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-27 mean on my insurance denial?

CO-27 means 'expenses incurred after coverage terminated.' The insurer is asserting that your insurance policy was no longer active on the date you received the service. This can be the result of an administrative error, a premium processing delay, or a genuine lapse - each of which has different legal implications for your appeal.

What are my COBRA rights if my coverage was terminated?

Under COBRA (Consolidated Omnibus Budget Reconciliation Act), if you lost coverage due to a qualifying event (job loss, reduced hours, divorce, aging off a parent's plan), you have 60 days from the notice of termination to elect COBRA coverage. Critically, COBRA elections are retroactive to the date coverage ended - meaning you can elect COBRA after an illness and still have coverage for that period.

What if my employer stopped paying premiums without telling me?

This is a serious ERISA violation. Employers who administer group health plans must forward employee premium contributions to the insurer. If your employer withheld your premium contributions but did not forward them, you may have a claim against your employer under ERISA. File a complaint with the Department of Labor's Employee Benefits Security Administration (EBSA). Your insurer may also be required to honor claims during a grace period.

Is there a grace period after coverage lapses?

Most insurance policies have a grace period of 30-90 days during which coverage remains in force even if a premium payment is late. ACA marketplace plans have a 3-month grace period for subsidy recipients. During the grace period, claims must still be adjudicated and cannot be categorically denied solely because of the late payment. Check your plan documents for the specific grace period length.

Can I appeal a CO-27 denial after the grace period has passed?

Yes. Even after the grace period, you can argue that the termination was invalid due to improper notice, administrative error, or a pending enrollment correction. The ACA requires insurers to provide advance written notice of termination. If the insurer failed to follow the required termination procedures, the termination itself may be invalid, and any claim denied during the 'terminated' period must be reprocessed.

CO-27

How to Appeal a Coverage Terminated Insurance Denial (CO-27)

Claim denied because your insurance coverage was terminated (CO-27)? You may have more rights than you think - COBRA, grace periods, and retroactive enrollment can reverse this denial.

What does CO-27 mean?

A CO-27 denial means the insurer is claiming that the patient's insurance coverage had already ended before or on the date the service was provided. This is one of the most serious denial types because it asserts you had no coverage at all - but it is also one of the most frequently overturned when patients know their rights.

Why insurers issue CO-27 denials

Coverage termination denials occur in several scenarios: the employer failed to transmit premium payments; there was an administrative error in the insurer's enrollment records; the patient was in a premium grace period; coverage was terminated retroactively by the employer without proper notice; or the insurer's records don't reflect a special enrollment or COBRA election that was timely made.

Appeal strategy

Request your insurer's enrollment records and compare them against your employer's or exchange enrollment confirmation. If you paid premiums that weren't forwarded to the insurer, document this with payment records. If you qualify for COBRA, you have a 60-day election window and retroactive rights. If coverage was terminated without proper notice, cite ERISA and COBRA regulations. Contact your state insurance commissioner if the insurer terminated coverage without the legally required notice period.

Frequently asked questions about CO-27

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)