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.

What is the No Surprises Act and who does it protect?

The No Surprises Act (NSA), effective January 1, 2022, protects patients from unexpected medical bills in three situations: (1) emergency care at any hospital or emergency facility, regardless of whether the provider is in-network; (2) non-emergency care at an in-network facility from an out-of-network provider when you did not give informed consent to out-of-network billing in advance; and (3) air ambulance services from out-of-network providers. In these cases, you owe only your plan's in-network cost-sharing.

Can I be charged more than my in-network cost-sharing for emergency care?

No. Under the NSA, out-of-network providers who treat you in an emergency cannot bill you more than your in-network cost-sharing amount (your deductible, copayment, or coinsurance as if the provider were in-network). The out-of-network provider must resolve any payment dispute with the insurer through the federal Independent Dispute Resolution (IDR) process - you are not involved in that process.

What should I do if I receive a balance bill I think is covered by the NSA?

Do not pay immediately. First, send a written dispute to the provider, citing the No Surprises Act and stating you believe the bill violates the Act. Contact your insurer and ask them to confirm whether NSA protections apply to this bill. File a complaint at the No Surprises Help Desk: call 1-800-985-3059 or visit nsa-help.cms.gov. Violations of the NSA can result in civil monetary penalties against the provider.

What is the consent exception to the No Surprises Act?

For non-emergency care at in-network facilities, out-of-network providers can still balance bill you IF they provide advance written notice at least 72 hours before the service (or same-day if the appointment is within 72 hours) explaining they are out-of-network and what you may owe, AND you sign a written consent acknowledging and waiving NSA protections. This consent exception does not apply to emergency care, anesthesiology, radiology, or other ancillary services.

Does the No Surprises Act apply to all insurance plans?

The NSA applies to most employer-sponsored health plans, individual and small group market plans, and grandfathered plans. It does not apply to short-term limited-duration plans, health care sharing ministries, or excepted benefit plans. Medicare and Medicaid have their own billing protections. If you have a self-funded employer plan, the NSA still applies - the plan cannot exempt itself from the balance billing protections.

NSA

How to Fight a Surprise Balance Bill Under the No Surprises Act

Received a surprise medical bill from an out-of-network provider? The No Surprises Act may cap what you owe at your in-network rate. Learn your rights and how to dispute unlawful balance bills.

What does NSA mean?

Balance billing occurs when an out-of-network provider charges you more than your insurer paid and more than your plan's cost-sharing amount - billing you for the 'balance.' The No Surprises Act (effective January 1, 2022) dramatically curtailed balance billing for emergency care, out-of-network providers at in-network facilities, and air ambulance services. If you receive a balance bill in these situations, it may be unlawful.

Why insurers issue NSA denials

Before the No Surprises Act, surprise medical bills were one of the leading causes of medical bankruptcy. Patients undergoing surgery at in-network hospitals would receive bills from out-of-network anesthesiologists, radiologists, or surgical assistants they never chose. The NSA now requires these providers to accept your plan's in-network cost-sharing as payment in full and prohibits them from billing you for the balance.

Appeal strategy

If you received a balance bill for emergency care or care at an in-network facility, do not pay it without first verifying whether the No Surprises Act applies. Send a written dispute to the provider citing the NSA and your right to pay only the in-network cost-sharing amount. File a complaint with the No Surprises Help Desk (1-800-985-3059) or your state insurance commissioner. Many providers will immediately retract a balance bill when confronted with an NSA citation, as the law provides for significant penalties for violations.

Frequently asked questions about NSA

CO-50

Medical Necessity Denial (CO-50)

CO-11

Prior Authorization Denial (CO-11)

CO-55

Experimental Treatment Denial (CO-55)

CO-45

Exceeds Fee Schedule Denial (CO-45)