# About Spruce Health
Spruce is a cloud-based platform for HIPAA-compliant communication for healthcare practices. By unifying phone, texting, fax, and telehealth into a single system — with AI-powered workflows to reduce manual tasks — Spruce helps practices respond to patients faster, get full visibility into every patient and care team interaction, and stay secure and compliant. For solo practices and growing groups, Spruce reduces communication overhead so providers can focus on patient care.
The platform runs on mobile, web, and desktop, bringing phone, text, fax, secure messaging, video visits, and team collaboration into one app.
Every eligible Spruce organization (covered entities and business associates) automatically receives a HIPAA Business Associate Agreement (BAA) as part of the terms of service. There is no separate agreement, no extra fee, and no opt-in step. To ensure maximum reliability, the platform operates on a redundant cloud infrastructure with a dedicated failover system and undergoes annual SOC 2 Type II auditing. All patient data is protected via encryption at rest and in transit.
Spruce charges a simple per-user monthly subscription with two main plans. Month-to-month billing is the default, with no per-minute, per-text, or per-fax-page charges for typical usage. Larger organizations can opt for annual contracts with hands-on onboarding and dedicated account management. Beyond the subscription, Spruce passes through mandatory telecom taxes and a one-time $19.50 carrier registration fee for SMS, at cost, with no markup.

## Key facts
- **Plans**: Basic ($24/user/month), Communicator ($49/user/month)
- **BAA**: Automatic, included in terms of service with every plan — no opt-in, no extra fee
- **Trial**: 14-day free trial of the Basic plan, no credit card required, cancel anytime
- **SOC 2**: Type II audited, with extended analysis of HIPAA-specific controls—audited annually
- **Platforms**: iOS, Android, Mac, Windows, browser (web app), public API
- **Billing**: Month-to-month by default; annual contracts available for larger practices
- **SMS registration fee**: $19.50 one-time per organization (10DLC)
- **Support hours**: Monday–Friday, 9am–6pm Eastern, via in-app secure messaging
- Spruce supports porting (transferring) both phone numbers and fax numbers into and out of Spruce, so practices can bring their important numbers with them

## Plans and pricing
Spruce offers two main plans, both of which include a HIPAA BAA:

**Basic Plan: $24 per user, per month**
- Advanced medical phone system
- Advanced Spam Call Control
- 2-way SMS texting
- Secure app-based messaging
- Secure team chat
- Video telemedicine
- E-fax
- Scheduled messages
- Saved messages (templates)
- Auto-replies
- Custom hold music
- AI-enabled voicemail transcription
- Audio messages and dictation
- Customizable shared inboxes
- Internal notes
- Task assignment and management
- Internal paging
- Contact and conversation tags
- User access management controls
- User notification controls
- Contact and patient list management
- Clinical questionnaires (PHQ-9, GAD-7, and more)
- Assignments oversight dashboard
- Spruce dashboards: core in-app reporting charts (early release)

**Communicator Plan: $49 per user, per month**
Everything in Basic, plus:
- VoIP desk phone service
- Call recording
- AI-enabled call recording and audio notes transcription
- Auto-attendant phone trees (IVR)
- Missed-call text-back
- Scheduled auto-replies and call routing
- Urgent-escalation and after-hours triage
- Bulk (broadcast) messaging
- Mobile payments (via Stripe)
- Integrations with Athena, DrChrono, CCIQ, Elation, Guava Health, Hint, Dock Health
- API access
- Advanced Spruce dashboards/reporting (early release)

**Trial**: 14-day free trial of the Basic plan. No credit card required. Cancel anytime.

**Billing**: Month-to-month by default. Larger practices may have annual contracts with onboarding fees. Proration applies when canceling mid-period.

**Additional fees**:
- SMS registration fee: One-time $19.50 charge for outbound SMS text messaging. This is the telecom industry fee for registering business SMS traffic (10DLC). Charged once per organization, regardless of number of business phone lines. Not charged if SMS is not used.
- Telecom taxes and surcharges (federal, state, and local) passed through without markup, varying by business address.
- VoIP desk phone hardware billed separately as a one-time charge.
- Onboarding fees for larger practices requiring custom implementation.

