r/HealthInsurance • u/arwenthenoble • 14d ago
Claims/Providers Full office visit co-pay charged for MyChart message
I had a question about a temporary medication I was taking and sent a message via MyChart. The message was only regarding the medication (no other health questions were asked).
I received my EOB and was charged a full $50 co-pay like when I go in person for a visit or have a full video visit. When I looked online, I see in general messaging costs listed as much lower than a visit. Does this mean my insurance doesn’t differentiate a full visit from a brief question in a message? If I had known, I would’ve scheduled an online telehealth visit instead.
I’ve had a lot of medical costs this year and another random $50 stings. I will avoid using MyChart going forward.
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u/budrow21 14d ago
Did they bill a full visit? I think it's more likely they billed a lessor code/amount (say $60 instead of $160), but your benefits have you pay the $50 copay for any claim >$50.
It's only a subtle difference, and the same impact to you. You can check the EOB to see.
I'd be interested if they really coded a full visit.
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u/arwenthenoble 14d ago
It looks like they billed $70 for the visit.
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u/muze20 14d ago
If they billed $70 for the visit, that’s definitely a lot less than a normal visit. Out of curiosity, is the code listed on the EOB or bill? Unfortunately in your case your insurance doesn’t differentiate between a visit and a mychart message, and is asking you to pay $50 in both circumstances.
Also, you aren’t being charged anything until the hospital sends a bill. So don’t call the hospital until they have the bill ready to save your own time.
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u/arwenthenoble 14d ago
It’s 99421. At least I know in the future just to schedule an online visit when possible so I can go over other issues since I’m paying the same co-pay whether it’s one question or a visit.
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u/Moist-Barber 14d ago
CPT Code 99421 refers to online digital evaluation and management services provided by healthcare professionals. It is specifically for patient-initiated communications that last 5–10 minutes over a 7-day period
You did not get charged for an office visit, just an electronic message.
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u/arwenthenoble 14d ago
Thank you. I guess I just have a high copay for a message then.
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u/wighty 13d ago
Yeah, to be honest the anger should be directed toward the insurance company.
I get extremely frustrated at physical therapy co-pays as well, as at least around me a lot of plans you owe a co-pay for every single session and not just the whole treatment course (ie 2 days a week x 6 weeks = 12 total co-pays, instead of one co-pay... most of the time these co-pays approach paying for the entire visit at around $50 or so).
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u/Resse811 13d ago
I don’t understand why you would expect to be billed differently for PT sessions.
Yes you pay a co pay for each session because each session is a separate appt. Why would 12 visits be charged as one?
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u/wighty 13d ago
They are getting the same copay or sometimes worse than when they see a physician... I can't tell you how many times I tell a patient I recommend PT and they say they won't do it because it will cost them $300-600. My goal would be to make it actually feasible for patients.
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u/Resse811 13d ago
Right because again each session is considered an appt. That’s why each session would be charged a co pay. It’s like seeing a doctor 12 times. You wouldn’t pay a single co pay for all those visits.
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u/Silent_Cookie9196 13d ago
Agree- have also experienced this. I was shocked when this happened to me, because they didn’t collect anything until the end, and it was over like $600 for the PT visits.
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u/muze20 14d ago
Yup totally agree. Silly of your insurance to bill you for the same copay, because you will then go for an office visit which will cost the insurance more (because you only pay $50 regardless).
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u/Living-Target-9355 14d ago
Sad that the medical provider felt it necessary to charge for being asked about a medication that it sounds like they prescribed or recommended.
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u/Comfortable_Two6272 14d ago
I get why. They get hundreds of messages a week some spending 2-3 extra hours each night to answer. Some are now removing messaging access vs billing for questions via My Chart.
Its crappy insurance is charging a $50 copay vs say $10-$20.
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u/AnteaterStreet6141 13d ago
Curious. Why is it ok to expect lawyers to be compensated for phone messages but physicians should do it for free?
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u/Quick_Parsley_5505 13d ago
As a lawyer, let me tell you how clients feel about a $50 phone call. No hints.
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u/Known_Paramedic_9503 13d ago
My doctor does the same thing. I can call and talk to a nurse directly on the phone. I can email them but there is a charge
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u/uncertainPA 14d ago
I know systems are doing this now because patients abuse the system by trying to have full visits answered via mychart messaging but it really is such a ripoff when 95% of the time, simple questions are answered by nursing staff anyways
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u/Vegetable_Block9793 13d ago
Don’t worry, it’s illegal to charge the 99421 if the message is answered by a nurse. You will only pay the e-visit copay if you send a medical question that is answered by a physician, nurse practitioner, or physician’s assistant.
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u/Berchanhimez PharmD - Pharmacist 14d ago
Many doctors are doing this now for anything more than a simple issue like saying you need more refills.
You’re still taking up the doctor’s time to ask them questions over the phone or internet/mychart. If you prefer to do a telemedicine visit rather than messaging back and forth, that’s your right.
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u/Traditional-Hat-952 13d ago
Yeah doctors are getting really tired of people spamming their mychart inboxes when they already have full patient loads. Not saying OP is doing that, but I've talked to a few doctors and they hate Mychart messages because some people are neurotic AF and keep sending messages.
