More doctors are charging fees to respond to patient messages
More U.S. health providers are now billing patients for questions sent through portals, email, or messaging systems, prompting debate over whether this fairly compensates overworked clinicians or simply adds another opaque fee to an already costly system. Many patients say they struggle to get timely, meaningful responses even today and fear charges will deter necessary queries or be gamed by administrators, while some doctors argue uncompensated digital work is fueling burnout in a system that only reliably pays for in‑person visits and procedures. The conversation widens into a critique of U.S. healthcare incentives—heavy administrative overhead, constrained doctor supply, insurer behavior, and weak price transparency—alongside speculation that AI triage or telemedicine could help, but might also be used to justify new forms of billing.
Access and responsiveness of messaging
- Experiences vary widely: some patients say portal messages rarely reach the doctor and are handled by nurses with boilerplate replies; others report explicit 24‑hour SLAs and consistent direct responses.
- Many note that portals are labeled as “message my provider” but are effectively “message the office,” with triage by MAs/nurses.
Should messages be billable?
- Some are willing to pay modest copays for substantive, timely answers, seeing it as paying for professional time just like an in‑person visit, lawyer, or accountant.
- Others object to fees for trivial or practice‑inserted steps (e.g., an MA saying “I’ll forward this”), and argue basic office communications should be included in existing charges.
- Concern that patients won’t know the cost up front, unlike law/accounting, and that healthcare’s urgency, lack of alternatives, and power imbalance make the analogy weak.
Perverse incentives and administrative behavior
- Clinicians describe portal work as largely uncompensated under RVU systems; existing billing codes for e‑visits pay far less than office visits for similar time.
- Fears that management will treat messaging as a “profit center,” inserting extra back‑and‑forth or non‑physician/AI replies while billing as if from the doctor.
- Some report being billed for “phone support” and similar opaque items.
Broader failures of US healthcare
- Numerous anecdotes of extreme charges for ER visits, ambulance rides, imaging, and brief telemedicine check‑ins; difficulty getting simple prescription refills without costly visits.
- Commenters blame a mix of insurers, hospital administrators, pharma, malpractice environment, and professional groups; administration bloat and coding/documentation overhead are recurring themes.
- Several argue healthcare, housing, and education should not be run for profit; others blame government regulation and tort law more than “capitalism.”
Supply, workforce, and burnout
- Many clinicians describe packed schedules, after‑hours charting, and message overload contributing to burnout.
- Debate over whether increasing residency slots and loosening licensing would meaningfully improve access and reduce the need to bill for messages.
International and alternative models
- Commenters from other countries describe lower, fixed fees for visits and messages, easier refills, or no direct doctor messaging at all.
- Direct primary care, concierge‑like models, and subscription services (e.g., One Medical) are cited as working better for some.
Technology and AI in messaging
- Electronic records already use templates and dictation; some foresee LLMs triaging or drafting replies.
- Many are wary of insurer‑mandated AI front‑ends that both gate access to humans and still generate charges.