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More doctors are charging fees to respond to patient messages

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Re: More doctors are charging fees to respond to patient messages

#291

Post by gnicholas »

ejb999 wrote: post #261
resoluteteeth wrote: post #190

I have mixed feelings about this. On the one hand I don't want doctors to charge for an email consultation every time I need a prescription refilled. On the other hand, maybe insurance companies should encourage doctors to do this by paying them (and not charge a copay) because it will reduce the need for office visits which will probably be cheaper for them overall?

one of the problems is, how can a doctor in good conscience continue to renew your prescriptions, if they don't see you and re-evaluate the need? Maybe they put you on 5MG on amlodipine for your moderately-high blood pressure 18 months ago, but since then you have put on an extra 75lbs and now you have critically high blood pressure - lots of liability if they just keep re-prescribing a low-dose that doesn't match yo…

I have used the same allergy and asthma meds for years/decades. I haven't changed any other medications. This used to be no problem — I could renew for 2 years easy. For some reason they started making me come in more often a few years back. Pretty annoying! I get that blood pressure meds or other dynamic issues require different kinds of care.

Re: More doctors are charging fees to respond to patient messages

#292

Post by gnicholas »

adolph wrote: post #177
ericd wrote: post #64

A 15 minute email from my lawyer costs about $150, I don’t see why we should be outraged about $25? It’s much harder and more expensive to become a doctor.

Lawyers did pricing better than doctors. Medicine hid costs through a payment plan lumped in with hazard insurance. Now that the game of hide the money has played out, people see real costs and they act shocked.

Perhaps, but doctors get paid through opaque insurance. While that can be a hassle, it also introduces the huge benefit of OPM (Other People's Money). Convince your patients to come in for a 20 minute physical, for which they pay $25, and you get 20x as much from their insurance company. Lawyers don't have that play in their playbook!

Re: More doctors are charging fees to respond to patient messages

#293

Post by polski-g »

Volundr wrote: post #150
polski-g wrote: post #95

Earlier quoted context omitted.

Because we don't have death panels like in countries with government-run plans. Your insurance carrier won't deny you a bone marrow transplant because you're 85 (it costs over $1m). Other countries will deny it, because you're 85 and have had a good life. The UK's death panel is called NICE: https://en.wikipedia.org/wiki/National_Institute_for_Health_... We should have something similar in the US. 80% of all healthca…

> Your insurance carrier won't deny you a bone marrow transplant because you're 85 (it costs over $1m). Your experience with insurance in the US is very different from mine. My experience is insurance denying my 34 year old sister's MS meditation until she ended up in the ER.

True. I've never had a bad experience with them.

Re: More doctors are charging fees to respond to patient messages

#294

Post by gnicholas »

NoMoreNicksLeft wrote: post #198
gnicholas wrote: post #139

Earlier quoted context omitted.

Interesting point. That could make for some awkward conversations if the patient thinks messages were coming from their doctor but then the director had no memory of the messages. It would also seem fraudulent to have messages signed by the doctor when it wasn’t actually sent by that doctor. I think it’s much more likely that doctors will end up sending AI-autocompleted messages that take very little time to complete…

I have not used a medical messaging system, but if it's anything like the messages my bank or my insurance company sends on their own systems then these will look much more like text messages and less like emails. No place to "sign". No need to risk it looking like fraud. As for awkward conversations, I'd be shocked if many people don't experience circumstances where their doctors act as if they don't remember previo…

The medical messaging systems I've used all have "from" fields with the person's name and title. It's important because I take messages from the doctor much more seriously than the messages from the nurses.

Re: More doctors are charging fees to respond to patient messages

#295

Post by dumbfounder »

ToucanLoucan wrote: post #272
e_i_pi_2 wrote: post #266

My partner has had issues that could be fixed with a few messages and the doctor just refused to respond and said they have to wait until the next appointment. It begins to feel like malpractice when they're refusing to fix simple issues because of billing limitations. I think the core issue here is that we're trying to make healthcare profitable when it probably shouldn't be. Stuff like healthcare, housing, and educ…

The fact that so many messages in this thread are variations on "well this should be covered by insurance" to other stuff like "I understand they need to charge" makes me think we will never see a proper system of any kind in this country because everyone is just too heavily propagandized into thinking healthcare just must be expensive and that any attempt to have the Government in any way pay for it will quite liter…

Nobody cares about healthcare right now. We got wars and old guys yelling at each other and China all up in our apps and that border stuff going on. Healthcare is so early 2020s.

Re: More doctors are charging fees to respond to patient messages

#296

Post by __MatrixMan__ »

ejb999 wrote: post #258
tonymet wrote: post #250

Earlier quoted context omitted.