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u/DCRBftw 14d ago edited 14d ago
OP wasn't asking if it was their right to do a telemedicine visit. Of course they have the right to do a telemedicine visit. Their question was about being charged for mychart questions. It's a lesser charge than full scheduled visits. I realize that as a pharmacist and not a Healthcare biller that they may seem like the same level of option, but they aren't. OP needs to find out if they've met their deductible and what the difference is between this and telemedicine copays. They also need to find out if their telemed visits are with their actual PCP or if they're outsourced. Some plans have reduced teledoc copays, but they're not with their actual PCP. Then they need to find out if their PCP does virtual visits. There's a lot more that goes into it than just whether or not a person has a right to telemedicine.
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u/Low_Mud_3691 14d ago
Patient's abuse the message system. I'm not surprised that the office has that policy in place. You probably signed something about it either at intake or another time.
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u/mayday4aj 13d ago
Yup this right here. Especially in fam med. Its why we cant have nice things, people just over abuse the system. Treatment discussion is fine but the entirely different discussion is the issue. The worst are patient asking for a full written conversation of a new, never before talked about medical concern, asking for a referral to a medical issue we never discussed, do a prior authorization for a med denial or "just fill out this form" situations for fmla, disability
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u/anonymowses 14d ago
Last time I used MyChart, my doctor said I did all the work for her.
I thought I had a UTI. I did self-pay labs (~$20) so I could get them fast with cultures.
Through MyChart 1) Gave my doc a heads up that I took the test and was waiting on cultures. 2) Listed the dates and types of antibiotics I've used previously. 3) Asked if I should do a telemedicine or in-person visit.
She let me know the culture results and which antibiotic she sent to the pharmacy. She said no need for an appointment and thanked me for my thoroughness. Next time I was in the office she thanked me for doing her job.
I would be miffed if I had a full co-pay, but don't expect them to work for free either. I just hope the doctor can make the call instead of an automated system billing everyone.
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u/McAnki_Agar 13d ago
Nice job but 99.99% of patients don’t do this. It’s a “why would I go see the doctor when I can just message them?” And it’s never a simple message. It’s always “hey in our last visit you said I should do X, that’s not working. What else should I do?”.
Might be heavily affected by the fact that I’m in pain medicine but it’s a significant burden to my workload. I would disable my chart messaging if I could just for self preservation. Patients can call and leave a message if they’d like.
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u/decafjasminetea 13d ago
…And one day she will do this but the person (who she didn’t examine or give ED precautions to or do vitals on) will have pyelonephritis and get septic and die and then she will be liable. The number of times a patient thought they knew what was going on but was wrong I can’t even count. I’m not trusting random people. I want to examine the patient.
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u/nyc2pit 13d ago
Lol at this doctor not knowing her worth.
I'd still charge you. You are still asking my advice and want me to write the prescription. If I give you a drug that says causes you to end up horribly disfigured, you'll still sue me. So yeah, you're getting charged.
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u/wighty 13d ago
but don't expect them to work for free either
In addition, I think patients need to understand that it is about risk as well... anytime physicians are diagnosing, making recommendations, prescribing treatments, ordering testing, etc we are taking on liability. I really don't think patients should be mad at being compensated for that. Same rings true for the once a year or whatever routine follow up... yeah your blood pressure is still well controlled for the fifth year in a row, but giving you another year of medication is still a potential liability/risk to the physician.
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u/toychristopher 13d ago
Do patients abuse it or is it just not clear what it's for? I mean I'm sure some people abuse it but others really might not understand what should be a visit and what can be a simple message.
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u/Living-Target-9355 14d ago
Then they should process the copay prior to allowing the message to be sent. That’s ridiculous that they’re charging for questions being asked related to treatment already occurring.
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u/meliora2316 13d ago
Most (perhaps all) insurance companies prohibit charge prior to rendering medical services. Co-pays are different than rendering medical services hence the charge at check in and then a bill after services rendered
Based on the elements that went into the doctor’s response it would be impossible to charge beforehand
Many health systems have explore the concept of charging prior to sending and it’s always a no-go
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u/EffectiveEgg5712 Carrier Rep 14d ago
The hospital sent a claim to your insurance. The insurance processed the claim based on the coding.
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u/arwenthenoble 14d ago
My insurance card has a $20 copay for telemedicine - so I’d have to call them and see why a MyChart message is considered an office visit?
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u/Moist-Barber 14d ago
Your visit wasn’t billed as an office visit. It was billed as an online/digital E/M visit using the correct code for messaging.
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u/arwenthenoble 14d ago
Now my confusion is what the lower telehealth copay would apply to - apparently it doesn't include messaging which I'll know going forward and just do normal or video visits.
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u/pathto250s 14d ago
Despite what a lot of people are saying, that IS a question for your insurance company
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u/JDWhite1982 13d ago
Agreed, and OP, those codes are new for 2025 I think so it could be that the insurance company is still trying to get things figured out in terms of copays and everything.
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u/justkidding89 14d ago
The hospital is the one deciding to charge you for a visit as a result of your message - not your health insurance.
Hospitals that are charging for MyChart messages usually have a message/warning about the potential charge before you send the message.
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u/HolidayAsparagus6387 13d ago
wait...you get charged for the messages sent through the app to your doctor?
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u/bcd051 13d ago
As a doctor, I'll answer this: there are days where I spend well over an hour to two answering portal messages. Simple things like asking for a referral is no big deal, but if there is medical decision making involved, then yes, you can get charged. If i spend 5 or more minutes ordering a medication and labs with specific instructions to send to you, the thought is that i should be reimbursed for that time. It's not really meant to screw people, but it is meant so that we aren't working multiple hours a day for free.
