Spruce Health pricing: Are the hidden fees worth it?

A healthcare communication app like Spruce Health can seem like a good fit for practices handling lower patient volume. But as your team grows, limitations around Spruce Health’s pricing and features can cause friction.

We’ll explain everything you need to know about Spruce Health’s pricing in this article, including its:

• Features
• Limitations
• Hidden fees
• Add-ons

We also explore a Spruce Health alternative that can help better serve your patients as you grow, without losing the personal touch.

Spruce Health pricing and plans at a glance: What you get and what you’re missing

Spruce Health is a cloud-based patient communications platform. It was designed to help healthcare practices communicate with customers in a HIPAA-compliant way. This supports secure app-based messaging, video meetings, and Business Associate Agreements, or BAAs.

But once you dig into its pricing and features, you’ll see Spruce Health may not be a fit for small or growing healthcare practices.

Let’s take a closer look at what it has to offer:

Feature	Basic	Communicator
Price per month	$24 per user per month	$49 per user per month
Business Associate Agreement, or BAA	✓	✓
Secure app-based messaging	✓	✓
Two-way SMS texting	✓	✓
Secure team chat	✓	✓
Video telemedicine	✓	✓
Clinical questionnaires	✓	✓
Message templates	✓	✓
Saved messages	✓	✓
Auto-replies	✓	✓
E-fax	✓	✓
Auto-attendant, or IVR	X	✓
VoIP desk phones	X	✓
Scheduled auto-replies	X	✓
Time-of-day call routing	X	✓
Bulk, or broadcast messaging	X	✓
Mobile payments	X	✓
Integrations	X	✓
API access	X	✓

Basic plan

Pricing: $24 per user per month, billed monthly

Best for: Healthcare practices that need to host video appointments with patients

The Basic plan includes HIPAA compliance for calls, texts, and video calls with patients. Here are several other features you can expect to get:

• Business Associate Agreement, or BAA. Lets you communicate with your patients in a HIPAA-compliant manner
• Phone system. Access available via iOS, Android, and desktop apps
• Secure app-based messaging. This takes place between you and your patients via the Spruce app
• Video telemedicine. Requires patients to create a Spruce account 
• Clinical questionnaires. Let patients fill out health assessments so you can review and respond in-app; keep in mind that these questionnaires are fixed templates developed by the Spruce Health medical team and can’t be changed
• Secure team chat. Leave internal notes, assign tasks, and “page” coworkers within the app 
• Contact and patient list management. A soft CRM that lets you organize, categorize, and filter your contacts

But the Basic plan doesn’t offer phone trees or scheduled auto-replies. It also doesn’t provide after-hours triage, which lets patients flag their message to an on-call team member when your practice is closed. You also won’t have access to integrations. 

Communicator plan 

Pricing: $49 per user per month, billed monthly

Best for: Traditional health practices that still use desk phones

The Communicator plan unlocks enterprise features like bulk messaging and integrations. You’ll get access to the following features:

• Auto-attendant, phone tree, or IVR. Route calls to the right healthcare professional or department
• VoIP desk phone support. Integrate your VoIP desk phone with Spruce if you’re not ready to move to mobile and desktop apps
• Missed call text back. Set up custom auto-replies to send to missed calls and voicemails
• Urgent escalation and after-hours triage. Let patients flag urgent messages to trigger alerts for your on-call team, so you can provide support after your practice closes
• Scheduled auto-replies and call routing. Set business hours and after-hours so your call routing and auto-replies automatically change based on the time of day. For example, when your front desk closes for lunch, you can let patients know when to expect a call back from your team
• Mobile payments. Send payment requests to patients and collect invoices in the Spruce app
• Broadcast messaging. Streamline important or emergency messages to everyone on your client list
• Third-party integrations. This includes API access if you want to embed Spruce Health into your existing software

Keep in mind, even on the most expensive plan, you won’t get access to modern features like AI call tagging. You also have to pay extra for third-party integrations you add, but the exact cost isn’t available without contacting support.

Spruce Health’s paid add-ons and other fees

Spruce Health’s pricing plans don’t include every cost, fee, or add-on.