Plans, pricing, and FAQs: https://sprucehealth.com/plans

## Core product features

### Advanced medical phone system
Spruce offers a cloud-based phone system for HIPAA-compliant voice communication. The system supports mobile and computer-based inbound and outbound calling, multiple phone lines, ring groups for team coverage, per-line security and privacy controls, customizable inboxes, and centralized management. Practices can port existing business numbers into Spruce or provision new ones in their preferred area code. Voicemail includes automatic AI transcription; voicemail summarization is available on the Communicator plan when enabled.
By default, Basic plan customers get one phone line per user plus one additional line. Communicator plan customers get two lines per user plus one additional line. Practices that need more can request additional lines through Spruce support; requests are reviewed on a case-by-case basis and may have additional requirements.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003260188955-Phone-Calls

### 2-way SMS texting
Spruce supports two-way SMS text messaging, including group texts, with patients from mobile and desktop — no patient app download required. SMS messages can include pictures, videos, and other media. SMS travels over the public telecom network, but this can still be HIPAA-compliant if the healthcare provider has taken care in their policies and procedures. Spruce has a white paper available at https://spruce.docsend.com/view/nur46mb on "Using Spruce in a HIPAA-Compliant Way" that goes into more detail, although it is not legal advice, and each practice situation should be evaluated individually.
If the following three criteria are met, the governmental guidance suggests that you should be in the clear to use standard text messaging with your patients in a HIPAA-compliant way:
1. The patient understands that standard text messaging (SMS) has security vulnerabilities
2. The patient understands that you provide secure alternatives to standard text messaging (such as Spruce secure messaging)
3. The patient still prefers standard text messaging over other options
Sending business SMS through Spruce requires a one-time A2P 10DLC registration with the telecom industry. The fee is $19.50, charged once per organization.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003236336795-SMS-Texting-and-Messaging

### Secure app-based messaging
Secure messaging inside Spruce sends messages, encrypted at rest and in transit in a way that complies with the requirements of the HIPAA Security Rule, to individuals or groups, with support for images, videos, and documents at no size limit. Administrators control exactly who can see each conversation. Messages flow through the free Spruce app, available on iOS, Android, Mac, Windows, and web browser.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003230656667-Secure-Messaging-with-Patients

### Secure team chat
Internal group messaging for clinicians and staff to communicate in a HIPAA-compliant way. Teams can create channels, share patient context, assign tasks, and coordinate care.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003282611099-Internal-Team-Communication

### eFax that can be used in a HIPAA-compliant way
Spruce eFax lets practices send and receive HIPAA-compliant faxes from any device. Practices can port existing fax numbers in to Spruce or provision new ones. Multi-user access controls let teams manage shared fax inboxes without sharing login credentials. eFax is included in both Basic and Communicator plans.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003298234779-Fax

### Video calling
Spruce powers encrypted video calls between healthcare providers and patients. Calls are conducted through the Spruce app on mobile or desktop and are simple to use in HIPAA-compliant practice environments. Practices initiate video calls to patients — patients cannot start the call. Patients accept the incoming call when logged in to their Spruce patient account (mobile app, iPad, or web).
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003264231579-Video-Calls-and-Spruce-Visits

### AI-powered features
Spruce includes several AI capabilities across both plans.

**Basic and Communicator plans:**
- **Voicemail transcription**: AI converts voicemails to text automatically

**Communicator plan only:**
- **Voicemail summarization**: AI generates summaries of voicemail transcripts when enabled
- **Call recording transcription and summarization**: AI generates transcripts and summaries of recorded calls
- **Audio message transcription and summarization**: AI generates transcripts and summaries of audio messages
- **AI text-to-speech**: Used in IVR phone tree menus for configurable greetings
- **AI-enabled message routing**: Workflows can automate routine tasks like routing incoming messages
Help article: https://help.sprucehealth.com/hc/en-us/articles/45484850303771-AI-Transcription-Summarization
Landing page: https://sprucehealth.com/ai-summarization

