The way healthcare providers navigate payer/insurer coverage policy is completely broken. Today, Penelope Health launches with $100m of committed capital to build the policy intelligence layer that US healthcare never had.
Every medical claim in America lives or dies by payer coverage policies โ documents that dictate which codes are covered, which diagnoses qualify, and what documentation is required. There are thousands of these documents which update several times per year and without warning, buried in 50-page PDFs across arcane insurer web portals.
Whereas claims submission got Waystar and Availity, the policy intelligence that sits upstream of every claim has been left to manual portal-trawling, static data vendors, and a lot of Googling.
The result is billions in preventable denials, appeals that take weeks, and clinical staff spending hours on admin that should take seconds.
The problem is harder than it looks. Payers update policies on a random Wednesday and change code coverage overnight. There are 5+ clinically significant differences between any two payer policies on average. And the most important information is routinely hidden in footnotes and appendices โ invisible to keyword search.
Penelope Health is the real-time medical coverage policy network that changes all of that with 500,000+ extracted codes, 2 million medical necessity criteria, daily policy updates and sub-second API response times. Query by payer, plan, CPT, ICD or HCPCS โ and get back structured, contextual intelligence you can actually act on: claim scrubbing, prior auth generation, appeal letters, payer competitive analysis.
Sohum and Mattijs are clinical and engineering maestros (and clinical operators!) with a rare combination of lived frustration and technical depth.
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@seedcamp @tom_wils