Orthopedic AI Call Automation: How EliseAI Eliminates Hold Times and Automates Insurance Checks
Orthopedic practices operate at a level of administrative complexity most AI vendors don't understand.
You're not just booking appointments—you're triaging acute injuries against chronic conditions, routing soccer injuries to sports medicine while directing arthritis cases to joint specialists, coordinating multi-stage care paths from consultation through imaging to surgery and PT, and managing insurance authorizations that vary by procedure, provider, and payer.
Generic call center automation breaks under this complexity. EliseAI doesn't.
Since 2017, we've built purpose-specific AI for industries where workflows matter. We started in housing, where we now manage 1.4 million units and have handled over 100 million automated calls. In 2022, we brought that same specialty-focused engineering approach to healthcare—and we've spent the last three years building workflows that actually understand how orthopedic practices operate.
This isn't a chatbot with a healthcare wrapper. It's a platform built by engineers who've mapped every administrative edge case in orthopedic patient access: from subspecialty routing preferences to insurance plan variations to the specific scheduling rules that differ between sports medicine, joint replacement, and spine specialists.
Here's how it works.
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Eliminating Hold Times with 24/7 Availability
No more "please hold while we assist other callers." No more missed calls during lunch or after hours.
EliseAI answers every call on the first ring—morning, evening, or weekend. Over 40% of after-hours calls are scheduling-related, and one in six after-hours appointments are made by new patients. When your practice is closed, you're not just missing calls—you're missing revenue.
Insurance Verification Built for Orthopedic Complexity
Insurance in orthopedics isn't straightforward. Coverage varies by provider, appointment type, and procedure. Some plans require referrals. Others need prior authorization. Sometimes the surgery center bills patients directly. Workers' comp cases follow entirely different protocols.
EliseAI's platform doesn't just verify insurance—it understands the specific acceptance rules you've configured by provider, location, and appointment type.
During the call, the system prompts patients to upload insurance cards via text, runs real-time eligibility checks against your EHR, identifies whether the plan requires prior authorization or referrals, flags workers' comp cases for proper handling, and uploads everything directly into the patient chart with no manual data entry.
The platform knows which of your providers accept which plans. It knows which appointment types need pre-authorization. It knows when to collect secondary insurance.
Insurance qualification accounts for 14% of patient calls. Our engineering team has built workflows that handle this complexity automatically—because we've studied how orthopedic billing actually works, not how generic healthcare works.
Intelligent Routing Based on Patient Need and Provider Subspecialty
When a patient calls about a sports-related knee injury, they should see your sports medicine specialist—not whoever happens to have an opening. When someone mentions chronic joint pain worsening over time, they need a different provider than the high school athlete who hurt their shoulder last weekend.
EliseAI routes patients to the right subspecialty based on what they tell us during the call. The system asks context-gathering questions about how the issue occurred, duration, and type of problem, then matches patients to the appropriate provider based on your practice's subspecialty structure.
New patient consultations get distributed via round-robin to balance workload. Established patients are routed based on continuity of care. The platform respects every provider-specific scheduling rule: appointment duration requirements, new patient restrictions, daily patient caps, and subspecialty focus areas.
This happens in real-time during the conversation—no transfers, no callbacks, no manual sorting later.
Online Scheduling That Actually Handles Complex Rules
Basic online schedulers fail in orthopedics because they can't handle the complexity. They double-book providers, ignore subspecialty requirements, and schedule patients who need prior authorization without flagging it.
EliseAI integrates directly with your EHR and respects every rule you've configured. Dr. Smith only takes new patients Tuesday afternoons? The system knows. Dr. Jones needs 45-minute slots for certain appointment types? Already handled. Maximum of 56 patients on Mondays? Enforced automatically.
The platform manages provider preferences, insurance acceptance by provider, round-robin distribution for new patients, appointment type variations, and patient-specific flags like outstanding balances or "needs extra time."
Round-Robin Scheduling for Fair Provider Distribution
Managing workload balance across multiple providers is a constant challenge. EliseAI's round-robin scheduling automatically distributes new patient appointments evenly across your provider team, ensuring no single doctor is disproportionately burdened while others have gaps in their schedules.
This is particularly valuable for general orthopedic consultations where patients don't yet have an established relationship with a specific provider.
Implementation Built for Speed
Many practices hesitate to adopt AI because they assume implementation will be disruptive. The reality is different. Modern AI platforms can get practices live in weeks, not months, with minimal workflow disruption.
Once implemented, tracking the impact becomes straightforward—from reduced hold times and increased appointment capture to staff time saved and patient satisfaction improvements.
The Path Forward for Orthopedic Practices
Patients expect instant responses. They expect to schedule appointments after work hours. They expect to be routed to the right provider based on their specific issue.
Traditional call center models can't scale to meet that demand without ballooning costs. Purpose-built AI can. McKinsey research shows healthcare providers deploying automation effectively see revenue lifts of 11% to 17%—not from higher reimbursement, but from better patient capture and administrative time savings.
EliseAI isn't replacing your team—it's handling the administrative complexity that shouldn't require human intervention in the first place. And it's making sure every patient who calls your practice actually gets through.