gBell is software that carries patient calls through scheduling, intake, system updates, and staff handoffs for clinics and hospitals. It is a software product, not an agency or a staffing service.

Small and mid-size medical and dental practices where the front desk is understaffed, and every missed call is a patient who books somewhere else or a no-show nobody confirmed.

Is gBell HIPAA compliant, and does it sign a BAA?

gBell operates as a business associate under HIPAA and signs a Business Associate Agreement with a practice before any patient information moves. The BAA governs how protected health information is handled and takes precedence over the standard terms of service. A vendor claiming its terms of service already cover HIPAA is not describing how the law works.

Yes. The agent states at the start of every call that the caller is speaking with an automated assistant and that the call is recorded. A practice can adjust the wording and the voice but cannot remove the disclosure or move it later in the call. If a caller asks not to be recorded, the agent offers to take a message or transfer to a person. Several states, California among them, require every party to a confidential conversation to consent before it is recorded.

Does gBell use patient data to train AI models?

No. Protected health information is not used to train, fine-tune, or evaluate any AI model, and agreements with model providers prohibit them from doing so with data gBell sends. Where a provider offers zero data retention it is enabled. Where a provider retains data briefly for abuse monitoring, that retention is covered by a business associate agreement and the data is still not used for training.

What happens if a caller has an emergency?

The agent is instructed to tell a caller describing an emergency to hang up and call 911, and to flag the call to staff at the highest priority. gBell is not an emergency service, cannot dispatch help, and must not be relied on as a triage mechanism. A practice remains responsible for an emergency plan that does not depend on the service being available or correct.

What happens when a call needs a human?

The call escalates to staff, who receive the transcript and a patient summary before they pick up rather than after. Practices configure when, how, and to whom calls escalate.

Can patients book without calling?

Yes. gBell provides an embeddable self-scheduling widget a practice can place on its own website, and patients who booked by phone can reschedule or cancel through a link sent to them.

How does gBell protect patient information in emails and text messages?

Patient-identifying detail is not placed in email or SMS message bodies. Those messages carry a link, and the patient verifies with a one-time passcode before anything is shown, so a forwarded message or an unlocked phone does not expose someone’s appointment.

Does gBell verify insurance?

Yes. gBell sends a 270 eligibility request, reads the payer’s 271 response, explains the returned coverage and benefits, and routes missing detail to the next action.

Does gBell post EOBs and ERAs?

Yes. gBell Payment Posting matches an EOB or ERA to the right claim lines, applies approved posting rules, and reconciles the remittance to its check or EFT before clean work reaches the practice system.

Does gBell include a clinical scribe?

Yes. gBell Scribe turns post-visit clinician dictation into a case-specific draft with exact source quotes, uncertainty review, clinician approval, and export.

Does a practice keep its own phone number?

Yes. Practices keep their own number, their own calendar, and their own tone. The agent answers in the practice’s name, not the vendor’s.

Insurance & eligibility · August 2026 · 8 min read

Insurance eligibility software for small practices: real 2026 pricing

Insurance eligibility data is a commodity. Every vendor in this market sells the same underlying thing, a 270/271 transaction to the payer, and the honest differences are price, developer experience, and what's bundled around the check. Yet published pricing is rare enough that we ended up assembling it ourselves while choosing a clearinghouse for our own product. Here's what everything actually costs, with sources.

Context on the rail itself, because it explains why this is a commodity: HIPAA mandates electronic eligibility, over 94 percent of medical eligibility verifications already run on the standard 270/271 format per CAQH's index, and CAQH CORE operating rules require payers to answer real-time inquiries within 20 seconds. The pipes are old, boring, and excellent. You're shopping for the tap.

The prices, vendor by vendor

Availity EssentialsFree, as a portal: a human logs in and checks one patient at a time. Paid upgrades start around $25 to $35 a month. Free in dollars, paid in staff minutes; this is what most small-practice front desks are actually using today.

Office AllyThe per-check floor: eligibility is $10 for the first 100 transactions a month, then $0.10 each. Practice Mate is $0 and the EHR is $44.95 per provider monthly. A 20-year-old shop; the API works but shows its age.

