Nebraska Medicine to bill patients for some electronic messages to health care providers

Most messages sent to a patient’s health care team will remain free, according to the health system’s web page. Those include requests for prescription refills and appointments, messages that lead to an appointment, follow-up care related to surgeries within the past 90 days and messages that take only a few minutes to answer.

But those that require medical expertise and more than five minutes of provider time may be billed to insurance. That list will include messages about new symptoms that require medical assessment or referral; changes to medications; check-ups, changes or flare-ups in chronic conditions and requests to complete medical forms. 

Health system officials said they expect the new policy to affect about 1% of patients, based on the experience of other health systems nationwide that have begun billing for electronic messaging through patient portals. 

By mid-August, that list numbered 22 health systems, including the Cleveland Clinic, the U.S. Department of Veterans Affairs and the Mayo Clinic, according to a tally by Fierce Healthcare, a healthcare business publication. Most similarly bill for messages that require added time and expertise.

Nebraska Medicine’s webpage indicates that making the change allows the health system to continue to provide patients with “cost-effective care” that “may otherwise have to be done through a more expensive in-person or telehealth appointment.”

So far, the health system is the only one in Nebraska set to begin billing for certain messages, officials said. But the move comes as electronic communications, from messaging to telemedicine, are playing a growing role in health care, fueled by the COVID-19 pandemic and ensuing changes in Medicare billing that broadened coverage for telehealth visits and allowed it for messages through electronic portals.

Such changes are expected to continue, said Jeremy Nordquist, president of the Nebraska Hospital Association.

“As patient care continues to move toward digital platforms, it is important that health care providers are appropriately compensated for their expertise and time,” he said in a statement. “Over the next decade, we will certainly see innovation play a bigger role in health care delivery and payment for those services will continue to evolve.”

Nebraska Medicine noted on its website that costs for messages may be covered, depending on the insurer. Patients may receive a bill for a copay, coinsurance or deductible. Nebraska Medicine uses the MyChart portal offered by EPIC, its electronic health record provider. 

Nebraska Medicaid patients will not be charged out-of-pocket costs. For most Medicare patients, the out-of-pocket costs will be $11 to $21. The average out-of-pocket costs for most patients with private insurance and for those with no insurance will be $24.