The problem
Insurance denials are routine. In 2023, HealthCare.gov Marketplace plans denied about 1 in 5 in-network claims, 86 million in all, and consumers appealed fewer than 1% of them. When people do appeal, they often win: 81.7% of appealed Medicare Advantage prior authorization denials were partly or fully overturned in 2023, yet only 11.7% were appealed. Providers spend an estimated $19.7B a year fighting denials. Patients and claimants mostly don't fight at all.
Why the gap exists
An appeal is a legal argument, and patients are handed a form letter. Private plans, ACA plans, Medicare, Medicaid, SSDI and SSI each run on different law, timelines and review levels. The winning text sits in regulations, coverage determinations and plan documents most people never see. Deadlines lapse and records go unrequested, so strong cases die on paperwork, not merit.
What Dearbh does
Dearbh builds appeals from the insurer's own rules. It identifies the rules that govern the denial, quotes every claim word for word from its source, requests the exact records each rule requires and tracks every reply, then drafts the appeal and watches every deadline. A person reviews every appeal. Nothing files on its own. It is accessible by design, with eye tracking, switch and speech support, and it is also available inside ChatGPT and Claude through the Dearbh MCP connector.
Built to be checked, not just believed
Every sentence traces to a six-layer knowledge base: the law, precedent (42,448 California IMR decisions), the payer's own policies, clinical references, the person's case record, and a ledger of what has actually won. Retrieval is exact-match and auditable. 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, and inference runs under a signed BAA.
Business model
Individuals pay $25 per appeal. Advocates and practices filing 25 or more a month pay $20. Institutions pay a $3K to $5K monthly platform fee plus tiered per-appeal rates from $12 down to $8. Buyers include rare disease clinics, manufacturer patient access and hub services, specialty pharmacy, behavioral health groups, foundations, health systems, advocates and law firms.
Where we are today
Two pilots are in setup: a nonprofit family services organization in Athens, GA, and a pediatric therapy clinic in Falls Church, VA. We have 50 waiting-list sign-ups and filing-rights registries covering 52 jurisdictions.
Why this founder
Thomas McShane is a compliance and data governance expert, with former roles at ICE/NYSE and as data custodian for a large Medicaid patient population at UF Health. He lives with spinal muscular atrophy and builds by eye tracking and speech. Dearbh works for people who can't easily fight paperwork because he is one.
The raise
Dearbh is raising a $1.5M pre-seed round to cover 18 months of costs, including the full licensed data set, with no revenue assumed. 18-month targets: 12 institutions, 10,000 appeals filed, $684K ARR and $984K total yearly revenue, past break-even.