Smith.ai · AI + human hybrid receptionists, billed per call

The Smith.ai alternative built for medical, not for everyone

Smith.ai's hybrid is a smart design: AI handles routine calls, humans pick up the complex ones, with published plans billed per call: Free for 25 calls a month, Pro from $150 a month for 75 calls, and Enterprise from $500. For a general small business it's a strong default. The gap is that Smith.ai serves every industry, and medical after-hours is not a general problem. Lydoh is narrower on purpose: caller-decided urgency triage, 911 deflection, an on-call cascade that dials your providers until one accepts, prescription refill capture, and the talk-time record your biller needs. One vertical, done deeply, priced by included minutes rather than by the call: Lydoh After Hours is $99/mo with 300 minutes included, with a published $0.25 a minute after that.

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Side by side

Smith.ai vs. lydoh

	Smith.ai	Lydoh
Pricing model	Per call: Free for 25 calls, Pro from $150/mo for 75 calls, Enterprise from $500/mo	Included minutes: Lydoh After Hours $99/mo with 300 minutes included, Lydoh Frontdesk $249/mo with 1,200 minutes included
Busy-month bill	Overage per call past the tier's calls	$0.25/min past the included minutes, published
Who answers	AI first, human agents for complex calls	AI only; urgent calls escalate to YOUR on-call provider
Industry focus	General small business	Medical, dental, veterinary and chiropractic practices, and med spas
Medical after-hours	Message-taking and transfers	Triage + on-call cascade + timestamped audit with talk time
Prescription refills	General message	Structured Rx capture with medication and pharmacy
Integrations	Broad app catalog	Signed webhooks (calls, transcripts, requests) to any endpoint

Disclosure: Lydoh wrote this page. Competitor facts are from their published materials (sources below), compiled July 2026; verify current pricing directly. We've tried to be fair; tell us if we got something wrong: hello@lydoh.com.

The honest split

Who should stay, and who should switch

Stay with Smith.ai if…

Stay with Smith.ai if you want human agents available inside the same service, or your business spans use cases beyond an appointment-driven practice; their generalist breadth and app catalog are real advantages.

Switch to Lydoh if…

Switch if you're a medical practice whose hard problem is nights and weekends: triage, reaching the on-call provider, and proving what happened. That's the part a generalist hybrid doesn't build.

FAQ

Smith.ai vs. lydoh, answered

Isn't Smith.ai cheaper?

At low call volume, yes: Smith.ai's Free plan covers 25 calls a month, and Pro starts at $150 a month for 75 calls, with a per-call charge past the tier. Lydoh prices by minutes instead: Lydoh After Hours is $99/mo with 300 minutes included, and each minute past that is $0.25. Which costs less depends on how many calls you get and how long they run, so price your busiest month on both.

What does Lydoh have for medical that Smith.ai doesn't?

The after-hours stack: an opening 911 deflection on clinical lines, urgency decided by the caller rather than the AI, an escalation cascade that dials your on-call rotation (with holiday overrides) until a provider accepts, structured prescription-refill capture, and a timestamped audit trail with provider-to-patient talk time exportable for time-based E/M billing.

What do I give up leaving Smith.ai?

Human agents on the line itself, and a broad prebuilt integration catalog. Lydoh escalates to your own people rather than staffing operators, and integrates via signed webhooks, which cover CRMs and automation tools but require a receiving endpoint or a tool like Zapier.