More doctors are charging fees to respond to patient messages

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.