Itzik
Cohen

While running Beyond Finance - a debt settlement company he had built into a top-two national operation - Itzik Cohen started noticing something in his enrollment data. Medical debt was growing faster than any other category. Not credit cards. Not auto loans. Medical bills.

Most people in that position would file it as a market insight and move on. Cohen founded PayZen.

That pattern - see the signal in the numbers, act on it directly - runs like a wire through everything Cohen has built. At WebEx, he was reading the early geometry of internet communications and staking his career on video calls before they were obvious. At Prosper, he was building peer-to-peer lending infrastructure when consumer fintech was still a novelty. At Beyond Finance, he was automating debt settlement workflows that were still being run by call centers. Each stop sharpened a specific instrument. By the time he sat down to design PayZen in late 2019, he had a full orchestra.

PayZen's premise sounds almost too clean: patients get interest-free, AI-underwritten payment plans for medical bills. Providers collect more - 30 to 35% more - because the plans are designed around what patients can actually pay, not what the billing department hopes they will. The company takes a percentage of collections. Nobody charges the patient interest. Nobody sells the debt.

The platform integrates directly with EMR and EHR systems - Epic MyChart and others - so the patient experience is embedded in the healthcare workflow, not bolted on afterward. AI underwriting models assess individual financial capacity in real time, generating plans that are personalized rather than standardized. The result is high enrollment, high repayment, and high NPS scores in a domain usually associated with the opposite of all three.

In August 2024, NEA led a $232 million round - $32 million equity plus a $200 million credit facility - that brought PayZen's total capital raised to $452 million. The round was oversubscribed and highly competitive. Mohamad Makhzoumi of NEA joined the board. Existing investors 7wireVentures, SignalFire, and Viola Ventures all recommitted.

The company's trajectory has been steep: 6x year-over-year growth sustained over two consecutive years, 100% customer retention, 132% net revenue retention. Those numbers land differently when you know the sector - healthcare technology sales are notoriously slow, trust is hard-won, and switching costs work against new entrants. PayZen has not lost a customer. That detail matters more than the headline funding number.

Cohen describes PayZen not as a lending solution or a buy-now-pay-later product, but as the operating system for healthcare affordability. The distinction is deliberate. BNPL implies a transaction layer. An operating system implies infrastructure that everything else runs on top of.

The ambition maps to the problem's scale. The average American family now spends $4,400 per year in out-of-pocket healthcare costs. Hospitals run on 1.2% average margins - thinner than most grocery stores. Patients delay or forgo care because they can't see a path to paying for it. Providers absorb bad debt and pursue collections that further damage patient relationships. Everyone loses.

PayZen's bet is that AI underwriting can identify - at the individual level, in real time - what a patient can actually pay, and construct a plan around that reality. Not a standardized payment schedule. A personalized one. When the plan fits, patients enroll. When they enroll, they pay. When they pay, providers collect more than they would have otherwise, and nobody has been charged interest.

The company is on track for cash flow positivity. It has 132% net revenue retention - meaning existing customers expand faster than the company acquires new ones. The $200 million credit facility embedded in the Series B gives PayZen the balance sheet to underwrite plans at scale without being constrained by equity capital.

Cohen has been methodical about trust in a sector that punishes impatience. He started with pilot programs. He built on success-based revenue models that aligned his company's outcomes with his customers'. He grew with the relationships rather than past them. It's the strategy of someone who watched WebEx earn its way into Cisco, and Beyond Finance earn its way to the top of its market. Two decades of learning what doesn't work, applied to the problem that matters most.