Read this before you mail anything

Counterclaim is an artificial-intelligence tool that takes a denied health-insurance document - a denial letter or Explanation of Benefits - and produces a draft appeal letter, a checklist of supporting documents to gather, and a rough estimate of the appeal's strength. It is built around five specialized prompts (Reader, Researcher, Writer, Adversary, Editor) running on a large language model.

It is meant to give you a credible, well-organized first draft you would otherwise spend hours researching and writing. It is meant to surface the state and federal authority that applies to your situation. It is meant to flag the deadline before you miss it. It is meant to remove cost as a reason a denial goes unchallenged.

Counterclaim is not:

• A law firm.
• An attorney, paralegal, or legal-services provider.
• A health-care provider, physician, or clinical advisor.
• A licensed patient advocate.
• An insurance broker or claims adjuster.
• A substitute for professional legal, medical, or insurance advice.
• A guarantee that any letter it produces will result in your denial being overturned.

Using Counterclaim does not create an attorney-client relationship. The Operator is not your lawyer. Communications with the Service are not privileged.

Why this matters

Large language models are extraordinary writers and terrible auditors. They will happily produce a paragraph that sounds authoritative, cites a statute that does not exist, and quotes a "court ruling" that nobody ever issued. They will sometimes apply California law to a Texas plan, mis-remember whether the deadline is 60 or 180 days, or overstate how much weight a particular regulation carries. The drafts our pipeline produces have been cross-checked, adversary-tested, and edited - but cross-checks and adversary tests are not infallible either.

That means three things you, the human, must do:

1. Read the draft in full. Every word, every paragraph, every footnote.
2. Verify every citation - every statute, regulation, court case, deadline, insurer-policy reference, code, dollar amount, and date - against your actual denial letter, your actual EOB, your actual plan documents, and an authoritative source for the law.
3. Adapt the draft to your specific situation. Add facts the Service didn't know about, remove arguments that don't apply, soften or sharpen the tone to match your voice, and check that the recipient address and member number on the letter actually match the documents in front of you.

If any of that feels overwhelming, or if the situation is high-stakes, the rest of this page is for you.

These are real categories of mistake that AI drafting tools - including the kind Counterclaim uses - have made. None of them are theoretical. We list them so you know what to watch for when you read your draft:

• Cited a "Texas Insurance Code Section 1259.999" that does not exist (real statute numbers should always be verified).
• Cited Smith v. Aetna in the wrong state, the wrong year, or as a precedent that does not exist at all.
• Mis-stated CPT 99213 vs CPT 99214 reimbursement rules.
• Confused two different patients' member IDs when summarizing.
• Applied California's Knox-Keene Act to a self-funded ERISA plan (it does not apply).
• Quoted a clinical-policy section that has since been amended or rescinded.
• Mixed up internal-appeal and external-review deadlines.
• Generated an "expedited 72-hour" appeal demand for a non-urgent case, undermining the credibility of the whole letter.

Run this list end-to-end before you sign, mail, fax, e-mail, or hand-deliver any letter Counterclaim generates for you:

1. Is every legal citation a REAL, CURRENT statute, regulation, or case? (Look it up in an authoritative source.)
2. Is every dollar amount on the letter the same as on your EOB and itemized bill?
3. Is every patient name, member ID, claim number, date of service, CPT code, and ICD code correct?
4. Is the appeal deadline ON the letter the same as the deadline ON your insurer's denial notice?
5. Does the letter describe YOUR diagnosis and treatment, or did the AI substitute a generic one?
6. If "URGENT" or "EXPEDITED" appears anywhere, is your case actually urgent under your insurer's definition?
7. Have you removed any sentence that seems generic, padded, or that you cannot personally vouch for?
8. Are the enclosed exhibits the ones you actually plan to send?

If you cannot answer "yes" to every one of these, the letter is not ready to mail. Edit, verify, and re-check before sending.