Claim.MDThe flat-rate value: $30 a month basic, $60 for 100 combined transactions, and $120 for unlimited claims, unlimited ERAs, and 1,000 eligibility checks. That works out to about $0.12 a check with the claims rail bundled free.

StediThe developer-first option: pay as you go with no monthly minimum, $0.30 per check for the first 250 a month, $0.15 to 3,500, $0.10 to 10,000, $0.08 beyond. Free sandbox, self-serve BAA, modern docs. It dropped its former $500 monthly minimum, which is the fact most buyers have not caught up with.

WaystarMid-market territory: roughly $200 to $800 a month for groups of 4 to 20 providers, sold as a suite rather than a metered API.

pVerify and similarPlans in the $125 to $150 a month range with contract terms, sitting between the cheap self-serve tier and the suites.

One warning that applies to every vendor: a small number of payers add their own per-transaction fees on top of whatever your vendor charges. Ask which of your top ten payers carry payer fees before you model costs.

Which one wins at which volume

At near-zero volume, while you're piloting, Stedi's no-minimum pay-as-you-go is hard to argue with: a hundred checks costs $30 and a quiet month costs nothing. At steady small-practice volume, say 500 to 1,000 checks a month, Claim.MD's $120 unlimited plan takes over, especially if you'll ever submit claims through the same connection. At pure per-check economics with real volume and no need for modern developer ergonomics, Office Ally's $0.10 is the floor.

The switching cost between them is genuinely low, which is unusual and worth knowing: everything speaks the same 270/271 underneath, so moving vendors is an enrollment cycle and a config change, not a rebuild. Pick for today's volume, not for the volume you hope to have.

The checklist beyond price

A business associate agreement, in writing, before real patient data flows. Eligibility responses tied to a named patient are protected health information. The self-serve BAA is a real advantage of the modern vendors.

Your payers, specifically. National coverage claims are easy; confirm your actual top ten payers, including your state's Medicaid managed-care plans, are supported for real-time eligibility.

Enrollment requirements. Most large payers answer eligibility with just your NPI; some require a one-time per-provider enrollment first. Ask which of your payers need it and how long it takes.

Real-time latency, if a patient-facing workflow depends on it. The CORE rule says 20 seconds; ask for actual median and p95 numbers.

Why we did this research

We build gBell, an AI front desk that answers practice phones and books appointments, and we wanted eligibility checking at booking time, while the patient is still on the line with their card in hand. That constraint, checks that happen inside a live phone call, is what pushed us toward the modern API vendors, and it's why latency made our checklist. Your constraints may rank the list differently, which is why the prices are all here rather than just our conclusion.

Common questions

What does one eligibility check cost in 2026?

Between $0.08 and $0.30 through a modern API depending on vendor and volume, around $0.10 to $0.12 effective on the budget clearinghouses, and $0 through a free payer portal if you don't count the staff time. CAQH's index prices an electronic verification at roughly $0.34 all-in for the industry average.

Is there a free way to verify insurance eligibility?

Yes, two: Availity Essentials as a manual portal, and many payers' own provider portals. Free means a human logging in per patient, so it scales with staff time. The moment you want checks to happen automatically, you're in per-check or flat-rate territory, which for a small practice is tens of dollars a month, not hundreds.

Do I need a clearinghouse, or can I connect to payers directly?

Practically, a clearinghouse. There are hundreds of payers and each direct connection is its own project; a clearinghouse maintains all of them behind one API or portal. Direct connections make sense for large systems with narrow payer mixes, not for small practices.

Does eligibility checking need a BAA?

Yes. An eligibility response about a named patient is protected health information, so any vendor touching it is your business associate and must sign a BAA. Stedi, Claim.MD, and the established clearinghouses all do; confirm it's executed before live data flows, not after.

gBell

gBell is the AI operations layer for medical practices. Calls answered and booked, reminders run, after-hours covered, and the intake and insurance work behind the phone carried. It's the product these notes come from.

See how it works

Sources