Why You Might Get Billed for Messaging Your Provider in MyChart

The COVID-19 pandemic led to more telehealth visits and an avalanche of online communication requests from patients using popular online portals such as MyChart. Many patients have enjoyed the convenient free messaging tool, but it hasn’t been so great for providers. Now, many healthcare institutions are starting to charge for the time spent answering patient emails.

In March 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the scope of telehealth visits to let healthcare providers bill for eVisits—which include patient-initiated communications via online patient portals like MyChart.

As more healthcare institutions adopt billing policies for the use of MyChart, here’s how much you can expect to pay and which MyChart services are deemed billable.

MyChart: What Providers Can and Cannot Bill For

Online patient portals, such as MyChart, are great tools that let patients communicate directly with their providers, review lab tests, upload pictures, schedule appointments, and refill prescriptions. 

These essential functions of the portal will mostly stay free—healthcare providers will only be able to charge for some things that MyChart can do.

What Providers Can Charge For

According to CMS, there are strict guidelines for instances that make MyChart use billable:

• The provider must have an established relationship with the patient
• The patient must generate the initial inquiry
• Correspondence includes online assessment and management of medical conditions
• Communication can occur over a seven-day period

According to Jess Berthold, a spokesperson for theUniversity of California, San Francisco (UCSF) Medical Center (which started billing for MyChart messages in November of 2021) only certain kinds of emails between patients and providers are billable.

“We bill for medical advice and care. We don’t bill for routine correspondence, like a prescription refill request,” said Berthold.

“The eVisit codes are only applicable when a patient question requires a physician to do the same type of work that would happen some in-person visits,” Jack Resneck Jr., MD, president of the American Medical Association, told Verywell. “This could include diagnosing a problem, creating a management plan, ordering tests, prescribing treatments, or counseling in response to medical questions.”

Here is what counts as medical advice communication:

• New symptoms or medical problems requiring an assessment or referral
• Adjustment to current medication
• Chronic disease check-in and management 
• Flare-up or change in chronic condition
• Request to fill out a form

What Providers Can't Charge For

Most tasks completed on MyChart are free. MyChart services that cannot be billed include:

• Prescription refill requests
• Scheduling appointments
• Messages that lead to an appointment request
• Follow-up care linked to recent surgeries within the past 90 days
• Updating your provider or any other messages that do not require a response
• Messages that only take a few minutes to answer

How to Know If You'll Get Billed For Using MyChart

MyChart message charges should be transparent—patients should not get “surprise” bills.

At the Cleveland Clinic (which started billing patients for MyChart messages in November 2020) patients are made aware of the possibility that their message could be billed, depending on the skill level and time it takes to answer. They can decide to proceed with asking the question or make an in-person appointment instead.

Some healthcare systems, like the Cleveland Clinic and UCSF, have posted information on their websites announcing plans to start charging for medical advice received through MyChart.

“For Medicare patients, they must consent to receive eVisit services,” said Resneck. “That consent would typically include receiving notice that a copay or deductible may apply.”

Will Insurance Cover MyChart Charges?

Most insurance providers will cover eVisits, so many patients probably won’t even know they were charged. That said, it is up to the provider to decide if they will bill for applicable MyChart services.

UCSF provided some example charges you can expect based on the type of insurance you have:

• Medicare: For most patients, there is no out-of-pocket cost. For a small number of patients, the cost could be $3 to $6. Patients with Medicare Advantage will have a co-payment of $20 (the cost of an in-person or video visit).
  
• Medi-Cal: No out-of-pocket costs.
  
• Private insurance: Some patients will have co-payments similar to what they would pay for in-person or video visits (common copays are $10 and $20). If a deductible applies, the full amount will be charged (the average amount is around $75).
• Uninsured: For patients without insurance, it could cost upwards of $50 per MyChart message.
  

Who Is Billing for MyChart Communications?

Many healthcare systems have decided to allow providers to charge for the time and resources spent in responding to the growing number of MyChart messages they get from patients.

According to Resneck, there is currently no data on how many providers and healthcare systems are now billing for eVisits, including MyChart messaging.

“We do know that an increasing number of practices are adding this to improve seamless integration of virtual and in-person care for their patients,” he said.

While it is up to individual healthcare systems on if they want to start billing for eVisits, many prominent healthcare centers in the U.S. (like UCSF and the Cleveland Clinic) have already started doing so.

If you don’t know if you’ll be charged for online patient portal communication or if you want to avoid using MyChart, just give your provider’s office a call.