Patient Opt-Outs and Opt-Ins
What happens when a patient texts STOP, why an opt-out can affect more than one practice, and how to turn a patient's texts back on.
What happens when a patient texts STOP?
Two separate things happen, and they are independent of each other.
| Layer | What it does | Who controls it |
|---|---|---|
| The mobile network | Blocks further texts to that phone immediately and sends the patient its own brief confirmation that they are unsubscribed. | The carrier. Automatic, and outside our control. |
| Your dashboard | Records the opt-out on the patient's record so scheduled follow-ups, reminders and confirmations are skipped. The audit trail logs which word they used. | Us. |
Both layers act on their own. Even if one of them failed, the other would still stop the texts.
Which words count as an opt-out?
STOP, STOPALL, UNSUBSCRIBE, CANCEL, END, QUIT.
The word has to be the whole message on its own. Capitalization does not matter. A longer sentence such as "please stop texting me" is not read as a keyword -- it arrives as an ordinary message, and the patient usually gets a warm reply pointing them to your phone number. If a patient asks in their own words, nothing is switched off automatically. Switch their consent off by hand (see below).
CANCEL is a standard opt-out keyword across the whole industry, so we have to honor it. But a patient texting it in a reminder thread may well have meant "cancel my appointment".
When it happens: their texts are switched off, nothing on your schedule changes, and your appointments team gets an alert. Call the patient before you change anything.
Why did a patient stop hearing from us when they opted out of a different practice?
Because every practice's automated texts go out from one shared OzyOps number.
A patient who deals with more than one practice on our platform sees a single thread, from a single number, carrying messages from all of them. They have no way to tell those messages apart, and we never gave them one.
So when they reply STOP in that thread:
- The network blocks the number, not one practice. Nothing from any practice can reach them after that.
- We therefore switch the patient's consent off at every practice on the platform that has their phone number, so your records match what is actually happening.
We looked hard at doing this the narrower way, marking only the practice whose text they replied to. We decided against it: it would leave three other practices marked "allowed to text" while not a single message could be delivered. Records that describe a world that does not exist are worse than an over-broad opt-out.
What this means for you day to day: you may occasionally see a patient marked as opted out who never said anything to your office. That is expected, not a bug.
If a patient texts STOP to your practice's own phone number -- the number they call you on -- rather than replying to a text, only your practice is affected.
What does the patient see?
- A short confirmation from the mobile network, not from you or from us. We deliberately stay silent so nobody gets two confirmations for the same STOP.
- No more automated texts. Anything already scheduled is skipped.
- Phone calls are unaffected. You can still call the patient yourself at any time. An SMS opt-out is an SMS opt-out; it is not a request to stop calling.
- Automated follow-up calls stop at the practice the patient replied to. If the same patient is also on file at another practice, that practice's automated calls are not stopped by this opt-out. If you need those stopped too, switch the patient off at that practice from the dashboard.
What if the patient texts START?
Treat START as a signal, not a fix. It does less than most people expect.
| What START does | What it does not do |
|---|---|
| Unblocks the number at the mobile network straight away, so messages can physically reach the patient again. | Does not switch any practice back on by itself. |
| Tells us the patient wants texts again, and raises an alert so your team can act on it. | Does not restore consent at your practice, or at any other. |
The keywords are START, SUBSCRIBE and UNSTOP. YES counts too, when the patient is currently opted out.
This is the part that surprises people, so it is worth being blunt about it. A patient who texts START in the same thread they texted STOP in gets nothing switched back on. The network unblocks them, we log it and alert you, and their consent stays off at every practice until a person turns it back on from the dashboard.
The one exception: if your practice has its own inbound number and the patient texts START to that number rather than to the thread your reminders come from, we can restore consent at your practice, because they named you by texting you directly. Most patients will not do this, because the thread they are replying in is the one your reminders arrived in.
Why it is deliberately limited. Switching texts back on for a practice the patient never named would be permission we cannot show they gave, and that exposure sits with the practice, not with us. Turning a patient's texts back on is a deliberate act by your team, from the dashboard, at each practice the patient wants.
So a patient can text START and still not hear from you. Always confirm in the dashboard.
How do I turn a patient's texts back on?
Both halves have to happen. The patient has to unblock us at the network, and you have to switch consent back on in the dashboard. One without the other does not work.
- Ask the patient to text START from the phone they opted out on. Only the patient can undo a network-level block; nothing you do in the dashboard can.
- Open the call in Dashboard > Calls.
- Under SMS Consent, tick the box. It reads SMS follow-up opted out when it is off and SMS follow-up allowed when it is on. On a pipeline card, the equivalent control is Allow SMS/Call follow-up.
- If you run more than one account with us, repeat it in each one. Consent is per practice.
Only do this when the patient has actually asked for texts again, and note who asked and when. The change is recorded on the call's audit trail.
The toggle writes permission back for one stored version of the phone number. If that number was recorded in more than one format, an older record can keep the patient suppressed even with the box ticked.
If texts have not resumed within a day of switching it back on, email support@ozyops.com with the patient's call record and we will clear it. This is a known limitation we are working on, not something you have done wrong.
Common questions
A patient insists they never opted out, but the dashboard says they did. Almost always the shared-number case above: they replied STOP in a thread that also carried another practice's texts. The audit trail on their call shows the date and the exact word used.
Does an opt-out expire? No. It stays in place until someone turns it back on.
Does an opt-out stop phone calls too? It stops automated follow-up calls. Your staff can still call the patient by hand, and the patient can still call you.
What does HELP do? A patient who texts HELP or INFO gets a short reply with your practice name and your phone number.
Where do I see the history? On the call detail page. The audit trail records each opt-out and opt-in. The word the patient actually used is on the detail line underneath the entry, so read that line rather than the headline.
For how SMS is counted and billed, see the SMS Usage FAQ. For a text that was expected but never arrived, see SMS Delivery Troubleshooting.