We dont even recognize bad care. People are overweight and suffering from chronic disease , but since they are “alive “ and taking meds we still call that a good outcome

sadly, a lot of patients consider that good care - around me, doctors stopped weighing patients, and don't ever discuss lifestyle changes or dietary changes (patients by and large don't want to hear it) - they just give the patients the pills they want to offset the poor lifestyle choices.

On the flip side: It's so frustrating to go in search of guidance re: lifestyle changes and they don't wanna hear it, instead all that do is recommend drugs.

Maybe we need to remove gatekeeping access to drugs from the primary care physician's job so that they can focus on the other parts.

Re: More doctors are charging fees to respond to patient messages

#297

Post by otterley »

annoyingnoob wrote: post #265
otterley wrote: post #241

Earlier quoted context omitted.

Did you ask for a refund of those billings? If they refuse, you should report them to the State Bar if they're doing that. It's unethical to charge for services not rendered.

https://www.avvo.com/legal-answers/can-a-attorney-charge-for... https://lawstuffexplained.com/can-a-lawyer-charge-you-for-em...

Speaking as an attorney myself, I'm not the least bit surprised that a bunch of my peers are claiming that they can charge to merely view emails. Many attorneys -- especially bad ones -- are particularly defensive of the practice.

The problem is that without demonstrating somehow that they read it, they cannot prove they actually read that correspondence when they claim to have. This puts them in a difficult position because the client can plausibly claim that they did work they didn't actually do. Perhaps they don't need to send an explicit acknowledgment (even though it's the right thing to do), but if they don't even act like they received and read it, yet charge you for it, that's a real problem.

FWIW I've had little trouble getting my attorneys to credit me for activities I didn't ask them to do. Somewhat different situation, but most good attorneys aren't scumbags.

Re: More doctors are charging fees to respond to patient messages

#298

Post by meragrin_ »

neilv wrote: post #249

> “It just feels a little intimidating when you open the portal and the first thing it says is ‘be aware, we’re going to bill,’” she says. “We have to send these messages and we shouldn’t have to think to ourselves, ‘Should I send this?’” If the provider doesn't bill, problems from the patient's perspective: 1. Some patients are reluctant to message when they should, because they don't want to impose when they know t…

> 1. Some patients are reluctant to message when they should, because they don't want to impose when they know the provider isn't set up to charge.

Huh? While I won't challenge these people actually exists, I cannot imagine they are statistically significant. I have never heard of anyone being worried about being charged too little by a health provider.

Re: More doctors are charging fees to respond to patient messages

#299

Post by FireBeyond »

wighty wrote: post #283
FireBeyond wrote: post #256

Earlier quoted context omitted.

This is an absolutist take. No-one's saying it takes zero literal effort. Just "Should I be billed by the practice $25-30 for an MA to get my email and say "I have forwarded your question to the provider"?", and then a subsequent $100+ for the provider's response to my question. Why should that not be part of the intrinsic baseline officework and not a billable service? Especially when it's a 100% artificial roadbloc…

> After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider". That is semantics, could be changed to "Message the office" but that isn't going to be the most clear title for the majority of people to understand what it is doing. It's the same as calling the office, 99.9% of offices (basically all outside of concierge/direct care) are going to be triaged by an M…

> As far as the payment requirements I've heard of, I have never seen anyone bill just for the MA reply.

My comment on this was in response to a comment positing the potential for exactly this:

> How long until administration figures out that they can juice revenue by shitting up the emails to increase back-and-forth traffic?

And then, the reply I got was basically "Well, why shouldn't they be able to do that?"

Re: More doctors are charging fees to respond to patient messages

#300

Post by maxerickson »

wighty wrote: post #270
ineedaj0b wrote: post #244

The hospitals are poorly run. Please hate your hospitals management more. Or if you are a good manager, convince some friends to run a hospital. Imagine 10 appointments a day, 30 mins each. You have to write /everything/ down the patient tells you. You often have to go over the 30mins because some patients need it. You need to follow up to order extra tests, you need to occasionally google something. You skip lunch o…

> The nurses have left and you can't legally 'bill' or code the appointment without the nurses. What? I've never heard this requirement and I cannot think of why it would be the case (I'm a PCP). The rest of your comment is pretty much the issue as PCP though. I have at least 30 minutes a day of "out of visit" requests (reviewing documents from outside hospital/consults, labs, imaging, other results, extra nurse pati…

I think it's pretty stupid that basic appointments are billed on complexity and not time. Well, and lots of other things too. Getting a radiologist to do a definitive diagnosis using imaging doesn't actually make the ER doctors job harder (rather, it de-risks the interaction for them).

It's also ridiculous that I have to promise to pay any bills that my insurance won't cover. If some care can't be justified as medically necessary, there should be a specific contract for that when it comes up, not a blanket rider prior to accessing treatment.

Forcing the two sophisticated entities to have a workable agreement where they can't dump costs off on the individual patient would at least improve perceptions of care.

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