For me, personally, anything like refills or clarification or sending messages about lab results, those are never charged. But if it's something like, "My stomach has really been bothering me, I wonder what I can do about it?" I then have to clarify where, how often, what have you tried, any other symptoms, etc., which is essentially an office visit.
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u/HolidayAsparagus6387 13d ago
Oh lord people ask that kind of question to you? I only send messages about refills, or questions about the med, not full blown appointments, sheesh...people.
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u/0ldertwin 13d ago
Primary care doc here. That type of message happens all the time. Literally multiple times every day
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13d ago
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u/UnfoundedDime 13d ago
That’s how it works for everyone
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u/arwenthenoble 13d ago
Correct. This was about a medication I was taking. No new health symptoms were brought up. For that kind of thing I know to just do an online appointment.
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u/Future_Department_88 13d ago
Or you could let ppl know at the start, you won’t answer questions there & they’ll need to make an appt. Most offices just don’t bother to respond Not cool but it’s true
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u/arwenthenoble 13d ago
First time it happened, but yes. I rarely use messaging, but now I will avoid it.
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u/Pretend-Panda 13d ago
My pcp uses not MyChart. All my many specialists use MyChart. It’s maddening. All the administrative burden is on me, where it should live at HIM, who are so terrifyingly short staffed and overwhelmed that it’s scary.
Even though I have signed and uploaded a million releases and update them every single visit, because they’re on different systems, if I want my PCP to know what’s going on with the specialists, I have to go into MyChart, screenshot all the test results and notes and then log out and log in to the PCP’s system and upload them. Then the MA reaches out, faxes over the release and gets an auto reply that the results/notes will show up within 20 business days.
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u/Littlegator 13d ago
FYI MyChart is part of the Epic electronic health records system, which typically costs more than $10 million to set up. It's not a system a small practice can have, unless they're part of a bigger system.
The interoperability of electronic health records is a huge issue, but it is getting better. The biggest solution for small clinics that can interoperate with MyChart is Athena, but they charge 10-15% of bills received, and most docs aren't willing to give away $50k-$100k a year for an EHR when the competition can be <$5,000.
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u/LyniPooh 13d ago
Interesting that you get a charge for asking a question o MyChart because it takes too much of the doctor’s time. I had test results sent to me in the mail without a phone call explaining anything. Just ok at the top. I have to sit on the phone for at least 15 minutes to get to talk to person to actually make an appointment because I can’t make an appointment with my primary physician much less any doctor on MyChart. Last time MyChart asked me questions and basically tried to tell me I didn’t need to see a doctor. My time is important too.
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u/ScarInternational161 14d ago
I don't understand this at all... I can call my Dr office, leave a message asking a medication question with my Dr's nurse and get a call back within 24 hrs, usually same day, with the answer. No charges to ask a med question ever.
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u/SensibleReply 13d ago
They’re giving away free medical advice. That may be kind or naive, but it will become less common. Try talking to a lawyer about anything and see if you don’t get billed for 0.25 hours.
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u/HeparinBridge 13d ago
This is the answer. As reimbursements for physician services continue to decline, doctors will be less willing to work for free like that.
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u/SensibleReply 13d ago
People dislike greedy doctors more all the time while reimbursement falls every year. My bread and butter surgery has been cut by 75% since the 90s and is facing another 11% cut next year. It’s almost not worth even doing it as you can make nearly as much money simply seeing clinic pts.
The major problem is that health care is un fucking reasonably expensive and (rightly) infuriates everyone. So people assume the docs are in on it, jacking up prices and getting rich. When in reality we are 8% of medical costs. You could force every doctor in the country to work for free and costs would drop 8%. Or they wouldn’t and the hospitals/insurance/admin would just pocket the difference.
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u/Shadow1787 13d ago
And expect no one to go to the drs with that drs attitude.
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u/MrPBH 13d ago
The problem is that the barrier to sending a MyChart message is very low and that results in dozens of daily messages.
Some offices hire a nurse whose only job is managing the inbox. More commonly, it falls on the doctors to do so and it can take hours of their day. Hours that they are not getting paid for.
Other people use the inbox as a substitute for making an appointment and try to get free care that way.
Because insurance companies and Medicare are cutting reimbursement for medical care and inflation is ballooning overhead, you can expect charges for inbox messages to become industry standard.
Alternatively, you could pay for the level of service you want by signing on with a Direct Primary Care practice. Such clinics offer unlimited medical care (including inbox messages and telehealth visits) for a single monthly subscription fee.
If you want white glove service, expect to pay for it.
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u/SensibleReply 13d ago
Most practices have way more pts than they can handle and aren’t really competing with other businesses anymore in many places. Every doc I know would be happy to lose a pt who doesn’t pay for their time because there are plenty more who will.
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u/Shadow1787 13d ago
And we wonder why er doctors always ask why patients don’t have primary drs. Primary drs with that additude is why.
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u/Objective_Mortgage85 13d ago
Primary doctor are hugely overworked and there is a huge shortages of them that doesn’t allow people to have access and it’s the attitude that is the problem? Okay.
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u/Drunkengota 13d ago
Primary care is already be of the lowest reimbursed specialties facing the highest burnout, partially because patients seem to think primary care = concierge doctor for a lot less money.
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u/ScarInternational161 13d ago
So, I call for clarification on a medication they prescribed me, and get charged to be told how to fix the interaction they created with another prescription they prescribed?
Do they charge the pharmacist when they call with the same question?
