One AI Build

AI receptionist for medical practices

Almost every call to a medical practice contains protected health information from the first sentence, which makes the phone a compliance surface as much as a revenue channel. Volume is front-loaded and unforgiving: Monday mornings, the hour after a practice reopens, and the hour after each specialist's clinic ends, all landing on a front desk that is also rooming patients, chasing prior authorizations, and working a fax queue. The person who normally answers is a medical assistant or receptionist with no clinical authority, so a caller describing chest pain, a post-operative fever or a suicidal thought is being triaged by whoever happened to pick up. A missed call is worse than a lost booking, because the caller either goes to an urgent care or an emergency department or waits, and with the average new-patient wait already at 31 days across six specialties in 15 large metro areas, they have every reason to try a different practice instead.

Typical job value: $105 to $214 allowed per new-patient office visit under Medicare, using 2024 national averages: 99203 $105.33, 99204 $160.28, 99205 $213.67. Average submitted charges for the same three codes were $267.25, $410.82 and $560.92. Routine follow-up allows less: 99213 $85.37 and 99214 $119.71. Commercial contracts normally pay above the Medicare allowed amount and any procedure, imaging or lab billed at the same encounter adds to it, so a practice should substitute its own contracted rate before running an ROI number.

Checked August 19, 2026
31 days
The average wait for a new-patient physician appointment across six medical specialties in the 15 large metro areas surveyed is 31 days, up 19 percent since 2022 and up 48 percent since the survey began in 2004.
amnhealthcare.com · read August 19, 2026
23.5 to 41.8 days
New-patient wait times by specialty: obstetrics-gynecology 41.8 days, gastroenterology 40 days, dermatology 36.5 days, cardiology 32.7 days, family medicine 23.5 days, orthopedic surgery 12 days.
amnhealthcare.com · read August 19, 2026
$160.28
For a new-patient office visit with moderate medical decision making (CPT 99204) billed in an office setting, the 2024 national average Medicare allowed amount was $160.28 against an average submitted charge of $410.82, across 11.4 million services.
data.cms.gov · read August 19, 2026
$85.37
The most common office encounter, an established-patient visit with low medical decision making (CPT 99213), was billed 64.8 million times in an office setting in 2024 at a national average Medicare allowed amount of $85.37; the moderate-complexity code 99214 was billed 95.4 million times at $119.71.
data.cms.gov · read August 19, 2026

The calls that come in

  • · Symptom calls that need triage rather than scheduling, ranging from a sore throat to chest pain, shortness of breath, one-sided weakness, severe abdominal pain, or a post-operative fever.
  • · Prescription refill requests, the highest-volume repeat call in primary care, split between routine maintenance medications and controlled substances that cannot be handled the same way.
  • · Test and imaging result calls, where the caller wants a number read to them and the agent must verify identity and route to the ordering clinician instead.
  • · Referral and prior-authorization traffic: patients chasing a referral, specialist offices calling about a shared patient, and payers calling about an authorization, none of which is new-patient scheduling.
  • · New-patient access calls that begin with insurance and panel questions, are you accepting new patients, do you take my plan, how soon can I be seen.
  • · Post-discharge and post-procedure follow-up calls, often from a family member rather than the patient, which raises an immediate authorization question.
  • · After-hours and weekend calls that must reach the on-call clinician or the answering service, with a clean handoff record of who was told what and when.
  • · Monday morning and reopening-hour surges, plus the block right after each clinic session ends, when the desk is at its thinnest.

What the bot must handle

  • · Screen for red flags and escalate instantly, without diagnosing. Chest pain, difficulty breathing, stroke symptoms, uncontrolled bleeding, anaphylaxis, suicidal or homicidal ideation, or a pregnancy emergency must break out of the flow to 911 or to a live clinician. The agent states the escalation, it does not evaluate whether the symptom is serious.
  • · Never diagnose, never advise on treatment, never tell a caller a symptom is nothing, and never advise waiting. Triage protocol belongs to licensed staff; the agent collects the symptom, its onset, its severity, and hands off.
  • · Keep PHI out of any channel the system cannot secure. No clinical detail in a voicemail on an unverified number, no diagnosis or medication name in an SMS, no results read back over the phone, and no chart content disclosed to a caller whose identity has not been verified.
  • · Verify identity before disclosing anything, using at least two identifiers such as full name plus date of birth, and confirm the caller's authority before speaking to a spouse, adult child, or caregiver about an adult patient.
  • · Route refills by drug class, not as one queue. Routine maintenance refills go to the clinical refill workflow with pharmacy name, medication, dose and last fill date captured; controlled substances and anything requiring a visit or lab monitoring go to the clinician and never get a promised turnaround time from the agent.
  • · Route referrals and prior authorizations to the right desk with the referring provider, specialty, diagnosis, payer, and urgency captured, rather than dropping them into the appointment queue.
  • · Never release results. Capture the request, verify identity, and route to the ordering clinician's queue. The agent does not read a value, characterise a result, or say whether it is normal.
  • · Book against the correct visit type and length: new patient versus established, annual wellness visit versus problem visit, telehealth versus in person, and the correct provider, because a mis-booked slot is both lost revenue and a delayed patient.
  • · Capture the insurance and demographic set needed to register the patient: legal name, date of birth, address, phone, payer, plan and member ID, subscriber details, primary care provider, and referral status where the plan requires one.
  • · Record the after-hours handoff. Who called, what they reported, the time, and which on-call clinician was reached, so there is a defensible record if the clinical question turns out to matter.

