VOBs Complete
142
↑ 23 today
Success Rate
87%
↑ 4% vs last wk
Avg Duration
18m
Target <25m
Escalations
9
Need review
Est. Revenue
$2.4M
Pipeline this wk
Live — Aetna VOB · PT-00142
[IVR → Press 2 → Hold 3m 20s → Agent: Marcus]
Agent → "Hi Marcus, Sunrise Recovery, NPI 1234567890. Verifying benefits for member ending 4421, DOB 03/15/89."
Marcus: "PPO plan, active, Delta Corp group."
Agent → "Is behavioral health carved out to a separate administrator?"
Marcus: "No — Aetna manages behavioral health directly."
Agent → "Individual deductible in and out of network?"
Marcus: "In-network $1,500, out-of-network $3,000."
Agent → "How much of the deductible has been met year to date?"
Recent VOB Calls
| Patient ID | Carrier | LOC | Status | Duration | Q's | |
|---|---|---|---|---|---|---|
| PT-00142 | Aetna | RTC | ● Live | 9m 18s | 8/20 | |
| PT-00141 | BCBS FL | PHP/IOP | ✓ Done | 22m 14s | 20/20 | |
| PT-00140 | Cigna | RTC | ✓ Done | 31m 05s | 20/20 | |
| PT-00139 | UHC/Optum | RTC | ⚠ Escalated | 45m 00s | 14/20 | |
| PT-00138 | Humana | Detox | ✓ Done | 19m 30s | 20/20 |
Carrier Performance
BCBS Florida
91%Aetna
88%Cigna/Evernorth
85%United/Optum
74%Humana
88%Magellan
79%System Log
09:42:17
PT-00141 — BCBS VOB complete. 20/20. Ref# BCB-2024-441.
09:39:04
PT-00142 — Aetna call live. IVR navigated to Marcus.
09:31:22
PT-00139 — UHC escalated. Rep refused CPT code rates.
09:18:55
PT-00140 — Cigna complete. BH → Evernorth detected.
Call Queue
| Priority | Patient ID | Carrier | LOC | Status | |
|---|---|---|---|---|---|
| URGENT | PT-00143 | BCBS FL | Detox/RTC | Queued | |
| HIGH | PT-00144 | Cigna | PHP/IOP | Queued | |
| NORMAL | PT-00145 | Aetna | OP Psych | Scheduled 10am | |
| NORMAL | PT-00146 | UHC | RTC | Scheduled 10am |
Live Calls
2 ActivePT-00142 → Aetna
[IVR → Press 2 → Hold 3m 20s → Agent: Marcus]
Agent → "Verifying benefits for member 4421."
Marcus: "PPO, active, Delta Corp group."
Agent → "Is BH carved out?"
Marcus: "No — Aetna manages directly."
Real-time VOB — PT-00142
8 / 20Plan Status
✓ Active
Plan Type
PPO
Deductible (In)
$1,500
Deductible (Out)
$3,000
Deductible Met
Asking...
OOP Max
—
PT-00141 → BCBS — Finalizing
Agent → "And the reference number for this call?"
Patricia: "BCB-2024-441, extension 3301."
[Call ending — VOB auto-filling...]
20/20 ✓
Completed VOB — PT-00141 · BCBS FL
Plan Status
✓ Active
Deductible
$2,500 / $1,847 met
Coinsurance
80/20 in-network
Prior Auth
⚠ Required
Ref #
BCB-2024-441
Rep / Ext
Patricia · 3301
VOB Results
VOB Detail — PT-00141 · BCBS Florida · Complete
1. Plan Status
Active — eff. 01/01/2024
2. Plan Type
PPO
3. Group
Delta Corp / GRP-44210
7. Deductible (Ind. In)
$2,500
8. Deductible Met
$1,847 (74%)
9. OOP Max
$6,000
10. OOP Met
$4,200 (70%)
12. Coinsurance
80/20 in · 60/40 out
14. Prior Auth
⚠ Required all LOC
17. CPT Coverage
H0035 ✓ · H0015 ✓ · 90837 ✓
19. Ref #
BCB-2024-441
20. Rep / Ext
Patricia · 3301
| Patient ID | Carrier | LOC | Status | Duration | Prior Auth | Est. Revenue | |
|---|---|---|---|---|---|---|---|
| PT-00141 | BCBS FL | PHP/IOP | ✓ Done | 22m 14s | Required | $38,250 | |
| PT-00140 | Cigna | RTC | ✓ Done | 31m 05s | Required | $51,000 | |
| PT-00139 | UHC/Optum | RTC | ⚠ Escalated | 45m 00s | Unknown | TBD | |
| PT-00138 | Humana | Detox/PHP | ✓ Done | 19m 30s | Not req. | $24,500 |
Analytics
Total Calls
142
Avg Hold Time
8.2m
First-call Complete
87%
Denial Risk Flagged
14
Call Volume & Success Rate — 30 Days
Avg Hold Time by Carrier (minutes)
Prior Auth Rate by Carrier
Escalation Root Causes
Revenue Forecast
Est. Gross This Week
$2.4M
Based on 23 completed VOBs
Avg Per Patient
$104K
High Denial Risk
14%
Prior Auth Needed
67%
Expected Revenue by LOC
Denial Risk Score — By Carrier
Knowledge Base
Zero PII storedCarrier Intelligence — Learned from Calls
UHC / Optum — Multi-hold Pattern
Agent learns: UHC averages 3 hold sequences. Agent now pre-announces "I can hold" to reduce disconnects. Confidence built from 38 calls.
