ClarityCare has raised $16.5 million to automate the insurance paperwork that can leave patients waiting for care their doctors have already ordered. The Series A, announced October 26 and led by venture capital firm Headline, brings the company's total funding to nearly $20 million.[1]
Its software, Electra, helps health plans process prior authorization: the review an insurer requires before covering certain tests, treatments, or prescriptions. Your doctor recommends the care, then the plan checks whether it meets its coverage requirements.[2][3]
ClarityCare is building a business around making that process faster. For patients, the news also raises a practical question: when is it worth paying directly for care and avoiding the insurance approval process altogether?
What ClarityCare actually does
ClarityCare sells software to health plans and the companies that administer health benefits. Electra works through the steps between receiving a doctor's request and sending a decision back to the office.[3]
Consider a request for a magnetic resonance imaging (MRI) scan. Electra can collect faxed notes, organize the patient's records, check their benefits, and identify which coverage criteria the records support. It then prepares the explanation and correspondence needed to finish the case. The company says Electra can approve qualifying requests or send cases for further review, but never issues denials.[1][3]
That matters because an authorization delay can involve several people waiting on one another. Someone needs to gather the records, a reviewer needs to assess them, and another person needs to communicate the decision. Missing documentation and unclear requirements can prolong the process.[4]
ClarityCare reported that one customer's authorization wait fell from 12 days to two, according to MedCity News. That is an early result from one customer, but it gives patients a concrete picture of what the company is trying to improve.[5]
The founders and investors behind ClarityCare
ClarityCare was co-founded by Hermine Tranie, chief executive officer, and Alex Andrei, chief technology officer. Tranie worked in machine learning research at the Massachusetts Institute of Technology and built software that interprets clinical text in electronic health records. Andrei previously led engineering teams and contributed to open-source healthcare data standards.[6]
The company launched in 2023 to automate document processing and reviews against coverage criteria, according to Tranie's Health Care Administrators Association biography.[7] Electra now extends that work through case creation, review support, and the letters and faxes needed to complete an authorization.[1]
Headline led the Series A, with new investors Arthur Ventures and FJ Labs joining existing investors Maverick, firstminute, Top Harvest Capital, and Transpose Platform. ClarityCare plans to use the funding to expand its engineering, clinical, and sales teams, build more products, and grow its work in the government sector.[1]
When paying cash can be the better choice
While companies like ClarityCare work to shorten insurance reviews, patients can sometimes avoid the review by buying a service directly. In an agreed self-pay arrangement, you pay the provider's price without asking your insurer to cover that service.
The decision starts with two numbers: the complete cash price and what you would personally owe through insurance.
Suppose a scan costs $400 in cash, while your estimated responsibility through insurance is $900. In that hypothetical example, paying directly saves $500 and removes the insurer's approval step. If your insured share is $80, the same $400 cash offer looks much less attractive.
There is also the rest of the year's spending to consider. Cash payments generally do not count toward your deductible or out-of-pocket maximum, so check your plan's rules before trading away that credit.[8]
What to compare | Why it matters |
|---|---|
Your insured cost | Compare the cash price with your actual share, including any remaining deductible. |
The full cash bill | Ask whether the quote includes the facility, interpretation, and separately billed services. |
Credit toward your annual limits | A lower cash bill today may leave you with more insured spending later. |
Timing | Ask when the service can happen under each payment option. |
For scheduled self-pay care, providers generally must give you a written good faith estimate when you book at least three business days ahead or request one. Ask each provider involved for an estimate so you can compare the complete cost.[9]
Our guide to how DPC doctors help patients find lower imaging prices explains how direct primary care practices arrange these options.
Why health plans are buying authorization software
Prior authorization requires the doctor's office and the health plan to exchange information before treatment is covered. Aetna describes a process in which the provider submits a request, the plan checks clinical information and benefits, and the provider can supply more information or challenge a denial.[10]
ClarityCare's opportunity is to reduce the work involved in that exchange. Faster handling can help patients receive decisions sooner while allowing health plans to keep their coverage rules.
