Cleveland Clinic to Charge for Patient Messages

The Cleveland Clinic announced that on November 17, 2022 it would begin billing patients’ insurance for messages that require five minutes or more of a healthcare provider’s time to answer.  The announcement provides:

[S]tarting November 17, 2022, MyChart responses that require your provider’s clinical time and expertise to answer may be billed to your insurance. There may be a co-pay based on your insurance company’s guidelines. This will allow us to continue to provide the high level of care you have come to expect from the Cleveland Clinic.

Messages that may be billed include:

  • Changes to medications
  • New symptoms
  • Changes to a long-term condition
  • Check-ups on long-term condition care
  • Requests to complete medical forms

The Cleveland Clinic warns that patients could owe $33 to $50 depending on their health insurance.

The Cleveland Clinic is not the first to charge for responding to messages. Ohio State University Wexner Medical Center already bills for some patient messages depending on the level of decision-making required to respond. Their fees can range between $50 and $160.

The rational for charging for e-mail and portal responses: it eliminates the need for an office visit or tele-health appointment. The providers assert that they are experiencing a loss of revenue due to patient use of the online communications instead of these visits. However, the Cleveland clinic more than tripled its operating income in 2021. The operating income was $746 million, up from $232.4 million in 2020 and $390.2 million in 2019. 

This shift in policy raises many questions. Is this just a cash grab? How can a patient insure that a physician is really doing the responding? How is a patient supposed to know exactly what they will ask that is billable? Will there be a chilling effect on the use of electronic communications leading to worse outcomes?

Will other providers follow suit? University Hospitals is already discussing making similar changes to its messaging system in 2023. It is very likely that many other providers are also evaluating making this change in the near future.