters based on publicly available legal and clinical information but does not constitute legal advice. For complex cases, consult a licensed healthcare attorney or certified patient advocate.

How does the WA IRO process work?

After internal appeal denial, file the IRO request with the insurer. The insurer forwards to a randomly-assigned, OIC-certified IRO. Decision is binding within 15 days standard / 72 hours expedited.

How long do I have to request IRO?

180 days from the final adverse determination.

Where do I file a complaint?

OIC Consumer Advocacy at 1-800-562-6900 or insurance.wa.gov.

Medical Necessity · Washington

Appeal a Medical Necessity Denial in Washington

Washington's IRO external-review process under RCW 48.43.535 is administered by certified IROs and decisions are binding. Patients have 180 days to request external review.

When a Washington insurer denies care as not medically necessary, the appeal should identify the specific UM criterion the insurer applied (carriers must provide on request under WAC 284-43), establish how the patient meets the criterion (or how it conflicts with standard of care), and reference the OIC's certified-IRO process.

After internal appeal exhaustion, the IRO request goes through the insurer to a randomly-assigned, OIC-certified IRO. The IRO decision is binding. Standard timeframe is 15 days from IRO assignment; expedited is 72 hours.

Washington also has notable consumer-protection provisions, including the right to a same-specialty peer reviewer and OIC enforcement authority over chronic UM violators.

Statutes and resources cited

RCW 48.43.535 (Independent Review)
WAC 284-43 (Health Carrier Administration)
OIC Consumer Advocacy: 1-800-562-6900

Generate your appeal letter

Upload your denial. Our 5-agent AI pipeline drafts a professional medical necessity appeal under Washington law in about 2 minutes, free.

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Frequently asked questions

Denial code guide

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