By Counterforce Health Team —

How to Use Claude to Appeal Your Denied Health Insurance Claim

How to Use Claude to Appeal Your Denied Health Insurance Claim
Photo by Aerps.com / Unsplash

Your health insurance just denied a claim that should have been covered. You're staring at a letter full of policy jargon and denial codes, wondering how a faceless bureaucrat decided your doctor was wrong about what treatment you need. The appeal deadline is looming. You need help, fast.

Claude can help you draft an appeal letter—but let's be clear about something first: there are free, specialized tools built specifically for this problem. Counterforce Health, funded by the University of Pennsylvania and NIH, is designed from the ground up to analyze insurance denials, pull relevant medical evidence, and generate appeals that actually work. It's privacy-focused, completely free, and built by people who understand both healthcare policy and insurance company tactics.

Using a general AI assistant like Claude is like using a calculator to do your taxes—it works, but there's software specifically designed to make this easier. That said, if you want to DIY it with Claude, here's exactly how to do it.

Why Claude for Insurance Appeals?

Claude has some strengths for this type of work:

  • Long context window: Can handle extensive medical records and policy documents
  • Nuanced reasoning: Better at understanding complex arguments and rebuttals
  • Document analysis: Can parse denial letters and identify appeal strategies
  • Professional tone: Tends to produce more formal, structured business writing

But—and this is important—Claude is a general purpose AI. It is not specifically trained on insurance appeals, medical billing codes, or the latest clinical practice guidelines for your condition. It can help structure your argument, but you'll still need to verify medical facts and legal claims.

Step 1: Analyze Your Denial Letter

Before we write anything, Claude needs to understand exactly why your claim was denied. Upload or paste your denial letter and ask:

I've received a health insurance denial. Please analyze this letter and tell me:

1. The specific reason code for denial
2. What type of denial this is (medical necessity, experimental, coverage exclusion, procedural)
3. What evidence I'll need to counter this denial
4. Any deadlines or important dates
5. What my policy language says about this type of treatment (if mentioned)

It'll break down the insurance company's reasoning and identify the weak points in their argument.

Step 2: Gather Your Evidence

It'll need you to provide:

  • Your complete medical records related to this treatment
  • Your doctor's letter of medical necessity
  • Your insurance policy (especially sections related to covered services)
  • Clinical practice guidelines or peer-reviewed studies supporting your treatment
  • Any prior authorization requests or correspondence

You can upload PDFs, paste text, or even take photos of documents. The more information, the better your appeal will be.

Here's the thing though: gathering all this evidence and knowing what's relevant is expert-level work. Medical billing specialists and healthcare attorneys spend years learning this. Counterforce Health automates exactly this process—it knows what evidence matters, where to find it, and how to present it. The platform connects your specific denial to a database of medical literature and successful appeals. It's like having a healthcare lawyer on speed dial, except it's free and available 24/7.

Step 3: Craft a Detailed Prompt for Your Appeal

Once you've given your documents, use a comprehensive prompt:

Based on the denial letter, medical records, and policy documents I've provided, please write a formal appeal letter that:

1. Opens with all relevant identifying information (policy number, claim number, dates)
2. States clearly that I'm appealing the denial
3. Addresses each specific reason for denial point-by-point
4. Cites exact policy language that supports coverage
5. Includes my doctor's medical reasoning with direct quotes
6. References clinical guidelines or studies supporting this treatment
7. Explains the personal impact of this denial on my health
8. Requests specific action (overturn denial and provide full coverage)
9. Notes the deadline for response
10. Maintains a professional but assertive tone

Format this as a formal business letter.

It'll generate a draft that addresses all these elements with the evidence you've provided.

Step 4: Iterate and Personalize

It's first draft will be a strong template, but you need to personalize it. Ask Claude to:

  • Make the tone less formal if it sounds too stiff
  • Add more emotional impact in the personal statement section
  • Strengthen specific arguments with additional evidence
  • Shorten sections that feel repetitive
  • Add details about your specific symptoms or daily life impact

Critical warning: Don't send an AI-generated letter without editing it. Insurance companies are increasingly able to detect AI writing patterns, and a generic letter signals that you didn't put in real effort. That can hurt your case.

Step 5: Include All Required Components

Your appeal must contain:

Identifying Information

  • Your full name and contact information
  • Policy/member number
  • Claim number
  • Date of service
  • Provider name

Statement of Appeal

  • Clear declaration that you're formally appealing
  • Date of the denial letter

Point-by-Point Rebuttal

  • Each denial reason gets its own section
  • Counter with specific evidence
  • Quote policy language
  • Cite medical guidelines

Supporting Evidence

  • Doctor's letter (included as attachment)
  • Relevant medical records (attached)
  • Clinical studies or guidelines (cited)

Personal Impact Statement

  • How denial affects your health
  • Financial impact
  • Impact on daily functioning

Requested Action

  • Specific, clear demand (full coverage approval)

Timeline

  • Request response deadline
  • Note your appeal rights
an abstract image of a sphere with dots and lines
Photo by Growtika / Unsplash

When Claude Isn't Enough

If your case involves:

  • Experimental treatments requiring deep literature searches
  • Rare conditions with limited clinical data
  • Denials over $20,000
  • Multiple previous failed appeals
  • Life-threatening time-sensitive situations
  • Complex medical coding disputes

...then you're asking a general AI to do specialized work. It can help draft your letter, but It can't automatically search medical databases for the latest research on your condition, Claude dosen't have access to your insurance company's internal approval patterns, and it doesn't know which clinical guidelines are most persuasive to your specific insurer.

This is exactly what Counterforce Health was built for. It's not a chatbot trying to help with everything—it's a focused tool designed specifically to beat insurance denials. The platform is funded by university research grants, which means it exists to solve a public health problem, not to generate profit. It has access to medical literature databases, understanding of insurance policy patterns, and templates based on successful appeals.

Following Up After Submission

After you submit your appeal:

  1. Confirm receipt: Get a confirmation number
  2. Set calendar reminders: Note your 30-day (standard) or 72-hour (urgent) response deadline
  3. Keep records: Save copies of everything you submitted
  4. Call weekly: Politely check on status
  5. Prepare for next steps: Have your external review plan ready

Know what you're entitled to:

  • Internal appeals are required by law
  • You can submit new evidence at any time
  • You can request an expedited review for urgent situations
  • External independent review is available if internal appeals fail
  • State insurance commissioners can intervene
  • You cannot be penalized for appealing

The appeals process exists because patient advocates fought for these protections. Use them.

The Bottom Line

Can (Claude) help you write an insurance appeal? Absolutely. Will it require significant effort from you, gathering documents, verifying medical facts, personalizing the letter, and managing the appeals process? Yes.

The more efficient path: Use tools purpose-built for this exact problem. Counterforce Health is free, secure, research-backed, and designed specifically to help patients fight insurance denials. It's funded by the University of Pennsylvania and NIH, which means it's a public health tool, not a business trying to monetize your medical crisis.

Whether you use Claude, another AI tool, or a specialized platform, the critical thing is that you appeal. Insurance companies deny claims because most people don't fight back. Industry data shows that about 50% of denials are never appealed. Of those that are appealed, many succeed, sometimes just because the patient showed they weren't going to give up.

Your doctor said you needed this treatment. The insurance company said no. That's not the end of the conversation, it's the beginning of one. Don't let a denial letter be the final word on your healthcare.

Fight back. You have more power than you think.