Here are additional costs to keep in mind:

1. VoIP desk phone hardware. While Spruce supports VoIP desk phones, the hardware isn’t included. You’ll need to purchase devices separately as a one-time cost, which can add up if you’re equipping a larger team. For example, the Yealink T44W costs $139 per device.
2. Onboarding and implementation fees. Larger practices may be required to pay an onboarding fee for setup, training, and customization. Pricing for this isn’t publicly listed, so you’ll need to contact sales to find out the full cost.
3. CSV data export. Spruce charges $100 per month for a CSV export add-on that gives you scheduled access to the raw data you already own and store in its app. These CSV files can include patient names and call activity, like “answered by,” “timestamp,” and “sent to voicemail.” That way, you can use these data points in your own reporting tools.
4. Payment processing fees. Spruce doesn’t charge to send payment requests, but all payments are processed through Stripe. This comes with standard fees of 2.9% + $0.30 per transaction. That means a portion of every payment goes to processing costs, which can add up over time as your volume increases.
5. Athena integration. Want to use Spruce with Athenahealth? There’s an additional monthly fee tied to that integration. But there’s no public pricing available, so you’ll have to contact sales for more information. This means you may have to spend extra per month just to connect with practice management and patient engagement software.

6 key things to keep in mind before choosing Spruce Health

Here are six other drawbacks you should know about Spruce Health:

1. You can’t see the full price upfront

As mentioned, Spruce Health doesn’t publicly list pricing for all its features and services. This includes onboarding and implementation fees, which aren’t easily found anywhere on the website.

Non-transparent pricing can make it hard to estimate total costs, especially as your practice grows. This is one of the biggest reasons why Spruce Health users switch to more open alternatives.

2. Integrations can come with extra costs

Unlike many other Spruce Health alternatives, some third-party integrations cost extra per month. Spruce’s Athenahealth integration, for example, requires a separate monthly add-on fee. And since pricing for this isn’t publicly listed, you’ll need to contact support to understand the full cost before connecting your tools.

3. You’ll need to upgrade for key features

Spruce Health can help you send automated messages on the base plan. But essential features most healthcare practices need require upgrading to the Communicator plan, which costs $49 per user per month. Without it, you won’t be able to access:

• Scheduled auto-replies that send different messages during business hours, after hours, and on holidays
• Scheduled call routing to switch phone trees based on your practice hours
• Missed-call text-back to automatically text patients after missed calls or voicemails, so they can still reach your practice when your team is unavailable

Without these features, it may be difficult to scale your business.

4. Desk phones add extra cost and complexity

You can use Spruce to support VoIP desk phones — useful if your team still relies on physical hardware. That said, you’ll need to be on the Communicator plan to use them. And the hardware isn’t included, so you’ll need to purchase devices separately as a one-time cost.

You should also know that the cost of VoIP desk phones will get expensive as your team grows. For example, a Yealink W73P handset and base station cost around $161. Once you factor in the price of the Communicator plan, the total would exceed $200 per user per month.

It’s more scalable to use tools that work from your existing devices, including medical office phone systems like Quo. That way, your team can call and text without needing to buy or manage extra hardware.

5. Patients need an account to message you

Spruce Health lets you call, text, and set up video meetings with patients. But to maintain HIPAA compliance, your patients will need to create a Spruce account first.

Some patients may go through with that. But others may not want to expend the extra time and effort. This can limit which patients you reach with calls, texts, and telehealth visits.

One mental health professional said this about Spruce’s messaging portal:

“The biggest downside here is that clients MUST make an account for messages to be HIPAA compliant. I get clients who text the number but won’t make an account… Also, when they do make an account, any messages they sent prior do not show up for easy archiving. I can send an invite, but many do not make an account, limiting its functionality.” — G2

6. Patients receiving phone calls can be hit or miss

Many past Spruce users say they’ve had issues with patients receiving phone calls. This could lead to missed opportunities and missed visits, which can cost your clinic time and money.

See for yourself:

“Reliability and difficulty some patients have receiving calls. Patients have told me, for example, that they hear no ring and saw no pop-up, despite obviously being signed in.” — G2

Quo: A more effective alternative to Spruce Health

If telehealth is one of your biggest priorities, you could make Spruce Health work for your practice. But if you’re hoping to build patient relationships at scale, it might not hold up to better-suited alternatives.

That’s why many small and growing healthcare practices turn to Quo’s HIPAA-compliant VoIP phone system.

