Pricing and Coverage
Cost decides where a caller goes. Read back your posted self-pay rates and contracted plan list exactly as written, and route estimate requests to billing.
For a self-pay caller, cost is not a detail, it is the whole decision. A vague answer sends them to the next clinic on the search results. A clear reading of your posted price, with an honest statement of what could add to it, is the most persuasive thing your phone can do.
Being in network is not the same as a service being covered, and neither is the same as what a patient will owe. Keeping the phone to a factual contracted-plan answer, and routing everything past that, protects the clinic from a promise it cannot honour.
The federal good faith estimate process has content and timing requirements your billing team already handles. The right phone behaviour is to recognise the request, capture who is asking and for what, and hand it to the people who produce estimates properly.
A patient quoted a visit price and billed for imaging, a rapid test and a splint feels misled even when every charge is legitimate. Stating up front that the posted price covers the visit and that services performed are additional sets the expectation before the encounter, not after the statement arrives.
24/7 coverage
Price and coverage questions answered at the evening and weekend hours self-pay callers ring
Dozens of languages
Posted pricing and payment policy explained in the caller's own language
HIPAA BAA included
Caller detail from pricing and estimate requests encrypted with AES-256 at rest and TLS in transit
Only if your clinic publishes a bundled price for that combination. Otherwise it reads the visit price, states that services performed are billed in addition, and lists the posted add-on prices you have approved. It does not add figures together on its own.
No. It answers whether a plan appears on your contracted list and nothing further. Eligibility, benefit and cost-share questions are captured and routed to your billing team, because an incorrect coverage answer on the phone becomes a billing dispute later.
It recognises the request, captures the caller, the service they are asking about and their contact details, and routes it to billing. The estimate itself is produced by your team under your process, not generated on the call.
Yes. Posted prices, payment policy and contracted plan lists are configured per site, so a caller hears the pricing for the location they are actually being directed to rather than a group average.
Then the system says so in your own words and routes the caller to billing. Publishing a self-pay price is a business decision. Inventing one on a phone call is not an option the system offers.
No. It does not offer site-of-care advice on the basis of cost. Where a caller describes something your clinicians flagged, their redirect instruction runs first and price is not part of that conversation.
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