Can AI take patient billing and payment calls?

A patient who calls about a bill can understand it and settle it in one call: a PolyAI voice agent verifies the patient, explains the balance in plain words and takes payment on the same call. If a patient can't pay in full, it offers your policy's payment plans and sends reminders, so the balance still gets settled.

Why patient balances take more work to collect

More of each bill now sits with the patient. As deductibles rise and more people move onto high-deductible health plans (HDHPs), the out-of-pocket share of a visit grows, and so does the number of patients calling to ask what a charge is for before they pay it. That is why the billing phone line matters as much as the statement.

Where the phone line fits in your revenue cycle

Revenue cycle management (RCM) runs from the first scheduling call to the final payment, and patient payment collection touches every stage of it:

• Upfront estimates and price transparency. Before the visit, your team checks eligibility and benefits and tells the patient what to expect. Uninsured and self-pay patients get Good Faith Estimates, which the No Surprises Act requires.
• Point-of-service (POS) collections. Copays, deductibles and any open balance are collected at check-in or check-out, under your front-desk process.
• Digital payments and patient portals. Patients pay through a portal with eStatements and online bill pay, a card on file, ACH payments from a bank account, or the phone.
• Payment plans for large balances. Your policy sets the terms, such as the minimum balance and the number of months, and your team or the agent offers them.
• Text message reminders and reminder calls. A reminder goes out with each statement, by phone or text, so a patient can ask about the charge and pay.
• Collection agency referral and outsourcing. Balances still unpaid at the end of your statement cycle go to a collection agency or an outsourced early-out partner, at the point your policy sets.

The agent takes the phone part of that cycle: it explains statements, takes payments, offers your payment plans, sends billing reminders and passes everything else to your team.

The billing calls the agent takes

Patient billing phone calls come down to a handful of questions: what a charge is for, why insurance didn't cover it, and how to pay. The agent answers each one from your billing data and the explanations your team has approved.

A patient says, "I got a bill for $180 and I thought my insurance covered this visit." The agent verifies who they are, pulls up the statement where your billing system shares it, and explains what insurance paid and what's left. Then it offers to take the payment now or send the question to your billing team for review.

Explaining statements and balances

The agent reads the balance and charges from your billing system and explains them in the wording your team has signed off. It can also update billing details such as the address on file, so the next statement reaches the patient.

Taking payments on the call

When the patient is ready to pay, the agent takes the payment on the same call through the payment provider you already use.

Payment reminders by voice or SMS

The agent sends a billing reminder by phone or text. A patient who picks up can ask about the charge and pay on the same call.

Balances before booking

If your policy says an open balance needs settling before a new appointment, the agent checks during the scheduling call and offers to take the payment or connect the patient to billing.

Your billing rules set the limits

You decide what the agent can offer, and it stays inside those rules. The agent does not change a balance, waive a charge or agree to a payment arrangement your policy doesn't allow. Disputes, hardship requests and questions about a specific claim go to your billing team with the patient's account and the reason for the call already captured, so nobody starts over.

If you're choosing where to begin, we think "what is this bill for" is the call to automate before any other, because patient payment collection goes better once the patient understands the charge, and the answer sits in data you already hold. Automating it leaves your billing team free for the disputes and hardship requests that need them.

Connected to your billing and payment systems

The agent works in your systems during the call, so it can answer from your own records. PolyAI connects to athenahealth for electronic health record (EHR) access, scheduling and billing in ambulatory (outpatient) practices, and to Epic through SMART on FHIR, a standard way for software to connect to health records. If your billing system or payment provider has an application programming interface (API), a way for one piece of software to talk to another, PolyAI connects to that too.

Patient data runs under HIPAA Security Rule controls examined within our SOC 2+ report, and a business associate agreement (BAA) is available for eligible healthcare deployments. You build the agent in Dialog Studio (formerly Agent Studio) or as code with the Agent Development Kit (ADK). Data handling, retention and model use are governed by your agreement and deployment configuration.

What the numbers look like

A Forrester Total Economic Impact study, commissioned by PolyAI, found a 391% return on investment over three years. The study looks at PolyAI deployments overall rather than billing calls in particular, so use it as a guide to the economics and measure your own billing line against it.

Three customer service measures show whether patient collections over the phone are working: first-call resolution (FCR), meaning the share of billing calls resolved end to end on the first call, payments taken during the call, and calls passed to your billing team with the reason already captured. Track them alongside the collection measures you already report, such as point-of-service collection rate, net collection rate and days in accounts receivable, and compare them before and after launch.