Cleveland Clinic started billing for electronic messages that take five minutes or more of a provider's time to answer—a move that comes in response to a high volume of time-consuming MyChart messages, Julie Washington writes for cleveland.com.

Patients may be billed for messages from Cleveland Clinic providers

Cleveland Clinic on Monday announced that patients could be billed up to $50 per electronic message to providers due to procedural changes. Under the new policy, which went into effect today, patients will be billed for any messages that use five minutes or more of a provider's time, including:

• Changing medications
• Discussing new symptoms
• Providing updates for a long-term condition
• Check-ins for long-term condition care
• Submitting requests to complete medical forms

According to Cleveland Clinic, patients will be informed of any possible charges before they send a MyChart message. They will be given the option to send the message or request an appointment instead. The Clinic has also financial advocates to help patients understand and calculate potential costs before they seek care.

If a patient's message is billed to their insurance, they may not be charged or they may be responsible for a low out-of-pocket cost. While some patients could pay between $3 and $8, others will not be billed at all. For those on Medicare, no out-of-pocket costs will be incurred, and Medicare patients who have secondary insurance will not owe any money.

While most private insurers will cover messages at little to no cost to patients, some patients who have a deductible or a plan that will notcover the benefit could be charged anywhere from $33 to $50.

However, patients will not be charged for messages that Clinic providers can quickly answer, including:

• Requesting a prescription refill
• Scheduling an appointment
• Sending a message that leads a provider to recommend a visit
• Following up for a recent surgery
• Requests regarding a visit for the same issue within the past week
• Requests that lead to an appointment for the same issue within a week of an appointment
• Any other message that can be answered in less than five minutes

Why some health systems are charging patients for electronic messages

According to Cleveland Clinic, the change came in response to a high volume of MyChart electronic messages, especially ones that require physicians to analyze medical records before responding.

"As the use of virtual healthcare services took off during the COVID-19 pandemic and continues to expand, more Clinic patients used MyChart to get their questions answered by their physician," Washington writes.

Since 2019, Cleveland Clinic noted that providers have been required to answer twice as many electronic messages within three business days. For complex questions, providers often need to review information sent by the patient, create an updated treatment plan, recommend tests, or conduct an in-depth review of patient records before responding.

"Sometimes, (providers) can quickly answer and get you the information you need," the Clinic said. "Other times, it requires time to look through your medical records and provide medical advice. Messages that involve a longer amount of your provider's time and medical expertise will be billed to your insurance."

In addition to Cleveland Clinic, other health systems are considering implementing similar policies. For instance, University Hospitals (UH) on Monday said it is discussing making similar changes to its My UHCare messaging system in 2023.

According to UH, requests that are considered complex, including those that require a detailed chart review, researching a specific issue, communicating with other providers, or multiple messages "may be elevated to a billable encounter."

While UH has not yet determined the costs associated with the billable messaging feature, it noted that the system may replace scheduled virtual or in-person appointments. (Washington, cleveland.com, 11/15)