Free AI scribe tiers rarely include a BAA

A solo OT or SLT who prices an AI scribe in October 2026 finds sticker prices running from $0 to roughly $600 a month. A comparison published by Twofold Health in August 2026 (a competing vendor, so read it with that conflict in mind) lists Twofold at $49 a month billed annually or $69 billed monthly, Tali AI at $100 annual or $135 monthly with five free scribes a month, Freed AI at $39 to $119 with a seven-day trial and no free plan, and Nuance DAX Copilot at about $600 per clinician. The same page describes the Nuance and Nabla figures as approximate, and says pricing changes often.

The sticker price is the wrong number to compare. That page also states that business associate agreements (BAAs) typically sit behind paid tiers. If you are a HIPAA covered entity, a free plan with no signed BAA still has a cost. It lands on your compliance file instead of your card statement.

What the free tiers are built to do

A free tier is a test allowance. It is sized to let you feel the product, not to run a caseload on it. The August 2026 Twofold comparison lists Tali's free plan at five AI scribes a month, which it calls fine for light testing. Freed offers a seven-day trial only. Twofold itself describes a free trial of commonly 20 notes.

Heidi's pricing page (accessed October 2026) shows three tiers: Free with one seat, Clinician with a 14-day trial, and Teams with custom pricing. The free plan carries a weekly trial allowance, with limits on transcription usage, evidence queries, advanced templates, patient linking, document sharing and coding features. The page as retrieved showed no dollar figures for the paid tiers, so none appear here.

Run the numbers on the most generous reading. Five scribes a month covers about 6% of a 20-session week (5 out of roughly 87). The other 94% of your notes still get written by hand, or by a tool you are paying for. You will hit the ceiling inside the first week of a real caseload.

So what for you: treat any free tier as a two-week trial of the workflow, not as a permanent line in the budget, and decide before you start which paid plan you would move to.

The BAA test decides what you can use

HHS states that "the HIPAA Rules generally require that covered entities and business associates enter into contracts with their business associates to ensure that the business associates will appropriately safeguard protected health information." A scribe that records and transcribes your sessions has access to protected health information. That makes the vendor a business associate, whatever the pricing page calls the plan.

HHS's cloud computing guidance goes further. It says a cloud service provider "that maintains ePHI on behalf a covered entity (or another business associate) is a business associate, even if it does not hold a decryption key." So a vendor claiming it cannot read your data does not remove the requirement for the agreement.

Vendors differ on how they handle this. Heidi's HIPAA page says: "We make a BAA available to every covered entity we work with." It does not say which plans that covers, so ask. OpenAI says covered entities can request a BAA by emailing baa@openai.com and that most API services are covered, but ChatGPT BAAs are limited to Enterprise or Edu customers, and it does not offer a BAA for ChatGPT Business. For a solo clinician, that rules out pasting identifiable session details into the chatbot you may already pay $20 a month for.

Frankly, the evidence points one way. Until you hold a signed BAA that names the plan you are on, put no identifiable patient information into any AI tool, free or paid. A good clinical note is not worth an OCR complaint. HHS is the enforcement body here, and "we were on the free plan" will not read well in a resolution agreement.

So what for you: the first question to ask any vendor is not "what does it cost?" but "will you sign a BAA on this exact plan, in writing, before I upload a session?"

The break-even maths at solo scale

Once a BAA is in place, the price question is simple, because your own hours are the benchmark. These are illustrative assumptions, not vendor claims: you see 20 patients a week and the tool saves 10 minutes per note. That is 200 minutes a week, about 3.3 hours, or roughly 14.4 hours a month (200 minutes × 4.33 weeks ÷ 60).

At Twofold's listed $49 a month, that is about $3.40 per hour recovered. At its $69 monthly rate, about $4.80. At Tali's $100 annual rate, about $6.90. Even the dearer plans cost less per recovered hour than a coffee. The gap that matters is annual versus monthly billing: $49 versus $69 is $240 a year at Twofold's listed prices, which is a reason to trial for a month and then commit annually if it fits.

The 10-minute assumption is deliberately conservative. TheraPlatform's own marketing page claims documentation drops from 10 to 30 minutes per note to 2 to 5 minutes. That is a vendor claim with no study cited, so we have not used it in the calculation. Measure your own: time ten notes by hand this week, then ten with the tool, and use your own difference.

So what for you: if your own timing shows less than 5 minutes saved per note, the sums turn marginal at the higher price points, and the free or lowest-cost compliant option is the right call.

A three-layer stack that stays inside the rules

For a clinician with no admin staff, a short stack beats a long one. Three layers cover most of the load.

Layer one is the note tool, under a signed BAA. This is where patient audio and identifiable detail go, and it is the only layer where money is justified. Our OT documentation spotlight sets out how the AOTA documentation stages map onto an AI draft.

Layer two is a general-purpose chatbot used with no patient data at all. It is good for blank templates, handout wording, policy drafts, marketing copy and an agenda for a difficult call with a payer. The rule is simple: if the text could identify a patient, it stays out. Our Q&A on AI marketing for OT and SLT practices covers the advertising and testimonial rules that apply to that copy.

Layer three is the scheduling and billing system you already use. Check whether it has a built-in AI feature before buying anything new. A feature inside a platform you already have a BAA with is cheaper to govern than a new vendor. For the billing side, see our billing automation spotlight.

One more point sits outside the BAA entirely. Recording consent is a state-law question, and several states require all parties to agree. A BAA does not cover that. The scribe consent Q&A explains how to script it.

So what for you: spend money on layer one only, keep layers two and three at or near zero, and write down which layer each tool belongs to so you can answer an auditor in one sentence.

Three questions to put in writing before you subscribe

Does the BAA cover this plan? Ask for the answer by email, and ask for the signed document before your first real session. A website statement that a BAA is "available" is not a signed BAA.

Where does the audio go, and for how long? Ask whether recordings are deleted after the note is generated, how long transcripts are kept, and whether your sessions are used to train the vendor's models. You need the answer to explain it to a patient who asks.

What happens when you cancel? Ask how you export your notes and how the vendor deletes your data, with confirmation. A solo practice has no IT team to chase this later.

So what for you: send those three questions to your shortlist of two tools this week. The vendor that answers clearly and quickly in writing is telling you something about its support.

What to verify before you act

As of October 2026, the prices above come from a competitor's comparison page and were not confirmed against each vendor's own checkout, apart from the Heidi pages quoted. Heidi's dollar prices could not be retrieved, TheraPlatform's pricing and BAA terms were not stated on the page we read, and free-tier allowances change often. Confirm each figure and each BAA with the vendor before relying on it. Nothing here is legal advice or clinical guidance; your state board and your professional body's ethics code, such as AOTA or ASHA, still govern your records.

If you would rather have the ranked shortlist for your own caseload, payer mix and state, book a free 20-minute discovery call. We look at your workflow and tell you where the money is worth spending, with no vendor relationships behind the advice.