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 Mental Health Parity and Addiction Equity Act?

The MHPAEA (2008), strengthened by the Consolidated Appropriations Act of 2021, requires most group health plans and health insurers to cover mental health and substance use disorder benefits at the same level as medical and surgical benefits. It prohibits imposing more stringent limitations on mental health coverage than on comparable physical health coverage - including visit limits, prior authorization requirements, and network adequacy.

What does a parity violation look like in practice?

Common parity violations include: requiring prior authorization for mental health visits but not for equivalent medical visits; imposing annual visit limits on therapy but not on physical therapy; applying stricter medical necessity criteria for psychiatric inpatient care than for medical inpatient care; having a much narrower mental health provider network than medical network; or requiring step therapy for psychiatric medications but not for comparable medical medications.

How do I request a comparative analysis from my insurer?

Send a written request to your insurer (or your employer's plan administrator for self-funded plans) citing MHPAEA and the Consolidated Appropriations Act of 2021, which explicitly requires plans to perform and document comparative analyses of their non-quantitative treatment limitations. The plan must provide this analysis within 30 days. Use the specific language: 'I am requesting the comparative analysis required under 29 C.F.R. § 2590.712(c)(4).'

Can my insurer deny mental health treatment as 'not medically necessary'?

Yes, but only using the same medical necessity standards they apply to physical health conditions. If the insurer applies stricter criteria to mental health - for example, requiring documented failure of multiple outpatient treatments before covering residential mental health care, when they don't apply the same escalation requirement to comparable medical inpatient care - this is a parity violation. Document the comparison carefully.

Where do I file a parity violation complaint?

File simultaneously in multiple places: (1) your insurer's internal appeals process; (2) your state insurance commissioner's office; (3) the Department of Labor's Employee Benefits Security Administration (EBSA) at 1-866-444-3272 for employer-sponsored plans; (4) the Department of Health and Human Services (HHS) Office for Civil Rights. Filing in multiple venues simultaneously maximizes pressure and creates a documented record.

MHPAEA

How to Appeal a Mental Health or Substance Use Denial Under Parity Law

Insurance denied mental health or addiction treatment that would be covered for a physical condition? The Mental Health Parity Act (MHPAEA) may require them to cover it. Learn how to appeal.

What does MHPAEA mean?

A mental health parity denial occurs when your insurer applies more restrictive coverage rules to mental health or substance use disorder (MH/SUD) treatment than they apply to comparable medical or surgical benefits. This violates the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, a federal law that prohibits unequal treatment of mental and physical health conditions.

Why insurers issue MHPAEA denials

Insurers often apply stricter prior authorization requirements, tighter medical necessity criteria, lower visit limits, or narrower provider networks to mental health and addiction treatment than they apply to equivalent physical health services. Courts and regulators have consistently found these practices violate parity law, but insurers continue them because most patients don't know their rights.

Appeal strategy

Request a 'comparative analysis' - MHPAEA requires insurers to provide, upon request, a written analysis showing how their mental health benefit restrictions compare to analogous medical/surgical restrictions. If the insurer cannot show that an equivalent restriction applies to medical/surgical benefits, the restriction violates parity law. File simultaneously with your insurer's internal appeals process and with your state insurance commissioner or the Department of Labor (for employer plans).

Frequently asked questions about MHPAEA

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)