A clinic's phone line is its front door for scheduling, results, refills, and questions. For patients who are deaf, hard of hearing, deaf-blind, or who have speech disabilities, that door only opens if the clinic can take and make calls through relay services and if staff know what to do when one arrives. Most of the technology is free and already available; the gap is usually training and configuration.
The obligation
Health care providers that receive federal financial assistance, which includes nearly every clinic that bills Medicare or Medicaid, are required under Section 1557 of the Affordable Care Act and Section 504 of the Rehabilitation Act to provide effective communication to people with disabilities. Title III of the Americans with Disabilities Act imposes a parallel duty on private providers as public accommodations. Effective communication includes communication by phone. A clinic that hangs up on relay calls, treats them as telemarketing, or has no way to reach a patient who uses a relay service is not meeting that obligation.
The good news is that the Federal Communications Commission funds telecommunications relay services nationwide, so the infrastructure exists at no cost to the clinic. What the clinic must supply is a phone system that works with relay and staff who handle the calls competently.
How relay services work
Telecommunications relay service (TRS) puts a trained communications assistant between two callers when one of them cannot use a standard voice phone. The patient connects to the relay provider through a text device, a video connection, or a captioning service. The communications assistant places a voice call to the clinic and relays the conversation in both directions. The clinic hears a voice; the patient reads text, watches a sign language interpreter, or reads captions. Federal rules require relay providers to keep call content confidential and to relay conversations verbatim, so a relay call can carry the same content as any other patient call.
Dialing 711 from any phone in the United States reaches the relay service for the caller's state. Clinics can use 711 to call a patient who has indicated that they use relay, and patients use it to reach the clinic. The clinic's own number does not change; 711 is simply the on-ramp.
Types of relay
| Service | How the patient communicates | What the clinic experiences |
|---|---|---|
| Text-based TRS (TTY) | Types on a TTY or text device; reads the assistant's typed relay of your speech | A voice call with pauses while the assistant types and reads; the assistant says "go ahead" to signal turns |
| Video relay service (VRS) | Signs in American Sign Language over video to an interpreter | A voice call with a nearly conversational pace; the interpreter speaks in the first person for the patient |
| IP captioned telephone service | Speaks directly and reads captions of your speech on a screen or app | A normal voice call; the patient may respond with a slight delay while reading |
| Speech-to-speech | Speaks; a trained assistant re-voices for clarity | A voice call where the assistant repeats the patient's words |
Video relay is now the most used service among ASL users, and captioned telephone is common among older adults with hearing loss. A clinic that assumes "relay" means an old TTY machine will misunderstand most of the relay calls it receives.
VoIP and relay compatibility
Relay calls are ordinary voice calls from the clinic's side, so any VoIP system that can receive a call from the public phone network can receive a relay call. Two configuration issues do come up:
- Spam and robocall filtering. Relay providers place calls from centralized call centers. Aggressive spam filtering, caller-ID reputation screening, or auto-rejection of unknown numbers can block them. Ask your VoIP provider how to allow-list relay provider numbers, or turn off auto-rejection for the main line.
- Auto-attendant timing. Menu trees with short timeouts can hang up before a communications assistant finishes relaying the options and receives the patient's choice. Lengthen timeouts, allow zero-out to a person at any point, and make sure the menu does not require rapid touch-tone entry.
Direct TTY use over VoIP is less reliable because TTY tones can be distorted by voice compression. If the clinic wants a native TTY device, check whether the VoIP provider supports real-time text (RTT), which is the modern replacement for TTY on IP networks. For most clinics, supporting relay calls through 711 covers the need without dedicated hardware.
Staff practice on relay calls
Most complaints about phone accessibility trace back to how staff handle the call, not the technology. Train everyone who answers the phone on a short set of practices:
- Do not hang up. A call that begins with "this is a relay call" or a communications assistant introducing themselves is a patient calling. Treat it exactly like any other patient call.
- Talk to the patient, not the assistant. Say "how can I help you today?" not "tell her I need her date of birth." The assistant relays your words as spoken.
- Verify identity the same way. The assistant is a conduit; the patient is on the line. Ask your standard identity questions and let the patient answer through the relay.
- Slow down and pause. Text-based relay needs time for typing. Say "go ahead" when you finish a thought if the assistant asks you to.
- Do not decline to discuss health information. Relay assistants are bound by confidentiality rules, and using relay is the patient's choice of communication method. Treating the assistant as a barrier to sharing information denies the patient service.
- Record the preference. Note in the patient's chart that they use relay, which type, and how they prefer outbound calls (relay via 711, video phone number, text).
Outbound calls matter too. Reminders, results, and callbacks must reach relay users. If your reminder system only places automated voice calls, add text or portal options and make sure staff know how to place a 711 call for a manual callback.
Beyond the phone
Phone access is one piece of effective communication. Clinics should also offer text messaging or secure portal messaging as alternatives, and should be prepared to provide a qualified sign language interpreter for in-person and video visits when needed. The patient's expressed preference carries significant weight under the federal rules; a clinic should give primary consideration to the method the patient requests.
A clinic checklist
- Confirm relay calls are not blocked by the VoIP provider's spam or unknown-caller filtering.
- Lengthen auto-attendant timeouts and provide an immediate path to a person.
- Publish 711 relay instructions and any video phone number on the website and new-patient paperwork.
- Train all phone staff on relay etiquette and re-train annually.
- Record communication preferences in the chart and honor them for outbound contact.
- Offer text and portal messaging as alternatives to voice.
- Keep a plan for interpreter services for visits.
Common questions
Does a clinic have to accept relay calls?
Yes. Federal disability rights laws require health care providers to communicate effectively with people with disabilities, including by phone. Refusing or hanging up on a relay call denies service to the patient on the line. Relay calls are free to the clinic and require no special equipment.
What is 711?
711 is the nationwide shortcut to reach telecommunications relay services. Patients who use relay dial 711 to reach your clinic through a communications assistant, and your staff can dial 711 to place an outbound call to a patient who uses relay.
Can we discuss protected health information on a relay call?
Yes. Relay communications assistants are required by federal rules to keep calls confidential and relay them verbatim. Verify the patient's identity as you would on any call, then proceed normally. Declining to share information because an assistant is on the line prevents the patient from receiving care.
Will relay calls work with our cloud phone system?
Relay calls arrive as ordinary voice calls, so any VoIP system that accepts calls from the public phone network can take them. Check that spam filtering does not block relay provider numbers and that auto-attendant menus give enough time for the assistant to relay options and responses.