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.

Where do I file a Florida insurance complaint?

The Florida Department of Financial Services Division of Consumer Services at 1-877-MY-FL-CFO (1-877-693-5236) or online at myfloridacfo.com is the primary consumer complaint forum. For HMO complaints you can also file with the Agency for Health Care Administration's Statewide Provider and Subscriber Assistance Program under section 408.7056. Both routes are available in parallel and do not conflict with external review.

How does Florida external review work?

After exhausting the insurer's internal appeals, you can request external review by an Independent Review Organization under section 627.6044. The insurer is required to provide the request form with the final adverse determination. The IRO is assigned through the federal external review framework with state oversight. The IRO decision is binding on the insurer. Standard reviews are decided within 45 days; expedited within 72 hours.

What is the Statewide Provider and Subscriber Assistance Program?

A Florida-specific program at AHCA under section 408.7056 that handles HMO grievances and provides an additional consumer protection layer. The SAP convenes a multi-stakeholder panel that reviews grievances and issues recommendations to the agency. It is available in addition to the carrier's internal grievance process and external review.

How long do I have to appeal in Florida?

ACA-regulated plans must give at least 180 days for the internal appeal. After the final adverse determination, you have 4 months (120 days) to request external review under section 627.6044. Your exact deadlines are on the denial notice and member handbook.

Can I file an expedited appeal in Florida?

Yes. Under section 641.511(7) for HMOs and parallel rules for commercial plans, expedited appeals must be decided within 72 hours when delay would jeopardize health. Mark the appeal urgent in writing and have your physician submit a written statement of clinical urgency.

Are surprise out-of-network bills covered in Florida?

Yes. Florida Statutes section 627.64194 limits patient liability for emergency services and out-of-network services at in-network facilities to in-network cost-sharing amounts. Disputes between insurer and provider are resolved through the federal No Surprises Act IDR process or Florida's parallel arbitration. If you receive a balance bill in violation of section 627.64194, file a complaint with DFS.

What is Florida's prudent layperson emergency standard?

Florida Statutes section 641.31 requires HMOs to cover emergency services if a prudent layperson with average knowledge of medicine would have believed an emergency existed. This protects against retroactive denial of ER visits the insurer later determines were non-emergent.

Does Florida cover ABA therapy for autism?

Yes. Senate Bill 1716 of 2023 and existing autism coverage mandates require Florida-regulated plans to cover medically necessary applied behavioral analysis for autism spectrum disorder, subject to age and clinical criteria. Denials based on age caps inconsistent with current statute or based on non-medical criteria are appealable.

Florida Insurance Appeal Letter Generator - Cite Florida Statutes

Florida regulates health insurance through three coordinated agencies: the Office of Insurance Regulation, the Department of Financial Services Division of Consumer Services, and the Agency for Health Care Administration's Subscriber Assistance Program. Upload your Florida denial and our 5-agent AI pipeline drafts an appeal under the correct Florida statute and routes you to the right complaint forum.

Florida insurance regulator

Florida regulates fully insured commercial health plans through OIR; consumer assistance and complaints flow through the Department of Financial Services Division of Consumer Services. AHCA's Subscriber Assistance Program at section 408.7056 provides an additional HMO grievance forum. Florida's external review process is administered through the federal HHS-administered process for self-funded ERISA plans and the state-administered process for fully insured plans under section 627.6044.

Florida Office of Insurance Regulation (OIR)File a FL insurance complaint

External review in Florida

Independent External Review under Florida Statutes section 627.6044 for fully insured plans, using the federal external review framework with state-approved IROs. Self-funded ERISA plans use HHS-administered external review or the plan's contracted IRO. Free to the patient. The IRO decision is binding on the insurer.

Internal appeal timing in Florida

Florida insurers must respond to standard pre-service appeals within 30 days, post-service within 60 days, and expedited within 72 hours. The Subscriber Assistance Program at AHCA provides additional consumer support for HMO members. External review must be requested within 4 months of the final adverse determination.

Statutes Counterclaim cites for Florida appeals

Florida Statutes chapter 627 (Insurance Rates and Contracts)
Florida Statutes chapter 641 (Health Maintenance Organizations)
Florida Statutes section 408.7056 (Statewide Provider and Subscriber Assistance Program)
Florida Statutes section 627.6044 (Independent External Review)
Florida Statutes section 641.511 (HMO grievance procedures)
Florida Statutes section 627.42392 (prior authorization standards)

Generate your Florida appeal letter

Upload your denial. Our 5-agent AI pipeline drafts a professional appeal citing the right Florida statute in about 2 minutes, free.

Upload my denial · Free

Frequently asked questions: Florida appeals

California appeal letter

Texas appeal letter

New York appeal letter

Pennsylvania appeal letter

Illinois appeal letter

Ohio appeal letter