A patient who has never replied may never have seen a message.
It is easy to read a zero-response patient as disengaged. Often they are not — the messages are arriving somewhere the patient never looks, or not arriving at all. Run these checks before you change anything about the patient's plan.
1. Check the phone's spam folder — this is the most common cause
iPhones filter texts from unknown senders into a separate folder that most people do not know exists. We have seen patients labelled non-responders who had every single message sitting unread in it. One patient, once shown the folder, started replying the same day.
Ask the patient to check:
Open Messages.
Look for a Filters or Unknown Senders view (on iPhone, tap Filters in the top-left of the Messages list).
If SaRA's messages are in there, replying once is usually enough to move the conversation into the main list.
Have the patient save the number as their provider's name while they are in there. A named contact is far less likely to be filtered again, and it makes the messages feel like what they are — a line to their care team.
2. Carrier filtering
Mobile carriers run their own automatic spam filtering on text traffic, and they do not notify anyone when they filter. A few things follow from that:
Filtering can affect some carriers and not others, so one clinic can see a cluster of non-responders on a single carrier while everyone else is fine.
A patient who has marked a lot of messages as spam in the past is more likely to have new senders filtered automatically.
We monitor deliverability and work directly with carriers when we see a pattern. If several of your patients on the same carrier all went quiet at once, tell us — that is a signal we want.
3. Confirm the number is right and is a mobile
A landline or a mistyped digit produces exactly the same symptom as disengagement. Check the number on the patient's record against what they actually use.
Correct it from the patient list (three dots, then the pencil icon) — you do not need to re-enroll the patient.
If the messages are arriving and the patient still isn't replying
Then it is a genuine engagement question, and the usual levers apply: talk about the messages at the next visit so the patient sees you using their replies, or change the cadence so it fits their week better. If a patient truly does not want them, unenrolling is a clinical judgment you are free to make.
Worth knowing: until you have checked deliverability, a zero-response patient and an undelivered patient look identical. That is why this check comes first — it is the difference between a patient who declined and a patient who was never asked.
Still stuck? Message us in the in-app chat with the patient's name and we will look at the delivery record for that number.