Thanks for the opportunity to review the proposed standard. I have 2 pieces of feedback: 1. The AMA has not updated the guide for uninsured services since 2018. It would be necessary to confirm with the AMA that they have plans to keep this document current before tying it to a standard - to my knowledge, there have not been any plans to update the AMA guide, though that may change if you have discussions with them about this draft standard. 2. The piece about requiring a 24 hour messaging service or voicemail is overly prescriptive (also outdated) and unnecessary. Appointments are generally booked online in our office these days and can be cancelled online as well. We have not had an answering machine accept messages for many years now as patients would leave inappropriate information on there waiting for a call back rather than seeking appropriate after hours care. It was dangerous and so we stopped accepting messages, though they are still given a message about how to access after hours care. We always made exceptions for patients that called early Monday morning to cancel - they were not charged if they weren't able to notify us because we were closed. Less prescriptive solutions and language would be preferable here please.