Some payor verification calls take three hours. Your team makes them anyway, because the order does not move until they do.
In production for a national sleep-care provider, Synthpop's payor agent has taken on more than 55,000 of those calls, some running the full three hours, with no staff time on the phone, getting PAP patients to therapy roughly twice as fast and letting the team complete 25% more orders without adding headcount.
Every DME and IDTF order waits on the same thing: an answer from a payor. Is the patient still covered, what will they owe out of pocket, and does this specific code need authorization first. Getting that answer reliably is anything but simple. Payor portals are inconsistent. Some return everything you need, some return nothing, and a few, including many Blue Cross Blue Shield plans, will not reliably reveal whether a code needs authorization without a phone call. That leaves teams dialing payors by hand, sitting through IVR menus, and working the details case by case.
The cost is easy to underestimate until you measure it. At one specialty diagnostic testing provider, a four-person insurance-verification team handles every order that comes through, and by their own account they spend as much as half of an eight-hour shift on the phone with payors, with a single regional Blue Cross Blue Shield plan accounting for well over a third of that call volume. The downstream effect is what hurts: every order the team cannot verify within five days risks falling out of the pipeline, and roughly one in ten orders ends up routed to patient self-pay simply because the verification could not be completed in time. That is revenue and patient access lost, not to a lack of skill, but to a lack of hours in the day.
The results
In production with a national sleep therapy and home sleep testing provider, The Synthpop's payor agent delivered:
- ~2x faster PAP time-to-therapy
- 55,000+ payor calls automated over two years, including calls running up to 3 hours, handled entirely by AI with no staff time required
- 25% more orders completed with the same staff
- 58% of manual payor calls eliminated
- 30% faster patient setup time
- Individual manual calls previously ran anywhere from 20 minutes to 3 hours
These are measured outcomes from live production traffic, not projections: real patients, real payors reached, and real orders and verifications closed.
Why it matters
For DME and IDTF providers, payor verification is the gate every order has to pass through, and getting through it well depends on the mix of channels involved. Some plans resolve cleanly through an API. Some require checking a payor-specific portal. Others, especially Blue Cross Blue Shield plans, require an actual phone call to get authorization information at all, because the portal simply will not surface it. Prior authorization in particular is still handled electronically only a fraction of the time across the industry, which is why the phone is not going away as a verification channel.
Even experienced teams that know their payors well are stuck doing this manually, call by call, code by code. One verification team reports completing roughly 85% of their Blue Cross Blue Shield objectives through the IVR alone, a strong bar set by people, not software. The opportunity is not that manual verification is done badly. It is that skilled teams are spending the bulk of their day on repetitive, high-volume calls that do not require judgment, work that can be automated without giving up the accuracy those teams have already proven they can hit.
"People gravitate toward this business because they want to help people. Automation lets us filter out the mundane work so our team can really use their expertise."
- VP of Operations, national sleep-care provider
What Synthpop's payor agent does
Synthpop automates the payor portion of the patient journey, eligibility, benefits, and authorization, across whichever channel actually gets the answer:
- Automated eligibility, benefits, and authorization checks. API-first, escalating to a phone call only when the electronic channel cannot resolve it.
- Payor-aware routing. Different plans need different channels. Synthpop routes each case down the path that actually works for that payor, rather than treating every payor the same way.
- AI voice agents that navigate payor IVRs and speak with live representatives. Capable of calls running up to three hours, without staff having to sit on hold or work through a phone tree.
- Structured, auditable outputs. Every check, call, and result is written directly back into the provider's own workflow, not left in a call log or a staff member's notes.
- Human handoff where it is actually needed. When a case genuinely cannot be resolved automatically, it is routed to the provider's own team with the verification work already done, not dumped back at square one.
Because the AI does the qualifying work first, the calls that do reach a person arrive pre-qualified rather than cold. And because the same architecture powers Synthpop's patient-facing and resupply calling, the payor step plugs into a platform that already runs at scale across sleep therapy, home sleep testing, and other DME categories where verification is most complex.
"A payor call should not be a three-hour tax on your best people. Our payor agent knows which channel will actually answer for each plan, and it hands providers a structured, provable result instead of a phone log. That gets patients to care faster, which is the whole point."
- Elad Ferber, Co-founder and CEO, Synthpop
See it run on your own payor mix: watch a recorded end-to-end payor verification, then book a working session where we walk through it using your own payor mix and call data.
