Now servingFairlawn, Ohioand the areas around it: Montrose-Ghent, Cuyahoga Falls, Akron, Sharon Center, Richfield, Norton, Barberton and Silver Lake.
Denied by insurance? Build an appeal backed by the insurer’s own rules.
Dearbh turns a denied claim into a cited appeal. Every line is quoted word for word from the policy, regulation, or coverage rule that governs it, and a person reviews the calls that matter before you file.
Private and ACA plans. Medicare. Medicaid. SSDI. SSI.
See it work
What Dearbh does, in two minutes.
Prefer reading? Everything said in the film is written on this page, starting with the example below.
What one appeal line looks like
Insurer says
“The records you sent do not support the therapy you asked for.”
Dearbh finds
Your plan has to tell you exactly what was missing, not just that something was.
“The notification shall set forth, in a manner calculated to be understood by the claimant— (i) The specific reason or reasons for the adverse determination; (ii) Reference to the specific plan provisions on which the determination is based; (iii) A description of any additional material or information necessary…”
You get
Documents received
- Your therapist’s progress notes
- Your doctor’s order for therapy
Documents outstanding
- The plan’s written list of exactly what it says is missing Dearbh drafts the requestUntil the plan names it, there is nothing to answer. This turns a vague no into a specific one.
- The visit notes for the sessions already refused Dearbh drafts the requestThese show the therapy was given and what it achieved, which is what the plan says it cannot see.
You can file now.
The plan has to say exactly what was missing, and it did not. Dearbh drafts that letter and the record request together, so the clock keeps running while the notes arrive.
Insurer says
“Our review criteria do not support more therapy sessions.”
Dearbh finds
The rules a plan applies to mental health care cannot be stricter than the ones it applies to medical care.
“In the case of a group health plan … that provides both medical/surgical benefits and mental health or substance use disorder benefits and that imposes any nonquantitative treatment limitation on mental health or substance use disorder benefits…”
You get
Documents received
- Your treatment plan
Documents outstanding
- The plan’s own limits on medical and surgical care, to compare Dearbh drafts the requestParity is a comparison. Without the medical side, there is nothing to hold the mental-health limit against.
- Your clinician’s notes for the sessions already refused Dearbh drafts the requestThey show what the treatment is doing, which is what a review-criteria denial disputes.
- The written criteria the plan says you did not meet Dearbh drafts the requestThe plan has to produce them. You cannot show a rule was applied more strictly if nobody will show you the rule.
You can file now.
Parity stands on its own. Dearbh drafts the appeal and, at the same time, asks the plan for its medical and surgical limits, because the comparison is what carries it.
Insurer says
“This drug is not on your plan’s list of covered drugs.”
Dearbh finds
Your plan has to give you and your doctor a way to ask for a drug it does not cover.
“A health plan providing essential health benefits must have the following processes in place that allow an enrollee, the enrollee’s designee, or the enrollee’s prescribing physician … to request and gain access to clinically appropriate drugs not otherwise covered by the health plan (a request for exception).”
You get
Documents received
- Your prescription
- The drugs you have already tried
Documents outstanding
- Your doctor’s written justification for this drug Dearbh drafts the requestThis is the centre of the appeal. It is what says this drug, for this patient, for this reason.
- Notes on how the covered alternatives worked, or why they cannot be used Dearbh drafts the requestA formulary denial assumes something else will do. This is what answers that.
- The plan’s formulary showing what it covers in this class Dearbh drafts the requestIt shows whether the plan covers anything at all here, which is the point the rule turns on.
- The plan’s written decision on your exception request Dearbh drafts the requestWithout it there is no decision to appeal, and the clock may not have started.
Get one thing first.
Your doctor’s written justification is the strongest thing missing. Dearbh drafts the request for it. If your deadline is close, it files to protect the date and adds the justification to the file after.
Insurer says
“Your home health hours are being cut.”
Dearbh finds
You have a right to a fair hearing when a claim is denied or is not acted on.
“Section 1902(a)(3) of the Act requires that a State plan provide an opportunity for a fair hearing to any person whose claim for assistance is denied or not acted upon promptly.”
You get
Documents received
Nothing in your file supports this yet. Dearbh will not write a line it cannot back, so it asks for these first.
Documents outstanding
- The notice stating the reason and the date the cut starts Dearbh drafts the requestEverything runs from this. It carries the reason, the rule, and the date your deadline counts from.
- Your plan of care Dearbh drafts the requestIt is what set the hours in the first place. Without it there is nothing to measure the cut against.
- Your nurse’s assessment of the hours you need Dearbh drafts the requestThis is the clinical answer to why the hours are needed, which is what the cut disputes.
- The state rule the plan says it is applying Dearbh drafts the requestThe plan has to name the rule. Until it does, no one can show it was applied wrongly.
- The plan’s own decision on your appeal to it Dearbh drafts the requestWith a managed-care plan the plan’s appeal usually comes first, and its decision is what opens the state hearing. Filing in the wrong place can cost you the deadline.
Not ready to file.
Dearbh will not tell you this appeal is backed when nothing in your file supports it. Get the notice and your plan of care first. If the deadline is close, Dearbh files to protect the date and says plainly, in the letter, which records are still coming.
Insurer says
“Seat elevation on your power wheelchair is a convenience feature, not a medical need.”
Dearbh finds
Medicare’s own coverage rule says seat elevation is a medical need when you use it to transfer in and out of the chair, or to reach what daily life requires at home.
“Effective for services performed on or after May 16, 2023, power seat elevation equipment is reasonable and necessary for individuals using complex rehabilitative power-driven wheelchairs, when the following conditions are met… The individual performs reaching from the power wheelchair to complete one or more mobility related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming and bathing in customary locations within the home.”
You get
Documents received
- Your doctor’s order for the seat elevation
- The paperwork for your chair, showing it is a complex rehab power chair
Documents outstanding
- The specialty evaluation from a physical or occupational therapist Dearbh drafts the requestMedicare makes this evaluation the first condition. Without it, the strongest facts about your day do not count yet.
- Notes that show how you transfer, or what you reach for at home Dearbh drafts the requestThe rule asks for just one of three things: standing transfers, helped transfers, or reaching to do daily tasks like eating or dressing. Most days already include one. It has to be on paper.
Get one thing first.
The specialty evaluation carries this appeal — Medicare’s rule names it first. Dearbh drafts the request for it. If your deadline is close, it files to protect the date and adds the evaluation to the file after.
Each tab shows one line of an appeal. A real denial letter usually gives several reasons at once. Dearbh answers every one of them separately. Each line gets its own rule, its own records, and its own entry in the file, so you can see what backs it and nothing in the letter goes unanswered.
Which rule governs depends on the kind of plan you have. These five run on different law: an employer plan, a marketplace plan, Medicaid and Medicare each answer to a different rulebook. The wheelchair rule here is Medicare’s; on a private plan it is the reference point the plan’s own words are held against. Dearbh works out which one applies to you before it writes a word.
Join the waiting list
Dearbh is in live testing and verification review now. Tell us who you are and we will let you know the moment it opens. If you want to help shape it, you can ask to join the group that tries it first.
We ask for the type of denial only as a category, so we know which problems to build for first. Please do not send us medical records or case details here — this page is not where a case lives.
Your denial isn’t the last word.
Build an appeal on proof they can’t wave away.