Cigna — BH Carve-out Detection
Cigna routes BH to Evernorth on 84% of employer group plans. Agent now pre-checks group type and dials Evernorth direct, saving avg 12 min per call.
BCBS FL — Fastest IVR Path Discovered
Press 2→3→1 reaches VOB dept in <90 seconds. Patricia and James are most knowledgeable reps. Confidence: 91% (22 calls).
Aetna — "System Maintenance" Deflection
Aetna reps use "system maintenance" to avoid giving per-diem rates on 31% of calls. Agent now pivots to coinsurance instead. Workaround success: 76%.
Knowledge Stats
Total KB Entries
847
Carrier IVR Maps
7
Ambiguity Resolution Rate
89%
Rep Profiles Learned
41
LLM Training Lab
⬡ VOBagent-7B · Fine-tune v0.3
Training Run — v0.3 Progress
CompleteVOBagent-7B vs. Retell Baseline
Training Data Bank
Labeled Examples
2,840
Carrier Sets
7
Status
Ready
Workflow Builder
Nodes
▶ Trigger
⬡ IVR Nav
◎ Hold / Wait
? Question
↗ Escalate
✓ Complete
Trigger
Patient Admitted
Webhook / Manual / Batch
Lookup
Carrier + IVR Map
Carrier DB resolve
Telnyx / Retell
Dial VOB Line
Verified caller ID
IVR Navigation
Navigate Phone Tree
DTMF per carrier map
Hold Detection
Wait for Agent
Re-engage on pickup
VOB Interview
20-Question Script
Real-time capture
Complete
VOB Auto-fill
→ Internal / Kipu
Carrier IVR Maps
| Carrier | VOB Phone | IVR Path | Avg Hold | Success | BH Carve-out | |
|---|---|---|---|---|---|---|
| BCBS Florida | 800-477-3736 | 2 → 3 → 1 | ~4 min | 91% | No | |
| Aetna | 800-624-0756 | 1 → 2 → 2 → 3 | ~7 min | 88% | Sometimes | |
| Cigna / Evernorth | 800-244-6224 | 3 → 1 → 2 | ~9 min | 85% | Yes → Evernorth | |
| United Health / Optum | 877-842-3210 | Complex 6 steps | ~18 min | 74% | Often → Optum BH | |
| Humana | 800-448-6262 | 1 → 3 → 2 | ~5 min | 88% | No |
Question Bank
All
Eligibility & Plan
Deductible
OOP & Cost Share
Coverage & Benefits
CPT & LOC Codes
Prior Auth
Network & Provider
Reference
| # | Category | Question | Answer Type | Priority | Notes |
|---|
API Console
Test Mode — SimulatedPOST /v1/vob/trigger
// Single real-time VOB call
{
"patient_id": "PT-00150",
"carrier_id": "bcbs-florida",
"level_of_care": "detox-rtc",
"priority": "urgent",
"mode": "test"
}
{
"patient_id": "PT-00150",
"carrier_id": "bcbs-florida",
"level_of_care": "detox-rtc",
"priority": "urgent",
"mode": "test"
}
Webhook — VOB Complete Payload
{
"vob_id": "vob-00141",
"status": "complete",
"questions_answered": 20,
"ref_number": "BCB-2024-441",
"answers": {
"plan_status": "active",
"deductible_individual_in": 2500,
"oop_max_individual": 6000,
"coinsurance_in": "80/20",
"prior_auth_required": true
}
}
"vob_id": "vob-00141",
"status": "complete",
"questions_answered": 20,
"ref_number": "BCB-2024-441",
"answers": {
"plan_status": "active",
"deductible_individual_in": 2500,
"oop_max_individual": 6000,
"coinsurance_in": "80/20",
"prior_auth_required": true
}
}