Some categories of denial benefit hugely from a lawyer's involvement. Counterclaim can still help you organize the facts and even produce a first draft - but in any of the following situations, you should at least talk to an attorney before relying on a generated letter:

• Claim value greater than $10,000. The math starts to favor paid representation quickly. Many health-law attorneys take cases of this size on contingency or for a flat fee.
• Self-funded employer plan (ERISA). ERISA's "administrative record" rule means anything you don't put in the internal appeal can be excluded from a later federal lawsuit. Get the appeal right the first time.
• Mental-health or substance-use disorder denial. The Mental Health Parity and Addiction Equity Act (MHPAEA) is a powerful statute, but it has procedural traps and the comparative-analysis demand benefits from experienced counsel.
• Oncology, transplant, or other life-threatening denial. Time matters, the dollars matter, and so does deep specialty-medical familiarity. Get a specialist.
• You're already past the internal-appeal stage. If you've been to external review and lost, the next step is litigation, a regulatory complaint, or a settlement negotiation - not another letter.
• You've been threatened with collections, lien, or lawsuit. A demand letter from a hospital's billing department or a collection agency changes the calculus. Talk to a lawyer before you respond.
• The denial is rooted in a coverage exclusion you want to challenge as unlawful. That's a legal-theory case, not a medical-necessity case, and it needs a lawyer.

These are starting points, not endorsements. You are responsible for vetting any provider you hire.

Licensed attorneys

• Your state bar's lawyer-referral service. Every state bar runs one. Search "[your state] bar lawyer referral service" - most offer a low-cost initial consultation with a vetted attorney in the relevant practice area (insurance, ERISA, healthcare).
• Legal aid clinics in your county for income-qualified residents. Legal Services Corporation directory is a good starting point.
• Law school clinics. Many university law schools run free or low-cost health-law clinics where supervised students take real cases.
• State bar pro-bono panels for income-qualified residents.

Patient advocates and nonprofits

• Patient Advocate Foundation - free case-management for patients with chronic, life-threatening, or debilitating illnesses, including help navigating insurance denials.
• Alliance of Professional Health Advocates (APHA) - directory of independent, board-certified patient advocates you can hire directly.
• Triage Cancer - free legal- and insurance-navigation resources for cancer patients and survivors.

Regulatory complaints

If you suspect your insurer is violating the law, you have free recourse to the regulators - in parallel with any appeal:

• Your state's Department of Insurance or, in California, the Department of Managed Health Care. Search "[your state] department of insurance file a complaint."
• Federal Department of Labor's Employee Benefits Security Administration (EBSA) at 1-866-444-3272, for self-funded employer (ERISA) plans.
• Centers for Medicare and Medicaid Services (CMS) for Medicare and Medicare Advantage disputes.

Counterclaim is provided "as is" and "as available," without warranties of any kind, express or implied, including any implied warranty of merchantability, fitness for a particular purpose, accuracy, or non-infringement. We do not warrant that any generated letter is correct, complete, current, legally sufficient, or that it will result in your denial being overturned.

By using Counterclaim, you accept full responsibility for reviewing, verifying, correcting, and deciding whether to send any generated draft. You are solely responsible for the final content of anything you mail, file, or submit, and for meeting every applicable deadline. You knowingly and voluntarily assume the risk that an AI-generated draft may contain errors, omissions, inapplicable arguments, or fabricated citations, and that relying on one without independent verification could harm your appeal.

To the fullest extent permitted by law, the Operator is not liable for any loss, denied claim, missed deadline, or other harm arising from your use of - or inability to use - the Service. These limits, and the full liability cap, are set out in the Terms of Service, which govern your use of Counterclaim. Nothing on this page is legal advice, and using the Service creates no attorney-client relationship.

A note from the team

We built Counterclaim because most people who are wrongly denied insurance never appeal - and the people most likely not to appeal are the people who can least afford the bill. A free, well-drafted appeal letter changes the math.

But a tool can only do what a tool can do. Read what the AI writes. Verify what it cites. And if you can afford to talk to a lawyer or a certified patient advocate - or if your case is in any of the higher-stakes categories above - please do. You can use Counterclaim's draft as a starting point in that conversation.

Good luck. We are pulling for you.