Request an independent external review after your insurer denies your appeal
If your internal appeal fails, you can usually ask an independent reviewer to decide. AI can help you build a well-documented case.
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1. Copy this prompt
Paste it into ChatGPT, Claude, Gemini or Grok (the free versions work), then replace the [highlighted brackets] with your details. Leave out account numbers and SSNs.
My health insurer denied my internal appeal for [TREATMENT / DRUG] on [DATE]. The denial reason is: [PASTE REASON]. My diagnosis and history (no identifiers): [SUMMARY]. My doctor's notes say: [PASTE KEY POINTS]. 1) Explain in plain English why it was denied and the strongest counter-arguments. 2) List the evidence an independent reviewer would want (guidelines, prior treatments tried, records). 3) Draft a two-page summary for my external review request. 4) Tell me how to check whether a state or federal external review applies and what the deadlines are.
2. Follow these steps
(stored only in your browser; uncheck to erase)
What to expect, and what to do if they say no
What happened when people tried it
Reported She received coverage. The insurer, IBX, says a second external physician reviewer approved it after finding the diagnosis in her records, and that AI did not influence the outcome.
What the AI did: After two failed appeals for ADHD medication, a Pennsylvania woman used Counterforce Health's free AI tool on a third appeal to the state's external review panel. It produced an 11-page letter with cited research.
Source: CBS News Philadelphia · 2025 · Patient's account; insurer disputes the role of AI
Why this works
The problem: Many people stop after the insurer's internal appeal, not knowing an independent external review is usually available.
How AI helps: AI can organize your records, summarize the medical-necessity argument, and help you fill out the external review request on time.
Tools & what they cost
| Tool | Cost |
|---|---|
| ChatGPT | Free option available (Paid upgrades exist, but the free version works for this) Free tier; paid plans available |
| Claude | Free option available (Paid upgrades exist, but the free version works for this) Free tier; paid plans available |
| HealthCare.gov: External review | Free (No cost at all) Free |
| Counterforce Health Nonprofit AI appeal-letter tool | Free (No cost at all) Free |
What do these labels mean?
- Free No cost at all.
- Free option available Paid upgrades exist, but the free version works for this.
- Costs money You pay a set price or subscription.
- Takes a cut of savings Charges a percentage of what it saves you.
- Time · Difficulty Our estimates for a typical first try, not guarantees.
- Reported What the linked source says happened, often self-reported. Your results will vary.
Watch out for
- The insurer in the reported case disputes that AI influenced the result; it says a second external reviewer found the diagnosis that had been overlooked.
- Ask your doctor to confirm every medical claim in the letter.
- Don't miss deadlines; ask for expedited review if your health is at risk.
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Sources
- https://www.cbsnews.com/philadelphia/news/counterforce-health-artificial-intelligence-pennsylvania/
- https://www.healthcare.gov/appeal-insurance-company-decision/external-review/
Last verified 2026-10-19. Not financial, legal, tax or medical advice. Disclaimer.