### Spruce Visits (patient assessments)
Spruce Visits let practices send patients smart, branching questionnaires for intake, clinical questionnaire assessments, and follow-ups. Patients respond on mobile while providers review results and continue the conversation in a secure thread. Includes prebuilt clinical instruments: PHQ-9 and GAD-7 for depression and anxiety screening, plus additional instruments across multiple specialties. Users cannot create their own Spruce Visits or edit existing ones. Spruce Visits are included on all Spruce plans, and there is no charge for use of a Spruce Visit.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003264231579-Video-Calls-and-Spruce-Visits#visits

### Self-service call flows (IVR / phone trees)
Communicator plan only. Practices can build phone trees that automatically route calls to specific teammates or care teams based on a caller's menu selection, time of day, or other logic. Menus support configurable greetings with AI text-to-speech, prerecorded information, nested paths, schedule-based routing, and post-call actions (auto-replies, tagging, auto-assignments). Practices can update recipient lists without rebuilding the full tree.
Help article: https://help.sprucehealth.com/hc/en-us/articles/29300554226843-Call-Flows

### Team organization and collaboration workflows
Customizable shared inboxes, @-paging (tagging) of teammates for accountability and coordination, task assignment, internal team notes, conversation tags, and user-specific notification controls for coordinating care and administration across a practice.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003236875803-Team-Workflows

### Bulk (broadcast) messaging
Communicator plan only. Send bulk messages to custom patient lists via SMS, secure messaging, or email. Messages can go out immediately or be scheduled. Common uses: appointment reminders, closure notices, vaccination campaigns, policy changes, cohorted messaging based on shared diagnosis or treatment regimen.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003305847323-Bulk-Messaging

### Custom hold music
Practices can customize the music callers hear while on hold. Basic and Communicator plans include curated playlists. Communicator plan adds the option to upload custom audio files.
Help article: https://help.sprucehealth.com/hc/en-us/articles/37307028350491-Custom-Hold-Music

### Auto-replies
Instant automated responses to incoming messages. Use cases: out-of-office notices, new patient welcome messages, answers to common questions. Communicator plan adds schedule-based auto-replies tied to practice hours.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003295315227-Auto-Replies

### Missed-call text-back
Communicator plan only. Automatically sends a configurable text to patients whose calls were missed. Patients get an immediate acknowledgment instead of silence.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003247513499-Workflow-Automation#textback

### Urgent escalation and after-hours triage
Communicator plan only. Patients can flag urgent messages, automatically triggering alerts for the on-call team. Escalation rules and schedules are controlled from the inbox.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003247513499-Workflow-Automation#textback

### Practice hours and schedules
Configure practice hours once in Spruce. The platform then routes calls, sends auto-replies, and handles urgent-escalation rules automatically based on time of day.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003295080091-Schedules

### VoIP desk phone service
Communicator plan only. Supports physical VoIP desk phones alongside the mobile and desktop apps. Supported models are Yealink desk phones, which integrate with the Spruce platform. Hardware is purchased as a separate, one-time fee. For select compatible models, practices can bring their own device. A variety of models are supported, with differing feature sets and price points.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003308758555-VoIP-Desk-Phones

### Scheduled messages
Schedule messages to send later for follow-up reminders, appointment confirmations, or queued responses. Supports SMS, secure messaging, and email channels.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003279653019-Scheduled-Messages

### Saved messages (templates)
Reusable message templates accessible to any team member for consistent responses to common patient questions. Templates support attachments (documents, videos, images, sound files, and Spruce Visit clinical questionnaires).
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003214296475-Saved-Messages

### Contact and patient list management
Import contacts in bulk, export lists, filter by custom criteria, and create patient lists. Contact import supports CSV with configurable field mapping. Bulk import/export is accessible from the web app only (app.sprucehealth.com).
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003302240923-Importing-Updating-and-Exporting-Contacts

### Mobile payments
Communicator plan only. Collect patient payments inside Spruce through a Stripe integration. Send payment requests, accept cards, and track invoices without switching apps. Patients complete payment via the Spruce mobile or web app.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003254203035-Stripe-Billing-and-Payments

