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Choose Ruby if you want live receptionists on every call, and choose Smith.ai if you want AI, people or a mix on one account. Smith.ai states one hard limit: it says it is not HIPAA-compliant and cannot handle calls involving protected health information.
Smith.ai bills by the call and Ruby bills by the minute. All details below were checked against each vendor's documentation on 9 November 2026 and can change.
This article is part of our AI Front Desk guide. It is general information, not legal or medical advice.
Key Takeaways
- Ruby says its calls are answered by live receptionists supported by AI tools, and AI doesn't answer on its own.
- Smith.ai sells an AI Receptionist, human Virtual Receptionists and a hybrid of both.
- Smith.ai says it cannot handle calls involving protected health information.
- Ruby says HIPAA service has no additional charge and that a team member provides a BAA.
- Smith.ai charges per call, while Ruby's plans are sold in receptionist minutes.
What each one is
Smith.ai
Smith.ai's AI Receptionist page describes AI answering, lead qualification, scheduling and transfers to your team. Its human service uses live agents.
The company also sells a hybrid plan. "Hybrid uses AI to handle routine calls and brings in a live agent when the moment needs more care."
Ruby
Ruby's AI page separates its service from AI-only answering. It says its model is a live receptionist supported by AI tools. It also says "The person still leads the conversation."
Ruby's AI features support the receptionist. The page lists call lookup tools, AI-generated transcripts, sentiment analysis and robocall filtering.
What they charge
| Option | Published price (9 Nov 2026) | Billing unit |
|---|---|---|
| Smith.ai AI Receptionist Free | $0 for 25 calls | Per call |
| Smith.ai AI Receptionist Pro | From $150 a month for 75 calls | Per call |
| Smith.ai AI Receptionist Enterprise | From $500 a month for 300 calls | Per call |
| Smith.ai Virtual Receptionists | $300 for 30 calls; $810 for 90; $2,100 for 300 | Per call |
| Smith.ai Hybrid | From about $2.50 a call | Per call, with live agent escalation |
| Ruby | $250 for 50 minutes; $395 for 100; $720 for 200; $1,725 for 500 | Per minute |
The numbers come from Smith.ai's AI pricing, Smith.ai's human pricing and Ruby's pricing page. Ruby's page does not list overage rates, so ask for them.
How the billing units differ
Smith.ai counts calls. Its AI pricing page says "Every call answered by your AI Receptionist counts toward your call quota by default." Known spammers are filtered, and you can remove up to 10% of calls from your bill for selected spam.
Ruby counts minutes. Ruby's FAQ says "Receptionist minutes are billed in 60-second increments, and calls are rounded up to the nearest 60-second mark." It also says "We include hold time and exclude the talk time once a call is transferred to you or your voicemail box."
Here is our own arithmetic for a rough comparison. Ruby's 200-minute plan works out to $3.60 a minute, so a three-minute call costs about $10.80. Smith.ai's human Basic plan works out to $9 a call, and its AI Pro starting tier to $2.
Healthcare and PHI
Smith.ai's legal-industry FAQ says: "Smith.ai is not HIPAA-compliant, so we cannot handle calls that involve protected health information (PHI)."
The same FAQ says Smith.ai works with medical, dental and wellness practices for non-PHI calls, such as FAQs, messages, new patient leads and transfers. It says "If your practice needs HIPAA-compliant support, we recommend discussing your requirements with our team before getting started."
Do not route patient details to Smith.ai on the assumption that this has changed. Ask in writing.
Ruby's HIPAA page says that service has no additional charges. It says a team member provides a BAA after sign-up. Under that service, Ruby says messages and caller information will not be emailed or texted to you.
Ruby's page also sets limits. It says receptionists answer non-medical questions. It also says "If you have a HIPAA compliant scheduling tool, that our Receptionists can access without a login, they can make appointments for your callers." Have your counsel review the BAA either way.
How to decide
| Your priority | Smith.ai | Ruby |
|---|---|---|
| Want AI to answer | Yes, AI Receptionist | No; live receptionists answer |
| Want a person on every call | Virtual Receptionists | Yes |
| Want both | Hybrid | No AI-only option stated |
| Handling PHI calls | Says it cannot | Offers HIPAA service with a BAA |
| Predictable per-call budget | Per-call plans | Minutes vary by call length |
Next step
Count your calls and average call length for one month. Then run both vendors' numbers and ask each for written answers on overage. For help with lead flow and your website, talk to us.
Frequently asked questions
Is Smith.ai HIPAA compliant?
Smith.ai's own FAQ says it is not HIPAA-compliant and cannot handle calls involving protected health information. It says it can support non-PHI calls. Ask Smith.ai in writing about your use case.
Does Ruby use AI to answer calls?
Ruby says its calls are answered by live receptionists supported by AI tools. It says AI runs features like transcripts and spam filters behind the scenes.
Is Ruby or Smith.ai cheaper?
It depends on your call length. Smith.ai's AI plans start at $2 per call on the Pro tier, while Ruby's plans are priced by the minute. Run the numbers against your own call logs.
Does Ruby charge more for HIPAA service?
Ruby's HIPAA page says there are no additional charges for customers who need that service. Your regular receptionist or chat charges still apply.
Can Smith.ai transfer a call to a person?
Yes. Its AI Receptionist can route calls to your team, and live agents can be added on a per-call basis. Smith.ai's page says there is no fee when the AI itself starts the escalation.