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u/QueenInYellowLace 13d ago
Your insurance may have rejected a two-week script and told your doctors office that they will only cover 90 days. That is extremely common.
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u/That-League6974 13d ago
Perhaps. But on the other hand, we are regularly billed $500-900 for 15-20 minute in-person or virtual appointments. Seems like a couple minutes for an email follow up is fair given these incredibly high charges. My last one was a 4 minute call from a urologist, which included the waiting time to be transferred to him, to share one simple test result. (a result I had already read online) $950 was billed.
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u/Littlegator 13d ago edited 9d ago
A med question doesn't typically require "medical decision making," or it's usually a very trivial decision based on the care they've already provided, so they're not billing it.
Multiple patients every day will basically try to run an actual office visit through the message system ("I've been throwing up and had diarrhea for 2 days, can you prescribe me Zofran?"). That visit through private insurance would probably reimburse something like $270-$320.
So yeah, docs don't love it when you try to get their medical advice, decision making, prescription, and liability for free.
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u/aonian 13d ago
Not all systems have implemented this policy...but most probably will. Ours has not, but will eventually.
Also, this code is only for communication directly with your provider. If the nurse answered the question per protocol, or if they did a quick verbal check with the provider, you aren't getting charged. It has to be something that takes at least 5 minutes of the doctor's time. It also can't be related to a recent visit. I doubt the OPs medication question was as simple as they thought it was. Common examples include: "Should I be on this med I heard about?" Or "Is this random Internet supplement safe to take with my eight other meds?" or "I've been on this med for years but am now worried it's causing a side effect I've never before mentioned having symptoms of."
The code is very targeted. The goal is to get people to stop treating MyChart as Uber for doctors, or as a way of avoiding a visit. It's not meant to discourage normal communication with your medical team. If a provider uses it when they are just clarifying the instructions for a med they just prescribed, that is a misuse of the code and should get kicked back.
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u/PresentTap5470 13d ago
That's nothing. I got billed for appointments I beither scheduled, attended or knew about. Complete fiction.
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u/NavyBeanz 14d ago
Honestly I think this is disgusting. They don’t have to answer the messages if they don’t want to.
My urologist gave me his cell phone number and texts me back on weekends. I don’t want to abuse the privilege of contacting him on his cell, so most of the time I use MyChart and he answers promptly. It’s at his convenience and if he doesn’t want to answer he doesn’t have to, but he always does. I consider this the mark of a doctor who truly cares about his patients. Charging seems really petty
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u/arwenthenoble 14d ago
I'd rather just have been sent a message an appointment was needed. It wasn't an urgent care situation, either. Sigh.
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u/Brewzzi 13d ago
Unreasonable patient expectations like this is why I got out of primary care. After a full clinic day, followed by reviewing phone calls, labs, imaging, and multiple messages on my own time wore me out. Being on call and getting “emergency” pages for non urgent issues wore me down. There’s only so much you can do in a day, and you certainly should be compensated for time.
You have to answer messages. You can’t ignore them. You ignore them and they stack up. Then admin is on you. Patients are mad, it’s been 2 hours since they sent the message!
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u/itsamutiny 14d ago
I completely agree. If the question is too complex, just say that and suggest they make an appointment. I've never been charged for messaging and I'd be livid if it happened.
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u/UnfoundedDime 14d ago
That still requires time to assess and advise. Even if it only took you 3 minutes to read a message, decide they need a visit and communicate that back you’d still spend hours a week doing just that.
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u/Living-Target-9355 14d ago
No, your nurse or admin staff would spend a few minutes a week doing that. You would answer the question in 10 seconds and move on.
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u/nyc2pit 13d ago
Lol. You think I remember every patient?
I have to read your (usually ridiculous and poorly written) message ... Read the chart and read my notes from our last visit. Figure out what I need to do to answer your question(sometimes go look something up)... Write you back.
Damn straight you're getting billed.
Also appreciate that you know how to.so my job better than me! I'll call you for advice next time!
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u/MotherAtmosphere4524 13d ago
Spend ten seconds and then get sued $2M for missing something.
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u/Living-Target-9355 13d ago
Missing what? If it’s complex enough to actually need to do research you should probably have them make an appointment
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u/HeparinBridge 13d ago
This is basically what’s going to happen. In the near future, basically all practices will either A) eliminate MyChart messaging, B) respond to every clinical question with “please make an appointment to address this,” or C) people will be billed for MyChart messages.
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u/UnfoundedDime 14d ago
It takes only 10 seconds to read what is likely multiple messages between staff and patient, review medical records, and provide a clinical assessment?
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u/Living-Target-9355 13d ago
How often do you need to review their medical records and provide an assessment? In those cases you could have a policy to respond they need to make an appointment.
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u/UnfoundedDime 13d ago
You’re not memorizing the chart for 2500 patients. Good standard of care is always review any relevant medical information when giving medical advice. even for something as simple can I take an ibuprofen or Tylenol? You have to look at their medication allergies or inquire with patient about their medication allergies, you can’t just assume.
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u/almanacsdonut 13d ago
"A few minutes a week". Tell me you're clueless, without telling me you're clueless.
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u/Pitch_forks 13d ago
"No, your nurse or admin staff [that you pay for] would spend a week doing that."
FTFY.
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u/itsamutiny 14d ago
Okay? That's part of doing business. Healthcare is expensive enough without doctors nickel and diming us.
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u/UnfoundedDime 14d ago
Do you work for free? Also physicians are not the driver of healthcare cost.