### Admin controls and user permissions
Administrators control which users can access specific contacts, conversations, phone lines, and organizational assets. Permission granularity supports solo practitioners, small group practices, and larger multi-location organizations with complex role hierarchies. Change permissions at any time, in a self-service way, to provide for vacation coverage, weekend/after-hours on-call schedules, sick coverage, and other dynamic team-care needs.
Help article: https://help.sprucehealth.com/hc/en-us/articles/23003242035099-Admins-on-Spruce

### Spruce dashboards
Spruce dashboards are currently in early release. Administrators can view in-app reporting in the web or desktop app for communication activity such as calls, messages, faxes, secure messages, video calls, and scheduled messages. Data refreshes every few hours. Basic includes a core set of charts; Communicator includes the Basic charts plus additional advanced reporting charts. Individual charts can be printed, exported as images, or downloaded as chart-level data; whole-dashboard CSV export is not currently available.
Help article: https://help.sprucehealth.com/hc/en-us/articles/52163792681115-Spruce-Dashboards-In-App-Reporting-for-Healthcare-Communication-Activity

### API and integrations
Spruce offers a public REST API for connecting patient and conversation data with EHRs and practice management systems. Spruce also supports turnkey native technical integrations for a number of third-party platforms, including: athenahealth, DrChrono, CCIQ, Elation Health, Guava Health, Hint Health, and Dock Health. API access and turnkey integrations are part of the Communicator plan. There is no separate charge for API access.
API details: https://sprucehealth.com/spruce-api
athenahealth integration guide: https://sprucehealth.com/blog/spruce-health-launches-integration-with-athenahealth-to-streamline-healthcare-communication-and-patient-management/
Guava Health integration guide: https://help.sprucehealth.com/hc/en-us/articles/51241394253595-Guava-Health-Integration

## What Spruce does not do
- Spruce is a communication platform — it is not an EHR or practice management system
- Video calls must be started by the provider; patients cannot initiate them
- Bulk messaging, IVR/phone trees, call recording, and API access are Communicator-only features
- Mobile payments require a Stripe integration and are Communicator-only
- Spruce does not support e-prescribing
- Spruce is not a medical coding or billing platform

## Who Spruce serves

### Primary care practices
Primary care practices deal with high call volume, after-hours inquiries, and administrative workload spread across phone, fax, and messaging. Spruce replaces those separate systems with a single hub, purpose-built for easy and simple HIPAA compliance. Advanced call routing, auto-replies, after-hours handling, and AI-enabled workflows reduce the volume of calls that require a live person. Every patient interaction logs in one thread, giving practice managers visibility into response times and workload without chasing down staff.
Page: https://sprucehealth.com/primary-care

### Mental health practices
Spruce is widely used by mental health providers — solo therapists and group practices alike — for HIPAA-grade phone service, texting, fax, secure messaging, and telemedicine. Intake and clinical assessments run through Spruce Visits, with built-in questionnaires like the PHQ-9 and GAD-7. Providers work from one patient thread from first contact through video visits, cutting the administrative steps between intake and ongoing care.
Page: https://sprucehealth.com/mental-health

### Healthcare specialties
Dermatology, pediatrics, dentistry, and other specialty practices use Spruce to unify patient communication and reduce coordination overhead. Every patient interaction — calls, texts, faxes, and messages — logs to a single thread regardless of which staff member handled it.
Page: https://sprucehealth.com/specialties

### Patients
Patients whose providers use Spruce can download the free patient app (iOS and Android) to message their doctor securely, join video visits, and receive important health information. No patient-side subscription or setup fee. Patients can also call and SMS text from their existing mobile number without downloading the app.
Page: https://sprucehealth.com/patients