And once you compare Quo to Spruce Health side by side, it’s easier to see why:

Features	Quo	Spruce Health
Starting price	$23 per user per month	$24 per user per month
Transparent pricing	✓	✗
Unlimited calling and texts in the US and Canada	✓	✓
Call recording	✓	✓
Shared numbers	✓	✓
Additional phone numbers	$5 per number per month	Not publicly listed
Auto-replies	✓	Scheduled auto-replies require Communicator plan at $49 per user per month
Intelligent call routing	✓	Time-of-day routing requires Communicator plan
Group text messaging	✓	✓
AI call tags	✓	✗
Desk phone support	X	✓

1. Foster team collaboration to provide better customer service

Quo offers shared numbers with team inboxes so you can easily split responsibility for patient conversations. Each member can call and text from the same phone number. Then, set up access controls to create guardrails and protect sensitive data.

You’ll also have access to internal threads, which can help you foster team collaboration and work together behind the scenes. For example, your team can tag you with an @mention to ask a question like “How should we handle this request from a patient, @john?” 

2. Transparent and flexible pricing

Quo’s pricing is listed online so you can estimate costs at any time. Easily decide which plan makes sense for you. Keep in mind you can use Quo in a HIPAA-compliant manner with Business Associate Agreements, or BAAs, available upon request. Once you’ve tested Quo for free during a seven-day trial and have an active account, you can request a BAA in under 15 seconds on a Business or Scale plan.

Each Quo plan was designed to scale alongside your business. For example, every user you add to your Quo account gets one free local US, Canadian, or North American toll-free phone number. 

This makes it easy to pick a plan that works for your practice, then scale up or down, depending on your needs.

3. Unlimited calls and texts to the US and Canada

With Quo, you can make and receive unlimited calls and texts in the US and Canada on every plan. No surprise fees. 

4. Save time with texting automations

Respond faster to incoming patient questions with Quo’s texting automations. For example, you can:

• Set up custom auto-replies for during and after business hours 
• Schedule messages to queue up texts to send during normal office hours
• Create reusable message snippets so your team doesn’t have to type the same message to patients 

Here’s what one Quo customer had to say about how the platform helps save time for its growing in-home care company:

“We will employ around 40,000 caregivers this year. Snippets, AI transcripts, and the ability to jump into any line save us thousands of hours. Quo has become a real partner in helping us grow and adapt.” — Owen Wible, Senior Director of Operations

5. Save time with HIPAA-compliant call recordings and transcripts

Patient call recordings often contain Protected Health Information, or PHI. If a recording identifies a patient or includes details about their care, it falls under HIPAA requirements. That’s why healthcare practices need a HIPAA-compliant call recording system.

Quo supports both automatic and on-demand call recording. Your team can record every call or only certain conversations. This gives your practice more flexibility while helping avoid recording more information than you need.

Need to quickly check what was discussed on a patient call? You can enable call transcripts so staff can review conversations without having to replay the full call.

6. Intelligent call routing to provide a better patient experience

Want to automatically route patient calls during and after business hours to certain teammates? Quo provides time-of-day routing you can easily customize based on your team’s needs.  For example, you can set up routing to direct calls to your front desk during opening hours or to an on-call provider after your practice closes.

Spruce Health pros and cons

Here are some of the pros and cons of Spruce Health:

Pros

• Supports voice and video calls for telehealth
• VoIP desk phones are supported if you use traditional hardware
• Integrates natively with EHR providers for private practices

Cons

• No public pricing for all features
• Extra costs for integrations
• Patients must create accounts for secure messaging
• Basic features like scheduled auto-replies and time-based routing require an upgrade

Quo: A better alternative to Spruce Health’s pricing plans

If you’re a very small healthcare organization juggling video calls, Spruce Health offers some bells and whistles to get you started. But as your team grows, it might run out of features to help you scale.

That’s why many past Spruce Health users end up porting their business phone numbers to Quo.

Compared to Spruce Health, Quo offers more transparency and features that make it easy for your practice to grow. You get unlimited calls and texts, shared phone numbers, and intelligent call routing. This makes it easier to work together on health-related conversations. With Quo, you can easily collaborate on delivering better patient outcomes.

Test us for yourself with our seven-day free trial. Then when you’re ready, easily move any existing US, Canadian, or North American toll-free number over to Quo. 

FAQs