For investors
Appeal denied insurance claims with proof.
Dearbh builds appeals from the insurer’s own rules. Every claim is quoted word for word from its source, and a person reviews every appeal before it is filed.
The problem
Most denials are never appealed.
In 2023, HealthCare.gov Marketplace plans denied about 1 in 5 in-network claims, and consumers appealed fewer than 1% of them.
Source: KFF (opens in a new tab)
81.7% of appealed Medicare Advantage prior authorization denials were partly or fully overturned in 2023, yet only 11.7% were appealed.
Source: KFF (opens in a new tab)
Providers spend an estimated $19.7B a year fighting denials.
Source: Premier (opens in a new tab)
What Dearbh does
Four steps, from denial to a signed appeal.
Finds the rules
Finds the rules that govern the denial.
Requests the records
Requests the exact records each rule requires and tracks every reply.
Drafts with proof
Drafts the appeal with every claim quoted from its source.
Watches every deadline
Watches every deadline. A person signs off; nothing files on its own.
Built to be checked
Every quote is found again in its source.
Dearbh draws on a six-layer knowledge base: law, precedent (42,448 California external-review decisions), payer policies, clinical references, the case record, and outcomes. Every quote is re-found word for word in its source, and an 11-check final audit must pass before sign-off. Data is de-identified before any model sees it.
Business model
Priced per appeal, with a platform fee for institutions.
Individuals
$25 per appeal
Advocates and practices
$20 per appeal
For 25 or more appeals a month.
Institutions
$3K to $5K a month
A platform fee, plus per-appeal rates from $12 down to $8 by volume.
For investors who own practices
A partnership, not only an investment.
If you own or back physician practices, Dearbh lowers appeal costs across your portfolio from the first month, while your investment grows. Partners get a documented record of every appeal by payer and denial reason, for payer contract talks and value at exit.
Traction
Where Dearbh is today.
2 pilots in setup
A nonprofit family services organization in Athens, GA, and a pediatric therapy clinic in Falls Church, VA.
50
waiting-list sign-ups.
52
jurisdictions covered by filing-rights registries.
Founder
Thomas McShane, Founder and CEO
Compliance and data governance; former roles at ICE/NYSE and as data custodian for a large Medicaid population at UF Health. Thomas lives with SMA and builds Dearbh by eye tracking and voice, so it works for people who can’t easily fight paperwork.
The raise
Pre-seed.
Dearbh is raising a pre-seed round. Investment terms are available on our Wefunder page (opens in a new tab).
Contact: [email protected]
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Dearbh is not currently offering securities on this page. Any offering will be made only through Wefunder and its offering documents. No money or commitments are being accepted here.