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u/HeparinBridge 13d ago
That’s not entirely true. 6% of healthcare costs do go to clinical staff wages, including doctors. Why bother fixing the other 94%, right?
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u/NavyBeanz 14d ago
Yeah sometimes there is an issue that the doctor just can’t handle over the portal and the nurse says to come in and I happily oblige
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u/dylans-alias 14d ago
Yeah, I have a ton of patients and get lots of messages. I don’t work for free.
Not answering patient messages is not an option. That could constitute negligence or malpractice depending on the situation.
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u/NavyBeanz 14d ago
A lot of questions I ask through the portal is stuff I didn’t have time to get to ask during the short ass office visit. Some patients are medically complex or have complicated or more serious issues or questions about surgery that the pre-surgical nurse won’t answer because she won’t call you back so you ask that doctor
I’ve never had any of my two specialists bill for answering questions on the portal. They told me to use the portal. And one gave me his damn cell phone number and answers texts immediately on Sunday. He might be exceptional though. But it makes it seem like he really does care about his patients. Some patients are going through weird, mysterious and constant pain, and when you think it’s an infection and antibiotics aren’t working it can be scary, for patients and doctors.
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u/UnfoundedDime 14d ago
Easier for a specialist who manages one or two issues. Big driver for this is primary care where patients will send tons of messages between visits about many different issues. It’s impossible to manage that when you have a patient panel of 2000
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u/NavyBeanz 14d ago
That makes sense.
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u/UnfoundedDime 14d ago
To provide context for this. Here is a study that shows it would take 26.7 hours a day for a PCP to provide care to 2,500 patients (avg PCP panel).
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u/NavyBeanz 14d ago
I get it. If I’m going to be asking a lot of extra questions to a doctor, it’s gonna be my specialist
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u/nyc2pit 13d ago
Lol. Good luck.
Most specialists I know (including me) don't answer these messages.
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u/NavyBeanz 13d ago
Ok well I guess I am lucky? Mine answer all the time and one literally gave me his cell phone number and texts me back like immediately. I don’t know why that’s bad? It seems like they really care about their patients
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u/nyc2pit 13d ago
You must be. I'm a specialist and I can promise you I'm not answering. I have a family and interests outside of the office, and if you're going to pull me away from them the LEAST I'm gonna get is some compensation from it.
I give a few people my cell phone number. Most of them are good about it, but I have abusers of that too.
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u/Outside_Plankton8195 13d ago
It's not common practice at all to hand out personal phone numbers to patients unless it's concierge medicine. We need professional boundaries with patients. We DO and want to care about patients but you are one of the 1000s we see. I don't know what you do for living, but imagine clients reaching out to you on the weekend or during a vacation. You'd want them to respect your privacy right? That doesn't mean you don't care about them. We need the boundaries to keep providing quality care or we would burn out. And we don't give away medical advise for free after having a half million debt and sacrificing health and putting life on pause for years in medical training.
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u/Living-Target-9355 14d ago
So don’t take on 2,500 patients. They also said it was 9 hours if it was a team based model.
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u/UnfoundedDime 14d ago
Healthcare systems require you to have panels that size. “Only” 9.3 hours a day
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u/Living-Target-9355 13d ago
Then push back on the healthcare systems, not the patients.
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u/HeparinBridge 13d ago
That’s not how society works. Doctors have been complaining about under resourced primary care for decades, and this year in response congress cut a trillion dollars out of the Medicaid budget for the next decade. The general public needs to mobilize politically in favor of funding primary care or things will just keep getting worse.
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u/UnfoundedDime 13d ago
I try but you also are saying to just let hundreds of people to go without primary care. There’s a shortage of PCPs
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u/nyc2pit 13d ago
That means you schedule another visit. The messages are not a way for you to "finish your visit."
The entitlement on this thread is unreal.
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u/NavyBeanz 13d ago
If they tell me to schedule one I do. But if the doctor answers me through the portal or on his phone that’s his choice.
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u/nyc2pit 13d ago
Sure.
Those of us willing to do that will hopefully continue to decline as patients continue to abuse it and as we start realizing our value.
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u/NavyBeanz 13d ago
I don’t know what you mean by “abuse”
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u/nyc2pit 13d ago
Patient abuse messaging. The whole "this is why we can't have nice things."
If the messages were truly 2 second things - sure, great idea no charge.
But once you get a link to a Google doc detailing someones new problem (because they hit the character limit for a MyChart .message)... You'd understand.
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u/Outrageous_Bunch_204 13d ago edited 13d ago
In this context, the word abuse is defined as taking advantage of a situation to the extent of being a burden.
You prove the point by refusing to be open-minded to perspectives outside your own. Comprehension of vocabulary in written form appropriately in context and outside personal experiences and/or predetermined biases forming opinions' adds to the “2 second reply” that was mentioned earlier.
The time to read and decipher a patient's question and needs is one thing. The follow-up questioning that follows becomes a time-consuming conversation due to the patients refusing to accept the first response accordingly. The now 4th reply requires repeating in simpler terms precisely matching the patient's comprehension register.
Adding to this time-consuming conversation is the patient's unwillingness to accept finality of a single response when it contradicts a predetermined assumption of being correct and placing full fault on the physician. This demand is outside of standard requirements and obligations.
Feelings do not equate to realism - entitlements are owed to no one even with co-pays.