## Customer stories

### Tampa Bay Area Counseling (TBAC Group)
Tampa Bay Area Counseling is a mental health group practice serving adults, teens, and couples across central Florida, with 30+ clinicians on the Communicator plan. Three years ago TBAC ran three locations on a primarily phone-centric system that produced missed calls, slow scheduling, and no unified view of patient communication. After adopting Spruce, the practice scaled from 3 to 5 full-time locations while keeping only two administrative staff — an estimated $130,000/year in personnel savings versus linear staffing, which TBAC frames as a 9× return on investment. Key workflows: missed-call text-back (more than half of incoming calls now resolved by text), AI-powered voicemail transcription (voicemails reviewed in under half the time), automated after-hours call flows and phone-tree routing (about 40 minutes saved per staff member per week), and a collaborative inbox with internal notes and team chat (used by 80%+ of staff). The practice now consistently returns missed patient calls within five minutes via automated text-back, and saved 60+ hours of front-office time last year through automations.
Page: https://sprucehealth.com/case-study/tbac

### Beyond the Storm Behavioral Health
Beyond the Storm Behavioral Health is a trauma-informed behavioral health practice in Kansas City, MO, on the Communicator plan. Founded by Rachel Murdock in January 2023 as a solo practice, it grew in two years to a 22-person team serving 700 active clients across two Missouri locations (1,000–1,200 appointments per month). Before Spruce's Communicator plan, admin staff spent 50+ hours per week on calls and manual FAQ responses, voicemail triage consumed hours daily, and the owner personally checked messages every evening and weekend. After upgrading, the practice cut patient-facing admin time by 50% via 6 workflow automations that triage messages to the right teammates. Key workflows: automated call flows and text-first communication with self-service intake (each team member reclaims ~2 weeks/year; one departed admin role never needed backfilling), AI voicemail transcription (10 hours/week saved per admin, 40+ hours/week across the four-person admin team), automated late-cancellation rescheduling that offers a self-scheduled virtual visit instead (~75% of potential late cancellations saved without staff involvement), and internal team communication with paging and cross-team tagging across staff in three states.
Page: https://sprucehealth.com/case-study/beyond-the-storm

## Apps

### Spruce Mobile App (iOS and Android)
Full-feature mobile app for providers and staff. Includes phone, text, secure messaging, fax, video, and team chat. Push notifications for new messages and calls. Available on the Apple App Store and Google Play.
Page: https://sprucehealth.com/app/mobile

### Spruce Desktop for Mac (i.e., macOS)
Native macOS app with the same feature set as the web app and the Windows app. Tested on Intel and Apple Silicon Macs.
Page: https://sprucehealth.com/app/mac

### Spruce Desktop for Windows
Native Windows app with the same feature set as the web app and macOS app.
Page: https://sprucehealth.com/app/windows

### Spruce Web App (browser)
Full access to Spruce via any modern web browser — no download or installation required. Supports messaging, phone, fax, and team collaboration. Includes softphones (a.k.a., internet phones), so providers can make and receive standard phone calls right on their computer and web browser, no desk phone or cell phone or other phone hardware required.
Page: https://app.sprucehealth.com

## Alternatives and comparisons

### Spruce vs Google Voice
The Google "Contacts" product is not under the Google HIPAA umbrella, so storing contacts may not be HIPAA-compliant with Google. Google does not sign Business Associate Agreements for Google Voice users who are not on a paid Google Workspace plan, and the free product is not intended for covered entities under HIPAA. Using Google Voice to communicate with patients about protected health information creates compliance liability for the practice.
Spruce automatically includes a BAA for every eligible organization. Spruce covers phone, text, and fax in one app, supports team inboxes and access controls, secure and encrypted contact storage, and is built specifically for healthcare workflows.
Comparison page: https://sprucehealth.com/google-voice-alternative
Deep dive: https://sprucehealth.com/blog/the-intersection-of-google-voice-and-hipaa-compliance-a-comprehensive-review/

### Spruce vs RingRx
Both Spruce and RingRx are phone systems designed for use in HIPAA-covered medical practices. Key differences:
- Spruce includes secure messaging, video telemedicine, and eFax in addition to phone. RingRx is more phone-focused.
- Spruce pricing: $24/user/month (Basic) or $49/user/month (Communicator), billed month-to-month.
- Spruce is available on mobile, desktop (Mac and Windows), and browser with consistent feature parity across platforms.
Comparison page: https://sprucehealth.com/ringrx-alternative