Rules that apply to you, not the vendor

  • · HIPAA covers the phone call itself. A practice that transmits health information electronically in connection with a covered transaction is a covered entity, and the caller's symptoms, medications, appointment reason, insurance status and even the fact that they are a patient are all protected health information. See the definitions at https://www.ecfr.gov/current/title-45/section-160.103
  • · A signed business associate agreement with the AI vendor is mandatory. 45 CFR 164.502(e) permits disclosure of PHI to a business associate only after satisfactory written assurances, and 45 CFR 164.504(e) sets the required contract terms: permitted uses, safeguards, subcontractor flow-down, breach reporting, and return or destruction of PHI at termination. A vendor that will not sign a BAA, or that reserves the right to use call audio for model training, cannot lawfully answer clinical calls. See https://www.ecfr.gov/current/title-45/section-164.504
  • · Security Rule technical safeguards apply to recordings, transcripts and AI summaries. 45 CFR 164.312 requires access control, audit controls, integrity, authentication and transmission security for electronic PHI, so call audio and its derivatives must be encrypted in transit and at rest, access-logged, retention-limited, and deletable on request. Ask where audio is stored, in which region, for how long, and who can replay it. See https://www.ecfr.gov/current/title-45/section-164.312
  • · Minimum necessary constrains the script. 45 CFR 164.502(b) limits uses and disclosures to the minimum necessary for the purpose, which means an appointment bot should not collect or repeat a full problem list, and must not read chart content back to a caller.
  • · No PHI in a channel the system cannot secure. A detailed voicemail on an unverified number, an SMS naming a diagnosis or medication, or a transcript emailed in the clear can each be an impermissible disclosure of unsecured PHI, which triggers the individual notification duty at 45 CFR 164.404 and, at 500 or more affected individuals, media and HHS notification. See https://www.ecfr.gov/current/title-45/section-164.404
  • · Substance use disorder records carry a stricter regime than HIPAA. 42 CFR Part 2 governs records from federally assisted substance use disorder programs and generally requires patient consent for disclosure with narrow exceptions, so any practice line touching addiction treatment needs the agent and the vendor scoped under Part 2, not just HIPAA. See https://www.ecfr.gov/current/title-42/part-2
  • · Triage is a licensed activity. Only licensed clinicians may assess symptoms, give clinical advice, or decide that a symptom can wait. A nonclinical agent that suggests a caller take a medication, characterises a symptom as minor, or offers a next-available appointment to someone describing chest pain is practising medicine without a licence and is creating direct liability for the practice.
  • · TCPA outbound limits: 47 CFR 64.1200(c)(1) bars telephone solicitations to a residential subscriber before 8 a.m. or after 9 p.m. local time at the called party's location and requires prior express written consent for autodialed or prerecorded telemarketing. Appointment reminders and care-related calls are treated more permissively than marketing, but service-line promotions, aesthetics offers and reactivation campaigns are marketing and need documented consent, an opt-out path, and a quiet-hours guard. See https://www.ecfr.gov/current/title-47/section-64.1200
  • · AI voices are covered by the TCPA. On February 8, 2024 the FCC adopted a Declaratory Ruling holding that calls made with AI-generated voices are artificial under the TCPA, effective immediately, so synthetic-voice outbound reminders and recall campaigns sit under the same consent, identification and opt-out rules as prerecorded robocalls. See https://docs.fcc.gov/public/attachments/DOC-400393A1.pdf
  • · Call-recording consent: California Penal Code 632(a) makes it an offense to record a confidential communication without the consent of all parties. Other all-party consent states, commonly including Florida, Illinois, Pennsylvania and Washington, apply similar rules, so a recording disclosure should be spoken at the top of every call in every market rather than configured per state. A recorded clinical call is both a consent question and a PHI question. See https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=PEN&sectionNum=632

What those missed calls cost a medical practice shop

Missed calls a month
35
at the rate you set
Jobs that walk
12.1
35% would have closed
Revenue on the floor
$1,273
every month

Your close rate is a guess unless you track it — start at 35% and adjust. The point isn't the exact number, it's whether the monthly figure is bigger than what an answering service costs.

