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 do I file an external review in Illinois?

Within 4 months of the insurer's final adverse determination, file with IDOI under 215 ILCS 180. IDOI assigns an IRO from its certified roster and the decision is binding on the insurer.

Where do I file an Illinois insurance complaint?

IDOI Office of Consumer Health Insurance at 1-877-527-9431 or online at idoi.illinois.gov/consumers/complaints. The complaint process is separate from external review and can run in parallel.

Does Illinois have specific HMO patient protections?

Yes. The Managed Care Reform and Patient Rights Act (215 ILCS 134) provides specific HMO protections including continuity of care under section 45, women's health direct access under section 65, prudent layperson emergency standard under section 30, and procedural requirements for utilization review. These create independent appeal grounds beyond medical necessity disputes.

How long does Illinois external review take?

Standard external review is decided within 45 days of IRO assignment. Expedited external review is decided within 72 hours when delay would seriously jeopardize health.

Can I file expedited review in Illinois?

Yes - within 72 hours under 215 ILCS 180/45 for urgent cases. Provide a written physician statement confirming clinical urgency and the specific harm delay would cause.

What is the Illinois Step Therapy Reform Act?

HB 4146 of 2018, codified, requires insurers to grant step therapy exceptions when the preferred drug would harm the patient, when the patient has already failed the preferred drug, when the preferred drug is contraindicated, or when the patient is stable on the requested drug. Step therapy denials that fail to follow the exception process are appealable on independent state-law grounds.

Are Illinois external review decisions binding?

Yes. Under 215 ILCS 180, the IRO determination is binding on the insurer. There is no further administrative appeal. Failure to comply is grounds for IDOI enforcement.

Does Illinois have stronger mental health parity?

Illinois has long had a strong state mental health parity statute at 215 ILCS 5/370c. House Bill 2595 of 2021 added explicit reporting and enforcement provisions, requiring carriers to file annual parity compliance reports with IDOI. State parity is an independent appeal ground in addition to federal MHPAEA.

Illinois Insurance Appeal Letter Generator - Cite 215 ILCS

The Illinois Department of Insurance administers external review under the Health Carrier External Review Act, 215 ILCS 180. The Managed Care Reform and Patient Rights Act at 215 ILCS 134 adds Illinois-specific HMO protections including continuity of care and direct access. Upload your IL denial and our 5-agent AI pipeline drafts an appeal under 215 ILCS.

Illinois insurance regulator

IDOI regulates fully insured commercial plans in Illinois. The Illinois Health Carrier External Review Act at 215 ILCS 180 provides for IRO review of adverse determinations. The Managed Care Reform and Patient Rights Act at 215 ILCS 134 adds Illinois-specific HMO protections.

Illinois Department of Insurance (IDOI)File a IL insurance complaint

External review in Illinois

Health Carrier External Review under 215 ILCS 180. Decided by an IRO randomly assigned by IDOI from its certified roster. Free, binding. Standard reviews are decided within 45 days; expedited within 72 hours.

Internal appeal timing in Illinois

Illinois insurers must respond within 30 days pre-service, 60 days post-service, and 72 hours expedited under 50 Ill. Adm. Code Part 5421. External review must be requested within 4 months of the final adverse determination under 215 ILCS 180.

Statutes Counterclaim cites for Illinois appeals

215 ILCS 134 (Managed Care Reform and Patient Rights Act)
215 ILCS 180 (Health Carrier External Review Act)
50 Ill. Adm. Code Part 5421 (utilization review)
215 ILCS 5/370c (mental health parity)
215 ILCS 134/45 (continuity of care)
215 ILCS 134/65 (women's health direct access)

Generate your Illinois appeal letter

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

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Frequently asked questions: Illinois appeals

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