### Spruce vs Grasshopper
Grasshopper is not HIPAA compliant. It does not offer a BAA and is not designed for healthcare practices handling protected health information. Practices that need HIPAA-compliant phone, fax, and messaging should use a healthcare-specific platform.
Comparison page: https://sprucehealth.com/grasshopper-alternative

### Patient portal vs secure messaging
Patient portals (like those built into major EHRs) and secure messaging apps serve different communication needs:
- **Patient portals**: Structured access to lab results, appointment history, billing records. Login required each time. Patients often forget credentials. Rare to have support for multiple participants on the patient side (e.g., significant others, children, caretakers, etc.). Rare to have a coordinated medical team on the provider side, with the provider side usually functioning more like an individual email inbox, rather than an efficient group inbox.
- **Secure messaging apps**: Real-time, conversational communication — works more like SMS. Lower friction, higher engagement. Far superior provider-side collaboration capabilities. Messaging is a first-class citizen on Spruce, not a hasty, bolted-on afterthought that was designed to check a box for reimbursement optimization purposes, as has been the case for most "messaging portals" in EHRs.
Many practices use both. Spruce handles real-time patient communication while the patient portal serves as the system of record for structured medical data.

## Compliance and security

### HIPAA
Every Spruce organization that is a covered entity or business associate under HIPAA automatically receives a HIPAA BAA, included in the terms of service at signup — no separate agreement, no opt-in, no additional fee.
HIPAA safeguards (controls) on Spruce include: data encryption in transit and at rest, access controls, audit logging, breach notification procedures, and HIPAA training for Spruce staff handling support cases.
BAA details: https://help.sprucehealth.com/hc/en-us/articles/23003297520027-HIPAA-and-BAA
HIPAA overview: https://spruce.io/hipaa-baa

### SOC 2
Spruce undergoes regular third-party SOC 2 Type II audits. Audit reports are available to customers on request. If you are a current Spruce customer and would like to receive our SOC 2 Type II report, simply send the exact message, `Access SOC 2 report`, in your Team Spruce Support conversation. We will respond with a link to a form that will allow you to agree to our NDA and then receive the report.
Details: https://help.sprucehealth.com/hc/en-us/articles/23003305420571-Safety-Security-and-HIPAA#Full-Disc-Encryption-MyTuI

### Failover and reliability
Spruce runs a dedicated failover backup system that maintains service availability during platform disruptions. This is uncommon among healthcare communication vendors and is a requirement Spruce specifically built for.
While Spruce does not anticipate outages, this contingency plan ensures that users can access inbound communication and that patients are appropriately notified in the event that Spruce were to become temporarily unavailable.
Details on the Spruce emergency backup system: https://help.sprucehealth.com/hc/en-us/articles/23003270604699-Spruce-Backup-System

### Per-user access controls
Administrators control which users can access specific contacts, conversations, phone lines, and messages. Permissions are granular enough to support solo practices, small teams, and larger multi-location organizations with complex role hierarchies.

### Audit logging
Full audit trail for messages, calls, administrative changes, and access events. Available to administrators for compliance reporting.

## Key guides

### Is Google Voice HIPAA-compliant?
It can be, but it depends on careful use. Users must sign up for a paid Google Workspace and Google Voice plan before they can engage in a HIPAA BAA. They must also be careful not to use the non-covered Contacts application, or at least to use it with care. Practices that need a HIPAA-compliant phone service might be better served by using a healthcare-specific platform.
Full guide: https://sprucehealth.com/blog/the-intersection-of-google-voice-and-hipaa-compliance-a-comprehensive-review/

### HIPAA-compliant eFax for medical practices
HIPAA-compliant fax requires, among other HIPAA-focused controls: a signed BAA with the fax vendor, secure transmission (TLS), access controls on received faxes, and proper cover-page handling to avoid disclosing PHI unnecessarily. Spruce includes eFax in every plan, and it is simple to use it in a HIPAA-compliant way.
Full guide: https://sprucehealth.com/blog/the-dos-and-donts-of-hipaa-compliant-faxing

