Clinics searching for an AI answering service often land on two options: MedReceptionist (fully automated AI voice agent built for healthcare) and Smith.ai (AI receptionist plus optional live receptionists). This page lays out the factual differences so you can make the right call for your practice.
MedReceptionist is a purpose-built AI phone receptionist for medical, dental, chiropractic, PT, dermatology, med spa, and other healthcare practices. It answers calls in under 2 seconds, speaks in natural conversational voice, books appointments directly into EHRs via API, sends SMS confirmations, handles after-hours calls, and signs a HIPAA Business Associate Agreement with every practice. No human agents are involved — the AI handles calls end-to-end. One flat plan: $349/month per practice.
Smith.ai provides an AI Receptionist plus North American live receptionists who answer calls and chats on behalf of businesses including healthcare practices. Agents are trained to follow custom call scripts. Smith.ai states it is not HIPAA-compliant and cannot handle PHI. Its receptionists book through calendar tools such as Calendly and Acuity. Pricing is per call: live-agent plans start at $300/month for 30 calls ($11.50 per additional call), and its AI Receptionist has a free 25-call tier and paid plans from $150/month.
Key factors that matter to medical practices — compared honestly.
| Feature | MedReceptionist | Smith.ai |
|---|---|---|
| Call Answering Model | Fully automated AI No human agents — AI handles calls end-to-end 24/7/365. | AI or live agents Offers an AI Receptionist plan and separate North American live-agent plans. |
| Real-Time AI Voice | Yes — sub-2s response Natural conversational voice. Patients often can't distinguish from a human. | Yes — AI Receptionist plan Smith.ai's AI Receptionist answers calls 24/7; live agents are a separate plan. |
| EHR Appointment Booking | Direct EHR API / FHIR Books in real time during the call into your EHR — no relay or follow-up needed. | Via calendar tools Books into calendar tools such as Calendly and Acuity ($1.50 per booking on live-agent plans). No EHR booking listed. |
| HIPAA Compliance | Yes — BAA standard BAA signed at setup. Encrypted calls. PHI handled per HIPAA requirements. | Not HIPAA-compliant (per Smith.ai) Smith.ai states it is not HIPAA-compliant and cannot handle PHI; it points practices needing HIPAA to other providers. |
| Pricing | $349/mo flat One flat plan per practice ($249/mo with a MedSiteAI website plan). 500 AI voice minutes + 10,000 texts/mo included; no per-call billing. | Free–$810+/mo Per-call pricing. AI Receptionist: free tier (25 calls), Pro from $150/mo. Live agents: Starter $300/mo for 30 calls, then $11.50/call. |
| 24/7 Availability | Always on 24/7/365 including holidays. After-hours not billed separately. | 24/7, billed per call 24/7 coverage on live-agent and AI plans; calls at any hour cost the same per-call rate. |
| Spam / Robocall Screening | Automated screening Spam and robocalls are screened automatically. Junk calls don't consume your minutes. | Spam not charged Smith.ai says it does not charge for spam calls when caller ID passes; its AI plan lets you remove up to 10% of calls as spam each cycle. |
| SMS Reminders | Included in plans Automated appointment confirmations and reminders sent via SMS. Included in the flat plan. | Text follow-up add-on Text and email follow-up is $0.50 per call on live-agent plans. |
| Healthcare Focus | Healthcare-only product Designed exclusively for medical, dental, chiro, PT, dermatology, med spa, and similar practices. | Multi-industry Serves law firms, home services, IT and other industries; its medical page targets healthcare-adjacent businesses that do not need HIPAA. |
| Setup Time | Live in 24 hours Configure greetings, hours, services, and call routing. Forward your existing number. Done. | Not published Smith.ai does not publish an onboarding timeframe. |
Pricing and feature information accurate as of May 2026. Smith.ai pricing sourced from published plan pages. Feature claims reflect publicly documented capabilities.
MedReceptionist is purpose-built for healthcare — it books appointments directly into EHRs, signs a HIPAA BAA, handles medical triage routing, and operates as a fully automated AI voice agent. Smith.ai offers an AI Receptionist and separately priced live receptionists, and states it is not HIPAA-compliant. For clinics that want 24/7 automated call handling without per-minute staffing costs, MedReceptionist is generally the more cost-effective fit. Smith.ai may suit practices that specifically want a human voice on every call.
Smith.ai states on its medical and wellness page that it is not HIPAA-compliant and cannot handle protected health information (PHI). MedReceptionist also signs a BAA with every practice as a standard part of setup, with no additional fee or plan upgrade required.
MedReceptionist are a flat $349/month per practice ($249/month with a MedSiteAI website plan). Smith.ai's live-agent plans start at $300/month for 30 calls, and its AI Receptionist has a free 25-call tier with paid plans from $150/month. Because MedReceptionist is fully automated AI, it can handle higher call volumes at a fraction of the cost of human-staffed virtual receptionist services. A busy practice with 200+ calls/month pays a flat $349/mo with MedReceptionist versus $810+/mo on Smith.ai's live-agent plans.
Smith.ai virtual receptionists can follow scheduling protocols and book via scheduling web portals, but this typically requires relaying information rather than direct real-time EHR API integration. MedReceptionist connects directly to your EHR via API or FHIR R4 integrations to book appointments in real time during the call — no relay, no follow-up required, and the appointment is confirmed to the patient before they hang up.
MedReceptionist provides fully automated 24/7/365 coverage — including holidays and weekends — at no additional after-hours fee. Smith.ai also offers 24/7 answering at the same per-call price. The difference is the billing model: Smith.ai charges per call, so after-hours volume adds to the bill, while MedReceptionist is one flat monthly price.
Yes. MedReceptionist applies automated spam and robocall screening and will not consume your call minutes on junk calls. Only genuine patient calls are processed and logged. Smith.ai also says it does not charge for spam or unsolicited sales calls, provided caller ID passes.
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Sources (competitor pages, checked 2026-10-16): smith.ai/pricing/receptionists · smith.ai/pricing/ai-receptionist · smith.ai/industries/medical-wellness-answering-service