My brother Russell Feldman has dealt with countless (unjustified) treatment and claim denials over the course of his ongoing fight with Ulcerative Colitis. Russell is not only my younger brother but one of my best friends. His struggle inspired me to take action. Last year, Tal Shulman and I started Protego Health to fight unfairly denied medical claims.

In a world where health plans can use algorithms to deny claims (1), our dream is that providers will be able to use our software to understand if a denial is incorrect, and to help appeal it using automation, before it becomes patient responsibility. I am proud to announce that Covered Health has now returned 5 figures of revenue to the very GI group of which Russell’s GI doctor is a member (thank you Moshe Bellows of Maccabee Ventures for the introduction). Our product, while still basic, can already save RCM professionals time fighting denials.

There are ~$450 billion in denied medical claims each year. Over half should be overturned  (2, 3), but 60% of denials are never reworked (4), because fighting denials has been named the most time consuming task in RCM (5). Epic reported that initial denials were up 14% in 2023 (now totaling 15.1% of all commercial claims), and unsurprisingly, late last year, Revenue Cycle Managers reported denials as their number one problem (6). When providers don’t get paid, patients often end up with the bill. We intervene before that happens.

Our journey at Covered has not been an easy one. Just as we began to build momentum last year, my Israel Defense Forces reserve unit was called up after the atrocities of 10/7, three days after we had begun our fundraise. I spent two months in the IDF, most of it in the Gaza Strip. We were released in December, and in January, we hit the ground running. I am proud to report that we are on pace to close our first round of funding in the next few weeks thanks to the support of Adam Frieman, who stepping in as interim COO in my absence.

I would be extremely grateful for introductions to:

- Independent provider groups looking for solutions to their denial problems
- Pharmaceutical companies looking to de-risk non-payment for their drugs.
- RCM experts
- Innovative health systems looking to co-develop solutions around denials
- Investors (Angels or VC) who can add strategic value

Tal and I are extremely grateful for your assistance.

1 - Cigna Sued Over New AI-Powered Claims System
‍2 - 60-80% of Insurance Denials Overturned or Reversed When Taken to Independent Medical Review
‍3 - Half Of Insurance Claim Denials Are Overturned On Appeal
‍4 - Claims Denials: A Step-by-Step Approach to Resolution
‍5- Denials Management Named Most Time-Consuming Task in RCM
‍6 - Claim Denials Pose Expensive Problem for Providers