Federal deadlines add pressure. In 2026, Medicare Advantage and specified Medicaid and Children's Health Insurance Program plans generally must decide non-drug authorization requests within seven calendar days, or 72 hours for urgent requests, with limited extensions. Those deadlines do not apply to every commercial plan or drug request.[11]
For someone waiting today, ask the office whether the insurer has received the request and exactly what is still missing. Your doctor can also assess whether urgent review is appropriate.[10]
Mark Cuban wants direct contracts to remove the wait
Mark Cuban described another approach on the October 28 episode of The a16z Show. In his direct contracts with hospitals, he offers payment on time and takes responsibility for patients' out-of-pocket costs in exchange for a better price. Trusting the treating doctor is part of the arrangement: “you're not going to need a pre-auth,” he said.[12]
The payment agreement determines how much approval work remains. ClarityCare automates the review inside insurance; direct payment can remove the need for that review for the service you buy.
Cash payment still requires a provider willing and able to accept it. Confirm the arrangement before scheduling, particularly if you have Medicare or Medicaid, and ask when the appointment is available.
What this means for DPC and concierge patients
Direct primary care (DPC) applies direct payment to routine primary care. A membership covers agreed-upon services without traditional insurance billing, removing the insurer from payment decisions for those services.[13]
The distinction becomes important when your doctor orders outside care. A scan, specialist visit, or prescription billed to insurance can still require authorization, even if your primary care visit was included in a DPC membership. Concierge practices may also bill insurance alongside their membership fees, so the fee alone does not remove approval requirements.[13]
A membership practice can help you compare options and coordinate the records needed for a request. Before joining, ask what the fee includes and who handles authorizations for outside care. Our DPC beginner's guide and specialist referral guide explain those responsibilities.
FAQ
Can I pay cash instead of waiting for prior authorization?
Often, if the provider accepts a self-pay arrangement. Confirm the full price and payment terms before treatment, including whether your plan gives you any deductible credit.[8]
Does prior authorization guarantee insurance will pay?
No. Approval does not guarantee payment or eliminate your share of the bill.[2]
What if my authorization is denied?
Ask for the reason and review it with your doctor. Your plan's notice should explain how to appeal and the deadline for doing so.[10][14]
Find a physician-led DPC or concierge practice on NextMD, and ask how the office helps patients compare cash prices with insurance coverage.
Sources
ClarityCare. (2026, October 26). $20M Raised to Help Get Patients the Right Care at the Right Time at the Right Place. Meet the New Electra. Series A investors, funding and product announcement.
HealthCare.gov. (Accessed 2026). Preauthorization. Definition and coverage limitations.
ClarityCare. (Accessed 2026). The AI Command Center for Healthcare. Electra's prior authorization workflow.
American Medical Association. (2025). Fixing prior auth: Clear up what's required and when. Documentation requirements and care delays.
Congdon, J. (2026, October 27). ClarityCare Raises $16.5M to Speed Up Prior Authorizations. MedCity News. Electra workflow and reported customer results.
ClarityCare. (Accessed 2026). Team. Hermine Tranie and Alex Andrei: roles and backgrounds.
Health Care Administrators Association. (2026, January 29). 2026 Executive Forum Speakers, p. 5. ClarityCare founder biographies and company origin.
Fortiér, J. (2026, April 13). How To Make a High-Deductible Health Plan Work for You. KFF Health News. Cash payments and deductible trade-offs.
Centers for Medicare & Medicaid Services. (Accessed 2026). Know your medical bill rights when not using insurance. Good faith estimates for self-pay care.
Aetna. (Accessed 2026). What is prior authorization? Prior authorization process and guidelines.
Centers for Medicare & Medicaid Services. (Accessed 2026). Improving Prior Authorization Processes. Decision deadlines, exclusions, and extensions.
Cuban, M., with Yoo, J., and Torenberg, E. (2026, October 28). Mark Cuban on Why AI Could Turn Solo Founders Into Trillionaires. The a16z Show. Interview, direct-contract discussion at 08:58.
American Academy of Family Physicians. (Accessed 2026). Direct primary care: What to know. DPC payment model and concierge comparison.
HealthCare.gov. (Accessed 2026). How to appeal an insurance company decision. Internal appeals and external review.