It clears.Then it dials.Sometimes it doesn't.
In the United States the expensive call is not the one that goes badly — it is the one that should never have been placed. Five things are cleared before any number is dialed, and when one of them fails the agent stops and tells you which.
- BAA before go-live
- Consent checked on every dial
- Flat monthly fee in USD
- Live in 7 days
Pre-dial clearance
Recall run · 318 numbers queued · 10:04:02
- ConsentOn file for this number and this purpose
- RevocationNone on voice, text or email
- WindowInside the patient's local calling hours
- IdentityPractice named, agent discloses it is virtual
- RecordingAnnounced — this state is all-party
1 number held back
Not dialedConsent revoked by text on 9 March. Logged the moment it was heard, applied to voice and messaging at once, and never queued again — the call your practice would have been liable for.
The safest call is the one it refuses to make.
Any vendor can make a phone answer. The one that decides not to dial — and can show you the consent record behind that decision — is the one your counsel signs off on.
See it clear a real listThe same Tuesday, with and without it
Nothing exotic — five ordinary moments from one day at a two-provider practice. The left column is what happens now.
07:52
Before the doors open
A recording asks them to try again at eight. Some of them do.
Answered, triaged against your booking rules, booked for 08:15.
Booked12:40
Four lines at lunch
Whoever is standing at the counter wins. The rest hang up.
All four taken in parallel. No hold, no callback list for tomorrow.
No hold15:05
A cancellation lands
The hour goes cold until somebody has time to work the waitlist.
Released at 15:05, offered in the order you set, filled at 15:11.
Backfilled17:31
Half an hour after close
Voicemail. Which is a callback list for tomorrow, on top of tomorrow.
New patient booked, insurance captured, intake texted before bed.
New patient09:05
The empty chair
The no-show is confirmed five minutes in. Nobody left to call.
Confirmed the day before — and when it still breaks, the slot refills.
RecoveredThe rules moved twice while vendors were shipping demos
An agent that phones patients is regulated twice over: once as healthcare, once as telecoms. Both changed recently. Here is the sequence, dated and cited — and what we do at each point.
Standing
45 CFR §164.502(e) and §164.308(b)
HIPAA and the BAA
Any vendor that creates, receives, maintains or transmits protected health information on your behalf is a business associate, and the relationship has to be papered before a single call is handled.
We sign the BAA before implementation begins — a precondition, not an upsell.
How we paper it →8 Feb 2024
FCC Declaratory Ruling, CG Docket 02-278
AI voices became “artificial” under the TCPA
The FCC ruled unanimously that calls using AI-generated voices fall under the artificial-and-prerecorded-voice rules: prior express consent, caller identification, and a working opt-out.
Consent is a field on the contact record, checked before every dial — not an assumption an implementation can skip.
11 Apr 2025
FCC consent-revocation rules, key provisions in force
Consent can be revoked in any reasonable way
Patients can withdraw consent however they naturally would — “stop”, “don't call me”, a reply to a text — and the request has to be honored promptly, within ten business days at the outside.
The revocation is recorded the moment it is heard, applied across voice and messaging, and that number is never dialed again.
Varies by state
State wiretap and eavesdropping statutes; configured per state
Recording follows the caller, not your head office
Several states require every party to a call to consent before it is recorded, and the rule follows the person on the other end of the line.
The agent announces recording where the state requires it and logs the acknowledgement, so the recording stays usable.
Calls in, calls out, and the line it will not cross
One agent, one memory, three jobs — and the third one is the reason the other two are safe to run.
Inbound
Nothing lands in a voicemail box somebody has to work tomorrow.
- Answers in seconds, in parallel
- Books, reschedules and cancels in your calendar
- Hours, locations, directions, what to bring
- Collects and verifies details before the visit
- English or Spanish, depending on the caller
Outbound
Consent is checked before every dial; a revocation lands on every channel at once.
- Reminders and confirmations by voice and text
- Waitlist backfill the moment a slot opens
- Recalls: overdue annuals, follow-ups, lapsed patients
- You approve the list and the script first
- Opt-outs applied instantly, everywhere
Escalation
The clinical boundary is hard-coded, not a setting an implementation can move.
- No clinical advice, ever
- Red flags transferred immediately, with context
- Out-of-policy calls handed over with the transcript
- Every conversation recorded, transcribed, summarized
- Knowledge gaps surface as work you can close
A week is 168 hours. Here is how much of it each option covers.
Solid means somebody — or something — can finish the job on the spot: book it, move it, refill it. Hatched means the phone was picked up and a message was taken.
Nine hours a day, five days — minus lunch, minus the other line, minus the day somebody is out.
More hands inside the same nine hours, billed per seat. The evening, the weekend and the recall list are exactly where they were.
Someone picks up at 2 a.m. and writes it down. Nothing is booked on the call, and the bill grows per minute.
Every hour of the week, in parallel, finishing the job — and every outbound dial cleared before it is placed.
One number a month, and nothing that grows behind your back
Sized once to your call volume, channels and locations. Busy January costs what quiet July costs — which is the entire point of not billing per minute.
In the monthly fee
- Voice + text, inbound and outbound
- Implementation and training
- BAA, signed before any record
- Recordings, transcripts, summaries
- Consent and revocation log
- Full data export, on request
Never billed
- Per minute
- Per message
- Per seat
- Onboarding fee
- Feature modules
- Monday-morning overage
Thirty minutes on your own call report, and the quote follows by email whether or not you go ahead.
Straight answers
Prefer email? Write to support@getarbol.com — a person answers.
Will you sign a Business Associate Agreement?
Yes, before implementation begins. Handling protected health information without one is not an option we offer.
How do you handle consent for reminder and recall calls?
Consent status is a field on the contact record, not an assumption. The agent checks it before dialing, captures it when a patient gives it on a call, and applies a revocation across every channel the moment it hears one.
Does the agent tell patients it is an AI?
Yes, in the opening line, using your practice's name. It also announces call recording where that applies. Transparency is not a setting an implementation can turn off.
Do we have to replace our EHR or phone system?
No. Arbol answers the number you already publish and books in the schedule you already keep. Nothing is migrated and your data is exportable in full.
What does it cost?
A flat monthly fee in USD, sized to your call volume, channels and locations — not per minute. You get the number in writing after a 30-minute call.
Next Tuesday it is already running.
The BAA is signed on day two, before anything touches a record. Five of the seven days are ours — you spend them approving the tone, the flows and the escalation paths.
Day 1
We audit the phone
Thirty minutes on call volume, abandon rate, no-show rate and how far out your book runs. Nothing is installed — you leave with the business case in your own numbers.
Days 2–6
BAA signed, agent trained
Paperwork first. Then services, providers, locations, hours, payers and booking rules — and you approve the tone, the flows and every escalation path.
Day 7
Live on your published number
Voice and messaging connected, consent checked before every outbound dial, every conversation recorded and searchable from hour one.