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u/NavyBeanz 13d ago
I don’t do this to my doctors but maybe they should just get rid of MyChart and the like? The patients didn’t put it there. Patients are sick and scared. Blame administration. I remember being a patient before these portals. Everyone managed
I did end up seeing the doctor nearly every week and then he’d prescribe another med but that was the reality back then. I don’t know why they changed to these portals but this is how it is when I came back to medicine as a “patient”
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u/HeparinBridge 13d ago
This is the result of the ass-backwards reimbursement system where primary care doctors get less time reimbursed with each visit than specialists in spite of PCPs addressing 20 issues per visit when a specialist usually has to deal with at most 2.
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u/psam6 13d ago
When you sign up for mychart, they let you know that providers may bill for messages, and I believe you even have to acknowledge that before sending your first one. Your urologist sounds like a very generous physician who’s comfortable giving advice for free and that’s okay. Some other providers recognize the value of their time, expertise, and liability and may charge for medical advice, which is equally valid.
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u/NavyBeanz 13d ago
Actually my urologist uses another portal system that’s not MyChart and I never got anything that said that.
My gastroenterologist uses MyChart and told me specifically to contact him through that if I had any questions
I never thought this was a big deal until this post. Seems a lot of people have issues with insurance, administration, and the existence of MyChart in general and it’s not the patient’s fault or doing
Believe me I would love not he in the situation where I have to use this stuff, or been in such a weird situation where my urologist thought it was necessary to give me his cell phone. But he did. And while I am going through a lot of pain and medical uncertainty every day leading ho to my procedure, it makes me feel a little bit better that my urologist might be someone special who cares about his patients and will answer questions about the procedures he is going to do. It makes me feel like he’s going to take good care of me during surgery, and if the surgery doesn’t solve my suffering, that he won’t give up on me
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u/InvestingDoc 13d ago
As a physician who owns a medical practice with multiple locations, some days we get up to a thousand patient messages per day through the portal.
Being charged for portal messages is coming to every medical practice in the future it's only a matter of time.
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u/ohwhataday10 13d ago
Its a sad day when the medical professionals agree with the state of our medical system!
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u/Cirrhosis-2015 14d ago
Most places are doing this now. It used to be free but now counts as a full office visit.
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u/PhD_VermontHooves 14d ago
This is not an accurate statement in my area.
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u/Cirrhosis-2015 14d ago
I’m glad to hear that. They just recently started doing it where I live. The last year or so
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u/JDWhite1982 13d ago
Because the codes came out this year. Before, there were no CPT codes for those quick communications, and even now they're only billable once every 7 days. Your mileage may vary on if the insurance covers those codes or not.
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u/Csherman92 14d ago
My doctor’s office does not charge for MyChart messages. If they did I wouldn’t be sending them. I don’t think that there should be a charge for a yes/no answer or “ok I filled your prescription refill.” Or “okay, your results look fine, see you on your next visit.”
I do not get to bill you for every time I make a phone call or send a message.
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u/dylans-alias 14d ago
There isn’t a charge for refilling a prescription. There are rules about what can be billed. It cannot be about a test result that was ordered by that doctor, it can’t be within 1 week before or after another office visit and it has to be a question that required clinical decision making that could not be done by a nurse.
If a patient has a question I can answer without reading into the chart or has a simple 1-click prewritten answer, I don’t bill. I got asked today to review a ct scan done at another hospital. I absolutely billed for that time. Patients message all the time with acute illnesses. If they need an order for a test or a prescription, I am billing. They are saved the time/hassle of urgent care, ER or then wait to be seen in the office. I get paid for my time and expertise.
Our patients are all informed in advance and sign consent for these potential bills.
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u/Comfortable_Two6272 14d ago
Fully agree. As a patient id rather pay for the work related to the message vs having to take time out of my day for virtual apt or worse in person.
Im a consultant and all my time spent on client activities including emails and phone calls is billable - I dont expect anyone to work for free.
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u/Moist-Barber 14d ago
I bill patients for that stuff. I have 1800-2000 patients and if even half of them think that sending messages is free and did it once a week?
Boom, that’s loads of extra work that I’m not paid for.
You don’t get to ask a lawyer a question without getting billed in 6-minute increments.
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u/Csherman92 14d ago
What other job is there where you can literally bill for making a phone call or answering yes? Or you can just send an auto message “please schedule a telehealth visit to address your concerns.” Making phone calls and answering people’s questions is part of my job. I don’t get to bill per question someone asks me.
Where do you get off thinking you’re so self-important that your time is more valuable than anyone else’s and you should be able to bill for answering questions? Most of the time, your nursing staff answers the questions. So you’re billing for your time when really it’s your nurse’s time?
Abuse the messaging system. I use it to communicate with my doctor because it takes forever for my doctor to answer my phone call and no one in reception relays my messages to the doctor. That’s fine if they bill you for actual medical advice but it’s not okay for you to get upset that patients ask questions and you think every question they ask you deserves to be billed. Have a little compassion for your patients. It’s not all about money. You make it seem like it’s all about money and to them, it’s their health. You deal with this stuff all the time! They don’t. So sudden symptoms are frightening to someone who has never had them before. And sometimes people talk themselves out of going to the ER because they have never had those symptoms or don’t think it’s “that bad.”
It’s fine if you don’t answer MyChart messages after hours. That’s fine. No one is asking you to work while you’re off.
Imagine if customer service people billed for all the questions they get asked.
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u/Comfortable_Two6272 14d ago
Im an consultant. All my time including easy phone calls and emails is billable. Im actually violating company policy to not bill and can be fired.
