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 long should a California prior-authorization decision take?

Standard: 5 business days from receipt of the request and supporting information. Urgent: 72 hours. If the plan misses the deadline, you may have a deemed-approved argument under section 1367.01.

Can I take a California prior-auth denial straight to IMR?

After the plan's internal grievance is denied (or after 30 days without resolution). IMR is free, decided by independent physician reviewers, and binding on the plan.

Is there a faster route for urgent prior auth?

Yes - urgent grievances must be decided within 72 hours, and urgent IMR within 7 days (3 days for imminent serious threat). Mark the appeal urgent and have your physician confirm.

Prior Authorization · California

Appeal a Prior Authorization Denial in California

California regulates prior authorization aggressively. Knox-Keene plans must respond to standard prior-authorization requests within five business days and to urgent requests within 72 hours. If the denial sits on shaky clinical ground, IMR through the DMHC will overturn it.

California Health & Safety Code section 1367.01 sets the timeframe for prior-authorization decisions. Plans that miss the deadline can be deemed to have approved the request, and the DMHC has issued penalty actions against carriers for chronic prior-authorization delays.

When you appeal a California prior-authorization denial, your letter should cite the section 1367.01 timeframe (and the actual date your provider submitted the request), the plan's own utilization-management policy or clinical-coverage bulletin (which the plan must provide on request under section 1363.5), and the DMHC's IMR right under Health & Safety Code section 1374.30.

If the denial involves emergency or urgent care, the prudent layperson standard at section 1371.4 applies and is a separate, stronger argument than ordinary medical-necessity review.

Statutes and resources cited

California Health & Safety Code section 1367.01 (prior authorization timeframes)
California Health & Safety Code section 1363.5 (disclosure of UM criteria)
California Health & Safety Code section 1374.30 (Independent Medical Review)
DMHC Help Center: HealthHelp.ca.gov / 1-888-466-2219

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Frequently asked questions

Denial code guide

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