Five ways to use AI agents: healthcare

Decisions about healthcare are some of the most important and stressful in our lives—even when it’s not an emergency. Yet the process is so often slow and hard to navigate. And while healthcare providers and payers are working to improve the quality of that support, they’re also grappling with rising costs and increased regulation. In the year since Sierra’s launch, we’ve seen how AI can help deliver better, more human care while also reducing costs for the industry.

1. Understanding Benefits & Eligibility

Understanding coverage is hard, from deductibles to co-pays, prior authorizations, in-network restrictions and referral requirements. AI can process enormous amounts of information almost instantly—enabling it to answer complex questions like “is my physical therapy covered?” or “what’s my out-of-pocket cost for this procedure?” much more quickly.

A major health insurance network is using Sierra’s platform to manage high call volumes, navigate fragmented internal systems, reduce administrative costs, and deliver more personalized care. Its agent handles detailed questions like "what's my co-pay for a primary care visit?" and "how many physical therapy sessions do I have left?" (with high CSAT scores). It can also verify eligibility in real-time and answer questions about coverage, plan details, and dependent enrollment. Members can get instant clarity on deductibles, out-of-pocket maximums, provider networks, and more—improving patient satisfaction while streamlining operational overhead.

2. Finding the right provider

It shouldn’t take research and a round of phone calls to locate a provider that’s accepting patients in your insurance network. But all too often it does. AI can search provider directories, checking availability almost instantly, while also taking factors like location, specialty, and patient preferences into account. By eliminating the guesswork, it can help connect patients with the right provider from the get-go.

A major nonprofit provider has built both voice and chat agents on Sierra to make the process of finding the right provider far easier, while also reducing the strain on its call centers. These agents help people identify in-network specialists, check availability, and find providers based on specialty or location. Replacing rigid IVR flows and manual inputs with AI has meant a faster, more consistent and patient-friendly experience, while also improving access to healthcare.

3. Simplifying appointment scheduling

Once patients find the right provider, booking an appointment shouldn't require multiple phone calls to juggle calendars. AI is great at handling logistics, easily identifying open slots and scheduling, and when patients need to reschedule, the agent handles it instantly—reducing no-shows and ensuring that people stay on track with their healthcare.

A leading multi-site primary and urgent care provider selected Sierra to power voice automation across its 30+ clinics. The agent answers common questions and manages appointments, improving the consistency and speed of support across a high volume of inbound calls. This gives patients faster access to care, and also significantly reduces the administrative load on clinic staff.

4. Streamlining patient intake

Pre-visit paperwork (often referred to as patient intake) can be a barrier to people getting the care they need, especially when it's lengthy and confusing. AI can guide patients through what to expect and why specific services or tests are needed—closing critical gaps in patient education, reducing uncertainty, and improving both satisfaction and clinical efficiency by ensuring essential information is gathered before the appointment.

A healthcare diagnostics company has built an agent with Sierra to collect patient information, replacing a 30 to 40 question pre-visit intake form that previously had to be filled out on paper. It’s boosted pre-visit intake conversion rates, which are critical to providing the best care, and reduced operational time in the clinic.

5. Resolving billing issues with empathy

Few things increase stress levels and erode trust more quickly than billing that’s opaque. Billing issues—like disputed charges, payment questions, or insurance claim status—are a frequent source of frustration for patients. AI can handle these conversations quickly and factually by retrieving claims information instantly, explaining any charges, and even initiating dispute processes when needed.

A leading healthcare financial platform built an agent with Sierra to help patients with billing questions over the phone. It enables them to more easily understand their payment status, explanations of benefits, and financial assistance eligibility. It is also HIPAA and privacy compliant, while delivering faster resolution times, measurable handle time savings, and placing a lower administrative burden on staff.

The future of healthcare customer experience

Creating more human customer experiences is arguably more important in healthcare than any other area of our life. Agents built on Sierra are already helping leading payers and providers improve patient interactions across the care journey. Unlike previous automation, AI isn’t just effective, it’s surprisingly good at the things people and patients value. AI makes the complex simple. It’s fast and efficient. It has the information at its fingertips. It’s patient and listens. And we seem to say things to AI we wouldn’t say to another person, either because it’s less embarrassing, or because we don’t feel the need to make things up to look better.

If you’re as excited about the potential of AI in healthcare as we are, please get in touch. Let’s invent the future together.