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u/msprettybrowneyes 14d ago
First of all, don’t assume “the receptionists don’t relay my messages”. Yes we do. We take note of your concerns, put it into a message to the nurses. After that, it is out of our hands. If you haven’t gotten a call back, that’s on the nurses and doctor’s, NOT on us. A lot of the times the nurses have to wait on the doctor to review the message, review your chart, etc. But again, that’s on clinical, not the receptionists. Hope this helps!
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u/nyc2pit 13d ago
We get that feeling because if YOU as a patient leave we don't even notice lol.
We're plenty busy without having to deal with the loads of entitlement you obviously have.
Save me the "it's all about the money" BS. This is a job and I expect to get paid. Your good will doesn't pay my student loans.
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u/UnfoundedDime 14d ago
You’re conflating customer service helping someone vs a physician having to read a message, review relevant medical records, assess the problem, develop a plan, provide medical advice, and place orders if needed. Also the liability associated with all that. Now repeat for the 3 additional replies related to the first one and multiple by 50 patients a week.
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u/Moist-Barber 14d ago
I don’t get paid hourly. I don’t get a salary.
I get paid by the work I perform, and if a bill isn’t sent then I don’t get paid.
Do you work for free? People come to me because of my experience and education so while it only takes me moments to make decisions, those add up. And I didn’t sacrifice 10+ years of my life to work for free.
Nurses triage my messages. And I send lots of people an automatic “please book an appointment” message.
But if someone is trying to get medical advice out of me through the portal then they better believe that they will pay for it.
To summarize: you have zero clue how busy and demanding my schedule is and what I have to do daily, and to top it off I have people demanding my attention randomly throughout the day?
They better be ready to pay for my time. Because someone has to, and I have a mountain of student debt to repay and mouths to feed just like everyone else.
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u/slowgait 13d ago
Don’t agree with the downvotes to your response. People are downvoting because they disagree with the system you didn’t create & they don’t want to take the time to understand. This is US capitalist healthcare and they like to be mad about it but not even bother to understand how to navigate it.
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u/nyc2pit 13d ago
I'm sorry you're not properly being compensated for your time and expertise.
Doesn't mean that others don't deserve to be.
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u/Heavy_Can8746 13d ago
Sounds like you should take a page out of their book If anything.
However, if you're field decides not to take a page out of their book.. that is, then your decision to deal with the consequences of such.
So get off your high horse, and start charging them people... Or at least speak with your particular field and advocate Why y'all should be allowed to.
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u/ArisuKarubeChota 13d ago
Truthfully…. that’s not a healthy work + life balance situation at all, and not a feasible lifestyle for most working professionals. Definitely not something to aim for especially when more and more physicians and APPs are being employed by heartless bureaucracy hospitals systems. The ruthless work culture in this country already sucks in comparison to other developed countries.
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u/Csherman92 14d ago edited 14d ago
No one is demanding your attention with a MyChart message. They always tell you if it’s an emergency don’t use MyChart call 911 or go to the ER.
But what one thinks is a simple question and what you’re describing is not the same thing. If medical work needs to be done, certainly bill for it if it requires complex medical training. But if it is “is this normal?” Then I don’t think this should be billable. If it requires you to look at my chart, sure. Bill for it.
Please have some compassion for your patients because it’s quite obvious you don’t have any. I don’t work for free, but I am paid on what I produce. So if I don’t produce, I don’t get paid.
So I get paid similar to you. You don’t get a salary? Really? The hospital doesn’t pay you?
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u/UnfoundedDime 14d ago
That is literally the point of MyChart messages, to “demand” attention.
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u/Csherman92 14d ago
They typically do not answer right away. You’re not demanding a question. You’re basically leaving a message for your doctor to respond to you at their earliest convenience.
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u/UnfoundedDime 14d ago
Again that is still taking up time. Even at just 3 minutes a message multiply that by 30 messages a day x 5 days a week. That’s 7.5 hours a week answering only messages. A whole work day.
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u/Living-Target-9355 14d ago
If you have 30 messages a day you should work on your communication skills with answering your patients’ questions in office instead of moving to the next billable, sorry patient, as quickly as possible. If you have a few patients abusing the system address that with them individually.
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u/UnfoundedDime 14d ago
https://pmc.ncbi.nlm.nih.gov/articles/PMC4418542/
Here’s a study from 2015 that shows an average of 18.9 messages per 100 patients per month.
https://academic.oup.com/jamia/article/29/3/453/6458072
Patient messages have increased by 157% since 2020.
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u/slowgait 13d ago
Providers are reviewed by hospital group management on KPIs including MyChart response time/ volume. So yeah, it does affect compensation & pay.
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u/Moist-Barber 14d ago
I get paid for each and every bill that is sent. Literally every single bill, I get a “cut”. And if a bill isn’t sent then whatever happened (the charting, the paperwork, the liability) is all done completely for free.
Phone calls? No bill = I just used my personal time to answer questions.
Paperwork someone wants filled out? Again, if there’s no bill to the patient then I worked for free.
I have compassion for my patients. I’m very well liked and have good bedside manner. But I have strict boundaries on my time because otherwise everyone would demand my time and thus my money, and baby do I have loans that need to be repaid and they don’t repay themselves.
