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 New York External Appeal work?

After your insurer issues a final adverse determination, you have 4 months to file an external appeal with DFS under Insurance Law section 4914. The case is reviewed by an Independent External Appeal Agent - a panel of physicians board-certified in the relevant specialty. There is a $25 filing fee, waived for financial hardship and Medicaid. The decision is binding on the insurer. Standard external appeals are decided within 30 days; expedited within 72 hours.

Where do I file a New York insurance complaint?

DFS Consumer Assistance Unit at 1-800-342-3736 or online at dfs.ny.gov/complaint. You can file a complaint and an external appeal in parallel - they do not conflict. The complaint process addresses regulatory violations like delays, improper denials, and bad-faith conduct.

Does New York have stronger external appeal protections than federal law?

Yes. New York's external appeal program is widely cited as among the strongest in the country. Distinguishing features include clinical reviewer panels rather than individual reviewers, a 4-month filing window, low $25 filing fee, ability to skip internal appeal exhaustion in true emergencies, and publication of decision summaries that serve as persuasive authority. Self-funded ERISA plans can opt in by contract.

How long do I have to file an internal appeal in New York?

ACA-regulated plans give at least 180 days. The deadline is on your denial notice and EOB. Missing the internal appeal deadline forfeits external appeal eligibility (except in true emergencies under section 4914(b)(4)), so file promptly.

Can I file an expedited external appeal in New York?

Yes. Within 72 hours when delay would seriously jeopardize health under section 4914(b)(4)(A). Mark the request expedited and have your physician submit a written clinical urgency statement identifying the specific harm delay would cause. Expedited external appeal can proceed in parallel with or even before internal appeal exhaustion in true emergencies.

Are New York external appeal decisions binding on my insurer?

Yes. Under Insurance Law section 4914(c), an external appeal decision in favor of the patient is binding on the insurer. There is no further administrative appeal. The insurer must implement the determination promptly. Failure to comply is grounds for DFS enforcement.

Are surprise out-of-network bills protected in New York?

Yes. New York's surprise medical billing law at Insurance Law section 3217-d, enacted in 2014 and predating the federal No Surprises Act, removes patients from disputes between insurers and out-of-network providers for emergency services and certain facility-based services. Patient responsibility is limited to in-network cost-sharing. Disputes between insurer and provider are resolved through baseball-style arbitration.

Where can I see prior New York external appeal decisions?

DFS publishes external appeal data and decision summaries on its website. Citing analogous overturned decisions in your appeal is permissible and substantively persuasive. The Insurance Circular Letters published by DFS also constitute citable interpretive authority.

New York Insurance Appeal Letter Generator - Cite NY Insurance Law

New York's external appeal program, administered by the Department of Financial Services under Insurance Law section 4914 and Public Health Law section 4914, is widely cited as among the strongest in the country. Decisions are issued by independent clinical reviewer panels and are binding on insurers. Upload your NY denial and our 5-agent AI pipeline drafts an appeal under NY Insurance Law and Public Health Law.

New York insurance regulator

DFS regulates fully insured commercial health plans in New York. The New York Department of Health regulates HMOs and the Medicaid managed care program. The External Appeal program is administered uniformly by DFS under Insurance Law section 4914 and Public Health Law section 4914, decided by Independent External Appeal Agents - clinical review panels of physicians board-certified in the relevant specialty.

New York Department of Financial Services (DFS)File a NY insurance complaint

External review in New York

External Appeal through DFS under New York Insurance Law section 4914 and Public Health Law section 4914. Decided by Independent External Appeal Agents (clinical reviewer panels). The decision is binding on the insurer. Filing fee is $25, waived for Medicaid and financial hardship. File at dfs.ny.gov.

Internal appeal timing in New York

New York insurers must respond to standard pre-service appeals within 30 days, post-service within 60 days, and expedited within 72 hours. Patients have 4 months from the final adverse determination to file an external appeal under section 4914. Expedited external appeal can proceed without internal appeal exhaustion when delay would seriously jeopardize health.

Statutes Counterclaim cites for New York appeals

New York Insurance Law section 4904 (utilization review and internal appeal)
New York Insurance Law section 4914 (external appeal)
New York Public Health Law section 4904 (parallel HMO provisions)
New York Public Health Law section 4914 (parallel HMO external appeal)
New York Insurance Law section 3217-a (managed care consumer protections)
New York Insurance Law section 3216 (individual accident and health)
New York Insurance Law section 3224-a (prompt payment law)

Generate your New York appeal letter

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

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Frequently asked questions: New York appeals

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