Secure Fax Apps for Small Practices (2026): Spruce vs iFax vs Medsender
iFax, Spruce and Medsender compared for small practices that still send and receive referrals and records by fax: published pricing, which plans receive faxes, BAA status and best fit. A starting point if you are looking at fax service alternatives.
Key takeaways
- iFax is a standalone online fax service. Its Basic plan ($12.49/mo) only sends, up to 200 pages a month; receiving on your own fax number starts with Plus at $24.99/mo, which allows up to 500 pages a month. The vendor’s HIPAA features and BAA apply to Plus and higher, not Basic (vendor pricing and HIPAA pages).
- Spruce puts e-fax in the same shared inbox as phone, texting and video, priced per user: Basic $24/user/mo, Communicator $49/user/mo. You can port an existing fax number. It suits teams replacing several tools; if you only need fax, compare the per-user cost (vendor plans page).
- Medsender is quote-only and aimed at specialty practices with heavy referral fax volume: its AI fax tier reads, sorts and files incoming faxes, starting at up to 3,000 pages a month. We found no public BAA statement, so its BAA is unverified (vendor pricing page).
- A BAA is one item on the checklist, not proof that a fax workflow meets HIPAA. Confirm which plan the BAA covers, who can open the fax inbox, and how long faxes are kept.
- Order follows the AIOP Score. iFax is an affiliate partner; that does not change its score or its position here.
Monthly cost for a small practice
- Receive and send on one number: iFax Plus at $24.99/mo for up to 500 pages a month, or Spruce Basic $24 per user (e-fax plus phone, text and video), so $48/mo for two users.
- Send only: iFax Basic at $12.49/mo for up to 200 pages a month; the BAA does not cover this plan.
- High referral volume: Medsender is quote-only; its starting AI fax tier covers up to 3,000 pages a month.
Illustrative, from published prices before tax and promotions. Confirm with each vendor.
 Spruce Health | iiFax | MMedsender | |
|---|---|---|---|
| Pricing | Basic $24/user/mo; Communicator $49/user/mo; e-fax, phone, texting and video on both plans; 14-day free trial, no credit card; one-time $19.50 SMS registration fee; taxes and fees extra (vendor plans page) | Basic at $12.49/mo covers sending only, up to 200 pages a month; Plus at $24.99/mo adds one fax number for receiving and up to 500 pages a month (the vendor lists HIPAA compliance on this plan); higher tiers and enterprise volume pricing on request; AI features (OCR, data extraction, AI chat) use AI credits; about 20% less billed annually, and a checkout promotion was advertised when we checked (vendor pricing page) | Quote only – AI Fax, AI Referral and AI Call Automation are priced separately by monthly volume (fax pages, referrals, calls) and contract length, with bundle discounts; starting fax tier includes up to 3,000 pages/mo; free trial covers basic non-AI cloud fax only (vendor pricing page) |
| What it does | Phone, text, video and fax in one shared inbox for care teams. Integrates with athenahealth, DrChrono, Elation, Hint, ModMed, Dock and Guava; API on Communicator plan (vendor integrations). | Online fax (the vendor markets it as HIPAA-compliant) for referrals, records and prior-auth paperwork: send and receive faxes from web, desktop, mobile or email, with smart routing, audit logs, AI OCR that turns faxes into searchable text, data extraction, and EHR, Google Workspace and Microsoft 365 integrations. | AI fax, referral and call automation for independent specialty practices: reads, titles, categorizes and files incoming faxes to the right patient chart, tracks referrals through scheduling, recaptures lapsed patients, and answers routine patient calls 24/7, with EHR integrations. |
| HIPAA BAA | Yes – automatic BAA for eligible organizations on every plan including trial (vendor help) | Yes – vendor's HIPAA fax page says a BAA is included; HIPAA features are on Plus and higher plans only, not the send-only Basic plan (vendor site) | unverified – vendor says its AI solutions are HIPAA compliant and SOC 2 Type II, but we found no public BAA statement; ask for one before connecting your fax line or EHR (vendor site) |
| Last checked | · source | · source | · source |
| Next step | Full listing Visit site ↗ | Full listing Visit site (affiliate) ↗ | Full listing Visit site ↗ |
Spruce Health
Patient IntakePhone, text, video and fax in one shared inbox for care teams. Integrates with athenahealth, DrChrono, Elation, Hint, ModMed, Dock and Guava; API on Communicator plan (vendor integrations).
iFax
Inbox & EmailOnline fax (the vendor markets it as HIPAA-compliant) for referrals, records and prior-auth paperwork: send and receive faxes from web, desktop, mobile or email, with smart routing, audit logs, AI OCR that turns faxes into searchable text, data extraction, and EHR, Google Workspace and Microsoft 365 integrations.
Medsender
Inbox & EmailAI fax, referral and call automation for independent specialty practices: reads, titles, categorizes and files incoming faxes to the right patient chart, tracks referrals through scheduling, recaptures lapsed patients, and answers routine patient calls 24/7, with EHR integrations.
Weighing a switch? Spruce Health alternatives · all alternatives
Related: Inbox & email implementation guide · Prior auth AI tools · iFax listing · Spruce listing · Medsender listing
Frequently asked questions
Which of these can receive faxes?
iFax receives faxes from the Plus plan up (Basic is send-only). Spruce includes e-fax on both Basic and Communicator. Medsender’s fax automation is built around incoming faxes and is priced by quote.
Can I keep my current fax number?
Spruce says you can port an existing phone or fax number. iFax lists fax number porting on its site. Ask Medsender during its quote.
Do these vendors offer a BAA?
iFax’s HIPAA fax page says a BAA is included, for Plus and higher plans. Spruce provides an automatic BAA for eligible organizations on every plan, including the trial. Medsender’s BAA is unverified: we found no public statement.
Is iFax an affiliate on this site?
Yes. If you sign up through the iFax link we may earn a referral fee. It does not change iFax’s AIOP Score or where it appears on this page.
Affiliate disclosure: Links marked “(affiliate)” on this page are affiliate links. If you sign up through it, we may earn a referral fee at no extra cost to you. That is how this free directory is funded, and it never affects our scores or listings.
Disclaimer: This site covers administrative and operational workflows only. It is not clinical, legal, or compliance advice. Pricing and plan details come from vendor sites or third-party reviews as of the date shown and can change – confirm directly with each vendor and your compliance advisor before using any tool with protected health information.