Alternatives
Smith.ai alternatives for medical practices
optni.ai is one of the options on this page, so read it with that in mind. Every entry states who it is genuinely best for, including the ones that are not us. Pricing checked in September 2026.
In short
The main reason practices look past Smith.ai is cost predictability: their model charges per call when a human takes over, so a busy month is an expensive month. AI-native alternatives bill flat monthly rates instead. optni.ai is the healthcare-specific option from $99 per month with a HIPAA BAA on every plan; Rosie and Goodcall are cheaper horizontal options without healthcare depth; Ruby is the closest like-for-like if you want to keep humans in the loop.
Why people switch
Common reasons practices look past Smith.ai
- Per-call handoff fees make monthly cost hard to forecast
- You want healthcare-specific scheduling rather than a generalist built for law firms
- You need appointments written into a practice-management system
- You want patient recall and no-show follow-up in the same product
The options
5 alternatives, compared honestly
optni.aithat's us
From $99/month flatHealthcare-specific AI front desk. Ava on voice, Max on text, one shared memory. Writes bookings back to Open Dental, ezyVet, ChiroTouch, Boulevard and more. BAA on every plan.
Best for: Practices with steady routine call volume that want predictable cost
Ruby Receptionists
Typically $235+/monthThe closest like-for-like to Smith.ai — human receptionists with a long track record. Choose this if the human layer is the point.
Best for: Practices that specifically want trained humans answering
Rosie
From ~$49/monthSimple horizontal AI answering with a low entry price and unlimited minutes on the base tier.
Best for: Non-healthcare small businesses where price leads the decision
Goodcall
From ~$79/month per agentHorizontal AI phone agent with a free trial and straightforward per-agent pricing.
Best for: Small businesses wanting to test AI answering with minimal commitment
Dialzara
From ~$29/monthLow-cost AI answering aimed at solo operators and very small teams.
Best for: Solo practitioners with light call volume
Questions
Before you switch
Most commonly cost predictability. The AI tier is competitively priced, but per-call charges when a human takes over mean a busy month costs materially more than a quiet one — which is difficult to budget for a practice with seasonal call patterns.
Ask each vendor directly whether they will sign a Business Associate Agreement, and get it in writing. optni.ai includes a BAA on every plan. Several horizontal AI answering services do not offer one at all.
The only comparison that settles it
Have Ava call you, then have the alternative call you. Whichever one you would want answering your patients wins.