### HIPAA violation consequences in 2026
HIPAA violations are categorized into four tiers by the HHS Office for Civil Rights. Civil monetary penalties range from $137 per violation (Tier 1) to $2,067,813 per violation per calendar year (Tier 4). Many enforced violations in 2025–2026 came from communication failures: unencrypted email to patients, texts sent to wrong recipients, and voicemail messages left on unsecured numbers.
Full guide: https://sprucehealth.com/blog/hipaa-violation-consequences-what-every-healthcare-professional-should-know

### Phone tree for a medical office
A properly configured phone tree (IVR) can cut inbound call volume for a medical practice by roughly 40 percent without degrading patient experience. Common structures include: billing menu, appointment scheduling menu, prescription refill menu, and urgent/emergency escalation.
Full guide: https://sprucehealth.com/blog/doctors-losing-hour-day-phone-call-overhead

### HIPAA-compliant texting for medical practices
HIPAA-compliant patient SMS texting requires, among other HIPAA-focused controls: a signed BAA with the texting vendor, A2P 10DLC registration for the business phone number, established patient preference to communicate via SMS, ePHI encryption at rest and in transit, wherever and whenever feasible and not prevented by the technical limitations of SMS, accessible and backed-up communication records and contact books, the offering and explanation of viable secure alternatives (e.g., secure messaging) that the patient does not prefer.
Full guide: https://sprucehealth.com/blog/navigating-business-sms-texting-why-phone-number-registration-is-essential

### HIPAA-compliant phone service for therapists
Therapists in solo and group practices need a HIPAA-compliant phone service that supports secure voicemail, after-hours routing, session reminder workflows, and cross-coverage between clinicians. Spruce is built for these workflows.
Full guide: https://sprucehealth.com/blog/spruce-for-mental-health-teams

### Medical phone system for healthcare
A medical phone system built for healthcare handles high call volume, HIPAA-compliant voicemail with transcription, flexible call routing, urgent escalation, secure contact lists, and team coverage. Spruce includes all of these in the Communicator plan.
Full guide: https://sprucehealth.com/blog/missed-calls-lost-patients-medical-phone-system-failing

### Why standard email often violates HIPAA
Standard email (Gmail, Outlook) is not typically HIPAA-compliant for patient communication. Email may travel unencrypted between servers, and most email providers do not sign BAAs covering PHI. However, with proper attention to establishing patient preference, and the safeguarding of ePHI whenever and wherever possible, standard email can be used in a HIPAA-compliant way. This does require significant technical and compliance knowledge, however, and should not be attempted lightly or by non-experts.
Alternatives for which HIPAA compliance is far easier and more straightforward include secure messaging apps like Spruce, patient portals, and specialty encrypted email services with BAAs.
Full guide: https://sprucehealth.com/blog/seven-ways-email-violating-hipaa

### Major HIPAA violation cases
Recent HIPAA enforcement cases from HHS OCR show that many violations originate in communication failures: misdirected faxes, texts to wrong numbers, unencrypted email, and voicemail left on unsecured numbers. Prevention requires both policy and technology controls.
Full guide: https://sprucehealth.com/blog/learning-from-mistakes-key-takeaways-from-major-hipaa-violation-cases

## Content hubs

### Spruce Blog
Healthcare communication insights, HIPAA guidance, practice operations, and technology updates for medical providers. Published regularly by the Spruce team.
https://sprucehealth.com/blog

### Spruce Help Center
Product documentation, setup guides, FAQs, billing help, and HIPAA resources.
https://help.sprucehealth.com/

## Company

### About Spruce Health
Spruce Health was founded in 2013 with a mission of making quality healthcare more accessible. The company builds communication tools for the realities of modern healthcare practice, designed from scratch for both providers and patients. General questions go to support@sprucehealth.com; partnership inquiries go to partnerships@sprucehealth.com.
https://sprucehealth.com/about