Vendors that document what medical practices need

Filtered to services whose own docs claim live transfer or real calendar booking — the two things this trade can't do without. Cheapest published price first.

Bland AI

AI only

$0/mo

Start plan

Developer and enterprise voice AI platform that owns its own telephony, speech-to-text, LLM, text-to-speech and pathway orchestration stack and sells it on a per-minute rate plus a monthly platform fee, so buyers build and operate their own phone agents rather than buying a packaged receptionist.

Free trialSpanishChecked August 19, 2026

Rosie

AI only

$0/mo

Website Chat (add-on) plan

AI answering service for US small businesses and home-services trades that answers calls 24/7, takes custom messages, books appointments and transfers callers to the owner's own team.

Free trialSpanishChecked August 19, 2026

Smith.ai

AI + human backup

$0/mo

AI Receptionist — Free plan

Smith.ai sells small and mid-sized businesses two products off one platform: an AI Receptionist that answers, qualifies and books 24/7 with escalation to its North America-based Live Agent Network, and a fully human Virtual Receptionist service, both billed per call rather than per minute.

≈$1.60 per callFree trialSpanishChecked August 19, 2026

Dialzara

AI only

$19/mo

AI SMS Agent plan

AI calling platform for small and mid-sized businesses led by an AI receptionist on flat monthly tiers of included talk minutes, with separately priced outbound voice agents, an AI SMS agent and a website chatbot in the same account.

Free trialSpanishChecked August 19, 2026

Goodcall

AI only

$66/mo

Starter (annual) plan

Agentic voice AI phone agents for local, multi-location and enterprise businesses, sold per agent per month with unlimited call minutes and a monthly cap on unique callers instead of per-minute billing.

Checked August 19, 2026

Simple Phones

AI only

$97/mo

Basic plan

Turnkey AI phone answering service for small businesses: Simple Phones generates a starter agent from your business details, assigns a number you forward missed calls to, and their team makes ongoing agent customizations on request rather than you building the agent yourself.

≈$0.97 per callFree trialSpanishChecked August 19, 2026

Questions

Can an AI receptionist handle medical practice calls?
Almost every call to a medical practice contains protected health information from the first sentence, which makes the phone a compliance surface as much as a revenue channel. Volume is front-loaded and unforgiving: Monday mornings, the hour after a practice reopens, and the hour after each specialist's clinic ends, all landing on a front desk that is also rooming patients, chasing prior authorizations, and working a fax queue. The person who normally answers is a medical assistant or receptionist with no clinical authority, so a caller describing chest pain, a post-operative fever or a suicidal thought is being triaged by whoever happened to pick up. A missed call is worse than a lost booking, because the caller either goes to an urgent care or an emergency department or waits, and with the average new-patient wait already at 31 days across six specialties in 15 large metro areas, they have every reason to try a different practice instead. The ones worth buying can Screen for red flags and escalate instantly, without diagnosing. Chest pain, difficulty breathing, stroke symptoms, uncontrolled bleeding, anaphylaxis, suicidal or homicidal ideation, or a pregnancy emergency must break out of the flow to 911 or to a live clinician. The agent states the escalation, it does not evaluate whether the symptom is serious., Never diagnose, never advise on treatment, never tell a caller a symptom is nothing, and never advise waiting. Triage protocol belongs to licensed staff; the agent collects the symptom, its onset, its severity, and hands off., Keep PHI out of any channel the system cannot secure. No clinical detail in a voicemail on an unverified number, no diagnosis or medication name in an SMS, no results read back over the phone, and no chart content disclosed to a caller whose identity has not been verified. — check each vendor's own docs for those specific features before you sign.
What does an AI receptionist cost for a medical practice business?
Published entry plans run from $0/mo up. Against a typical $105 to $214 allowed per new-patient office visit under Medicare, using 2024 national averages: 99203 $105.33, 99204 $160.28, 99205 $213.67. Average submitted charges for the same three codes were $267.25, $410.82 and $560.92. Routine follow-up allows less: 99213 $85.37 and 99214 $119.71. Commercial contracts normally pay above the Medicare allowed amount and any procedure, imaging or lab billed at the same encounter adds to it, so a practice should substitute its own contracted rate before running an ROI number., one recovered call a month usually covers it.

Sources