Want to email your doctor? they may charge you for it

WASHINGTON (AP) — The next time you text your doctor to ask about a pesky cough or itchy rash, you may want to check your bank account first; you may receive a bill for the question.

Hospital systems across the country are implementing fees for some messages patients send to doctors, who say they are spending increasing time poring over online consultations, some so complex that they require the level of medical expertise normally dispensed during an office visit. .

However, patient advocates fear that these new fees could discourage people from contacting their doctor and add another layer of complexity to the US health care system. opaque billing process.

“This is a barrier that denies access and will result in hesitancy or fear to communicate and potentially harm patients with lower-quality care and outcomes at a much higher cost,” said Cynthia Fisher, founder of Patient Rights Advocate, a Massachusetts-based organization. nonprofit that drives price transparency for hospitals.

the explosion of telehealth in the past three years — spurred by the COVID-19 outbreak and relaxed federal regulations for online care — led many physicians to embrace more robust telecommunications with their patients. Inquiries that once occurred in an office have become computer or smartphone visits. And health care systems have invited patients to use new online portals to message their doctors with a question at any time, American Medical Association President Jack Resneck Jr. told The Associated Press.

“When people realized that this is great and could improve care, they saw hospitals and practice groups saying to patients, welcome to their portal…you can ask your doctor questions if you want,” Resneck said. “We find ourselves as physicians receiving dozens and dozens of these a day and not having the time to do the work.”

Charges vary for each patient and hospital system, and messages range from $3 for Medicare patients to $160 for the uninsured. In some cases, the final bill depends on how much time the doctor spends responding.

Health systems that have introduced these new policies, many in recent months, say they automatically alert patients that they may be charged when they message their doctor through online portals such as MyChart, a system on line that many organizations now use to schedule appointments or release test results to patients.

Under the new billing rules, doctors can bill Medicare for as little as 5 minutes of time spent on an online message in a seven-day period, according to the Centers for Medicaid and Medicare.

Doctors should be paid for the time they spend giving expert medical advice, including through messaging, said Katherine Baicker, a health economist at the University of Chicago. But it’s also important for hospital systems to be transparent about what patients can expect to pay as they implement these new charges, she added.

“Copays do nothing when they aren’t clear to patients ahead of time,” Baicker said.

Physicians at the University of California San Francisco Health receive approximately 900,000 email threads (3 million total messages) in a year, according to Jess Berthold, a spokesperson for the system.

The hospital announced in November 2021 that it would begin charging for some of those messages, after noticing an uptick during the pandemic. Over a year’s time, 1.4% of email threads, or about 13,000, have resulted in an invoice.

Only certain messages trigger a charge. Patients will not be charged, for example, for refilling prescriptions, scheduling an appointment, asking a follow-up question about an office visit in the last seven days, or if their doctor advises them to schedule a visit in response.

What types of messages will generate an invoice? Send your doctor a picture of a new rash, ask them to fill out a form, or request a change in medication.

Navigating how much you might end up owing can be more complicated.

At UCSF, Medicaid patients who send messages to their doctor will have no out-of-pocket cost, and those with traditional Medicare may have to pay between $3 and $6. Patients with private insurance will be billed a copay, usually around $20, just like patients with Medicare Advantage, Medicare’s private insurance plans.

Cleveland Clinic in Ohio, the latest major hospital system to announce charges for online messages, launched similar guidelines late last month, with messages costing up to $50 for those with private insurance. And at Northwestern Medicine in Chicago, which charges $35 for some messages, less than 1% of those correspondence resulted in a bill, spokesman Christopher King said.

All of these systems use the MyChart online portal. Epic, the privately owned software company that runs MyChart, does not track which health systems charge patients for messages, spokeswoman Barb Herandez said in an email. The company did not respond to questions about whether it receives a share of the fees for those charges.

Giving advice to patients online can save them time or money in the long run, hospital systems argue. If the doctor can answer a patient’s question via email, the patient can reduce wait times for an appointment and avoid taking time off work to go to the doctor’s office.

Also, some patients simply prefer the convenience of getting a quick response from their doctor in an app, added UCSF’s Berthold.

“If patients can access a doctor right when questions or concerns arise, they can seek care faster and get treatment faster,” Berthold said.

But Fisher argues that it could have the opposite effect with patients thinking twice before sending a message to a doctor. Instead, some people may turn to unreliable and free advice online.

“It becomes a slippery slope, and that slippery slope does not favor the patient,” he said.