Your Doctor Replied to Your Email. That’ll Cost $25.
Mar 28, 2024
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doctors are charging fees to respond to patient messages
The next time you send your doctor an email, don’t be surprised if
they charge you a fee to answer.
More
healthcare groups are charging fees to answer patients’ electronic messages,
often the ones you exchange via their portal. Doctors say it’s only fair if
they’re spending time on the messages and note that an email
discussion can often save you the time of having to come in.
The typical cost of an email message claim was $39 in
2021, including both the portion paid by insurance and by the patient,
according to a Peterson-KFF Health System Tracker analysis.
Some patients have been taken aback
by the charges. They are surprised at the notifications on portals about the
change, and irritated at the idea of a new fee.
Dr. Lauren Oshman, a family
physician and associate professor at the University of Michigan Medical School,
says she initially experienced some patient resistance and anger about the
prospect of being billed for emails.
Now, she says, patients are
typically pleased that they are able to get a direct response from her through
a portal message.
“They’re thrilled when they get me
directly,” she says.
Doctors aren’t charging for every
email. Federal guidelines typically followed by private insurers say that
patients can only get charged for messages that require at least five minutes
of a doctor’s time over the course of seven days.
Billable messages also have to
involve some sort of medical decision-making rather than deal with an
administrative matter, like scheduling
an appointment, according to those guidelines. And emails that stem from a
follow-up to a visit, such as explaining
lab results, aren’t typically billed.
What that message will
cost you
Health plans covered the full cost
of about 82% of claims, according to the Peterson-KFF analysis. Patients who
shared the cost paid $25 on average.
The practice of charging for emails
has steadily increased in the past few years, as the volume of emails that
patients send has grown. A 2020 ruling from the federal Centers for Medicare
and Medicaid Services added billing codes that let medical providers get
reimbursed for email correspondence that takes more than five minutes over the
course of seven days and requires medical decision-making. That paved the way
for private insurers that typically follow what CMS does.
Medicare generally reimburses physicians $15 for
messages that take five to 10 minutes; $30 for those that take 11 to 20
minutes; and $50 for those that take 21 or more minutes.
Most patients with traditional
Medicare plans won’t face any out-of-pocket costs, says A Jay Holmgren, an
assistant professor in the department of medicine at University of California
San Francisco and the Center for Clinical Informatics and Improvement Research.
But people with commercial health insurance will pay something akin to a
copay—unless they have a high deductible plan, in which case they will
typically absorb the full cost.
A surprise in your
portal
Jennifer Ann Falandys, a
41-year-old who lives outside of Buffalo, N.Y., says she typically emails her
doctors at University of Rochester Complex Care Center once or twice a week.
Falandys says she has cerebral palsy, lung complications and generalized
anxiety disorder, among other things.
“Patients like me who are complex
patients, we require a lot of interaction,” says Falandys, who is a disability
advocate.
“It just feels a little
intimidating when you open the portal and the first thing it says is ‘be aware,
we’re going to bill,’” she says. “We have to send these messages and we
shouldn’t have to think to ourselves, ‘Should I send this?’”
The University of Washington
Medicine health system started charging for patient emails over the
summer.
The volume of emails has been
growing over the past decade, says Dr. Crystal Wong, a family medicine
doctor and associate chief digital officer at the University of Washington in
Seattle. The system received 1.5 million messages through its portal in 2022,
she says.
In just one morning recently, she
answered 14 emails.
“I do this on my lunch break, I do this in between patients, I do
this at night or in the morning before clinic,” she says of responding to
patient emails. “It is an amount of work that we need to acknowledge is
real.”
Wong
says a small percentage of emails—only 1% to 2%—is billed. Those typically
include medical issues that are safe to handle over the MyChart portal system,
such as a rash with attached photos, or questions about a medication or
supplement.
For
more serious health issues such as acute abdominal pain, it’s important for
patients to visit in person, says Wong. “I need to look at you and do a good
old-fashioned exam,” she says.
Emails that take time
Oshman
of the University of Michigan said that if patient messages take her less than
five minutes, she doesn’t bill for them.
However,
some involve a back-and-forth that takes more than five minutes of her time
over seven days. These may require her to review several past notes or another
doctor’s notes and make a medical decision.
For
instance, as an obesity medicine specialist, she may assess a patient’s
response to medication and lifestyle changes and recommend dose changes. Or she
might diagnose and treat a urinary tract infection, a rash, or manage treatment
for patients with depression or anxiety.
“Out
of every 10 messages, one or two of them are messages that take me a long time
to answer properly,” she says.
Source: Wall Street Journal