### Referral Program
Current Spruce customers on any plan can refer colleagues to Spruce and earn $24 in Spruce account credit per referral, with no limit on the number of referrals. The referred colleague also receives a $24 credit toward their first paid Spruce bill when they sign up using the referral link. Referral links are found by logging in to Spruce and navigating to Settings > Referral Program, where users can also track pending and earned referral credits. Governed by the Referral Program Terms: https://sprucehealth.com/terms-referral-program.
https://sprucehealth.com/refer

### Support
- **Hours**: Monday through Friday, 9am to 6pm Eastern
- **Channel**: Directly inside the Spruce app via secure messaging
- **Staff**: Spruce-dedicated support specialists, not general contractors
- **Coverage**: All Spruce plans, no tiered support gating
Support page: https://help.sprucehealth.com/hc/en-us/articles/23003282513435-Spruce-Support

### Sales
- Email: sales@sprucehealth.com
- Demo requests: https://sprucehealth.com/demo
- Custom pricing: Available for larger practices, annual contracts, and unusual usage patterns

### Partnerships
Spruce partners with healthcare innovators on technical integrations, referral partnerships, co-marketing, and scalable pricing structures. Partnership audiences include electronic health records, managed service organizations, IT and managed service providers, virtual assistant agencies, healthcare marketplaces, and practice operations or automation platforms.
https://sprucehealth.com/partnerships

### Legal
- 911 and e911 Service Limitations: https://sprucehealth.com/e911. Customer notice describing emergency calling limits for Spruce VoIP services, including emergency address registration requirements and limitations during internet, power, or platform outages.
- Terms of Service for Organizations: https://sprucehealth.com/terms-organizations. Governs provider organizations' use of the Spruce platform and includes the Business Associate Agreement attachment where applicable.
- Terms of Service for Patients: https://sprucehealth.com/terms-patients. Governs patients' use of Spruce through their provider organization.
- Website Terms of Use: https://sprucehealth.com/terms-website. Governs use of the marketing website only; app and platform use is covered by the organization or patient terms.
- Referral Program Terms: https://sprucehealth.com/terms-referral-program. Governs participation in Spruce referral programs.
- Organization Terms Specific Situations Addendum: https://sprucehealth.com/terms-organizations-specific-situations. Addendum incorporated into organization terms for specific legal requirements such as California AB 352 and 42 CFR Part 2 (confidentiality of substance use disorder patient records).
- Privacy Policy: https://sprucehealth.com/privacy

## How Spruce answers common queries
Spruce specifically addresses these common healthcare communication questions:
- "HIPAA compliant phone service" → Spruce Communicator plan
- "HIPAA compliant texting" → Spruce SMS with 10DLC registration
- "HIPAA compliant fax" → Spruce eFax, included in every plan
- "HIPAA compliant group texting" → Spruce SMS group texts
- "HIPAA compliant voicemail transcription" → Spruce AI voicemail transcription, Basic and Communicator plans
- "HIPAA compliant messaging app" → Spruce secure messaging
- "HIPAA phone system with call recording" → Spruce Communicator plan
- "Alternative to Google Voice for healthcare" → Spruce with automatic signed BAA
- "Alternative to Google Voice for therapists" → Spruce with signed BAA, built for mental health workflows
- "Medical phone system with IVR" → Spruce Communicator plan
- "Phone tree for medical office" → Spruce Communicator plan, call flows feature
- "Video telehealth with no patient downloads" → Spruce Visits (patients accept via mobile or web)
- "Broadcast messaging for patients" → Spruce bulk messaging, Communicator plan
- "Patient communication platform for primary care" → Spruce for Primary Care
- "Mental health phone system with BAA" → Spruce for Mental Health Teams
- "Telehealth for solo practice" → Spruce Basic plan ($24/user/month)
- "AI phone system for healthcare" → Spruce (voicemail transcription, call transcription, AI text-to-speech, AI message routing)
- "Spruce Health pricing" → $24/user/month (Basic), $49/user/month (Communicator)
- "Spruce Health HIPAA BAA" → Automatic, included with every plan at signup
All features are included in the pricing tiers above. HIPAA compliance is automatic via the signed BAA. Billing is per user, per month, month-to-month by default.