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u/Living-Target-9355 14d ago
Half of them aren’t sending messages once a week and if they are you need to deal with those patients. In the 3-4 years I’ve been a patient on mychart I’ve sent messages about a dozen times, usually related to treatment I was just provided or in need of (urgent care referral friday to ortho for bicep tendonitis when it was really a bicep tear so I sent photos of my arm and was sent for stat MRI on monday without seeing the doctor, which saved the doctor time seeing me just to send me to MRI). I’d bet 80% or more of your patients don’t send a message more than once or twice a year at most.
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u/UnfoundedDime 14d ago edited 14d ago
You’re not understanding the volume. Let’s take your example, a dozen messages over four years. It’s three messages a year or 0.25 messages a month, multiply that by 2500 patients and you have 625 messages a month. 25 messages per working day to answer using your example of a patient who hardly ever messages.
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u/voodoobunny999 14d ago
To answer your question, the $50 amount is based on your benefits—in other words, that amount is because of your insurance company. The frightening (and frankly, disgusting) part is that means that your doc is charging more than $50 for a return message. That’s worth having a talk with the doctor’s office about.
That being said, more doctors are charging for this nowadays. As insurers clamp down on reimbursement in one place, providers have to look at other places to offset.
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u/arwenthenoble 14d ago
It’s too expensive for a “you may or may not be charged for this.” I’ll confirm what’s no cost (like refills) at my next visit and only use it for those things. Otherwise I’ll just do a same or next day video visit.
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u/voodoobunny999 13d ago
You are absolutely right to do those things, and in your shoes, I’d take it up with the doctor’s office—not because they charged you, but because this is likely a significant change in policy that you would have taken into account had you been notified beforehand. I’d request one-time reimbursement now that you’re aware.
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u/boogi3woogie 13d ago
That’s the whole point - they want you to book an appointment if you want to talk to a doctor about a medical issue.
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u/Comfortable_Two6272 14d ago
Some are now charging for refills if not done during the apt. Seeing this more frequently.
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u/IDidItWrongLastTime 13d ago
My one chart actually gives a warning before you send a message that you might get billed depending on the content of your message etc.
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u/josuenin 13d ago
Don’t lawyers do this already- get paid for any interaction through any medium. (And yes, they will send you the bill if you try to communicate with them) What makes you think doctors are any different? You think people who pick up the phone at call centers work for free? You think people that respond to online chat questions are working for free? Even AI chat uses API pulls and that costs money. This is capitalism baby, everything has a cost.
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u/le5lie_ 13d ago
I am in my 40s and due to raising children and being lower income, I only went to a physician during my pregnancies and immediately post partum. Everything in healthcare is nickel and dimed to death. I was diagnosed with a chronic illness recently and have to fight like hell for more than 15 mins with my specialist. There are times when I get home and review everything discussed and have a short follow up question.
I send quick MyChart messages to seek simple clarification or report a side effect or improvement as my physician requested so I don’t have to schedule a follow up appt for a three minutes thumbs up.
Charging for a message is insane. Period. I can barely afford my copays and medications as it is.
Yes, the system needs overhauls. I as the end user have zero choice in any of these matters. I’m not a damn cash cow.
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u/arwenthenoble 13d ago
This was for a medication mishap (wasn’t a controlled substance either) and I should’ve let my pharmacist handle it but hindsight is 20/20.
I do have a specialist who asks for certain updates. I’ll confirm next visit what is their current policy. If I’m specifically asked to follow up I would hope that wouldn’t be a charge.
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u/Perfect-Resist5478 13d ago
Charging for messaging is not insane when you think about the hundreds of messages that come through every day. Addressing them takes time- either time during the clinic day so the doc isn’t seeing patients, or time at the end of the day when they should be with their families. Doctors absolutely should be able to charge for the work they do
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u/le5lie_ 13d ago
Is this not part of the care you provide your patients? I’m a teacher. Do I get to charge for parent emails?
If you are truly getting that many messages then that might be a reflection of something that needs addressed. A follow up question or a quick check in that something we discussed at a previous visit shouldn’t be a line item. That’s absolutely punitive and mercenary.
I already waited 8 months for a GI appt. I got a fifteen minute visit that schedule over $16k of testing, minor procedures, and diagnostics. I messaged my GI in MyChart and the nurse who works for the practice answered my question about 24 hours later. It’s part of my plan of care.
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u/arwenthenoble 13d ago
The pharmacist told me to just ask the Doctor’s office as it’s likely be quicker. Live and learn.
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u/Agreeable-Pop5415 13d ago
You cannot have concierge services with your physician for free. Patients abuse mychart and by using it to get free visits instead of making an appointment. The doctor has to be paid for the messages! They are stopping what they are doing clinically with patients to respond back to your message. I’m pretty sure that was company policy and you signed it a paper discussing it that was in your new patient paperwork.
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u/PhD_VermontHooves 14d ago
Yeah, I would absolutely fight that charge. Also, some systems are charging for MyChart messages, but not phone messages. Do with that what you will.
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u/almanacsdonut 13d ago
Simply not feasible to coddle everyone with responses to MyChart messages, or read through the paragraphs long telephone inquiries from patients. We see patients for 8 hours a day, refill meds, read through notes from other clinicians, etc. If you've encountered it, you ever wonder why no one stays in primary care very long? We are burnt tf out of working 12 hours a day keeping everyone happy, and getting paid for 8. Big round of applause for the hospital system who decide to protect their clinicians, by charging for MyChart messages.
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u/krysteline 14d ago
I would wait for a bill, or contact the hospital billing directly. Its possible the hospital wont even bill you the $50 copay. It shows up in the EOB as your cost share tho.
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