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 does CO-119 mean on my insurance denial?

CO-119 means 'benefit maximum for this time period or occurrence has been reached.' The insurer is saying you have used the full amount of a benefit it caps, such as a number of allowed therapy visits or a dollar limit on a benefit category, so it will not pay for additional services of that type in the period.

Are benefit maximums and visit limits legal?

Some are, but many are not. The ACA prohibits annual and lifetime dollar limits on essential health benefits, so a dollar cap on a covered essential benefit is generally unlawful. Visit limits (a count of sessions) may be allowed for some services, but under the Mental Health Parity and Addiction Equity Act they cannot be stricter for mental health or substance use treatment than for comparable medical or surgical care.

How do I check if the visit count is wrong?

Request a detailed accumulator or benefit-usage statement from your insurer and compare each counted visit against your own Explanation of Benefits records. Visits that were denied, duplicated, billed in error, or provided out-of-network are commonly miscounted toward the limit. If you find an error in the count, your appeal can restore the remaining benefit without challenging the limit itself.

Can I get coverage beyond the benefit maximum if I still need care?

Often, yes. If continued treatment is medically necessary, submit a request for a benefit limit exception or continued care with a letter from your treating provider documenting the clinical need. For mental health and rehabilitation services in particular, parity law and medical necessity arguments frequently support coverage beyond an arbitrary visit cap.

Does the parity law help with a therapy visit limit denial?

It can. If your plan caps mental health or substance use visits more strictly than it caps comparable medical or surgical visits (for example, capping psychotherapy sessions but not physical therapy sessions), that disparity may violate the Mental Health Parity and Addiction Equity Act. Request the plan's required comparative analysis of its treatment limitations and cite the disparity in your appeal.

CO-119

How to Appeal a CO-119 'Benefit Maximum Reached' Denial

Claim denied with CO-119 because you hit a benefit maximum or visit limit? Some limits are illegal under the ACA and parity law, and the count is often wrong. Learn how to appeal.

What does CO-119 mean?

A CO-119 denial means the benefit maximum for a time period or occurrence has been reached, for example, a cap on the number of physical therapy visits, mental health sessions, chiropractic treatments, or a dollar limit on a specific category of benefit. The insurer is asserting you have used up the allowed amount for that benefit. CO-119 is appealable both when the count is wrong and when the limit itself is improper under federal law.

Why insurers issue CO-119 denials

Plans impose benefit maximums to control costs: visit caps on therapy, annual limits on durable medical equipment, or occurrence limits on certain procedures. Two problems make CO-119 frequently appealable. First, the accumulator math is often wrong, denied, duplicated, or out-of-network visits are sometimes miscounted toward the limit. Second, some limits are illegal: the ACA prohibits annual and lifetime dollar limits on essential health benefits, and the Mental Health Parity and Addiction Equity Act prohibits applying stricter visit limits to mental health and substance use treatment than to comparable medical care.

Appeal strategy

Request a year-to-date accumulator statement showing exactly how the insurer counted toward the maximum, then verify every entry against your Explanation of Benefits records, miscounted, denied, or duplicate visits should not count. If the limit is a dollar cap on an essential health benefit, cite the ACA's prohibition on annual and lifetime dollar limits. If the limit is a visit cap on mental health or substance use care that is stricter than the cap on comparable medical care, cite the Mental Health Parity and Addiction Equity Act and request the plan's comparative analysis. If the care remains medically necessary beyond the limit, submit a continued-care or exception request with a physician letter.

Frequently asked questions about CO-119

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)