[thaddeusmt]

My spouse is a physician, and "patient messages" (aka "non-face-to-face" encounters) usually aren't reimbursed by insurance. Having a friendly online conversation with a patient doesn't generate the "RVUs" they need (contractually!), so time spent messaging is time taken out of their personal day on top of their regular workload.

Responding to messages can also just be very difficult and time consuming. Maybe you ask concise, clear, pertinent messages to your doctor (or think you do!), but most do not. It's similar to problems HN readers might be more familiar with: user-created support tickets, and comment moderation. Medical office staff help with this triage and moderation, but it has become a big problem to manage with how easy it now is for bored/sick/scared patients to send messages.

[matsemann]

I agree that charging a fee can be fine. For me it's often a win-win. I spend less time having to go there, and the doctor can spend less time than an in-person visit and even do it on some down-time. But it's still a service, so paying about same as a regular doctor visit (about ~$20 or so here in Norway) is fine.

My biggest gripe here is that if the doctor answers me outside office hours, an additional "emergency / inconvenience fee" is added. Like, I can't control when you answer, and I didn't choose it. If I send in something during daytime and you didn't get to it, answer me the next day, then. Or make it a choice that I want a prioritized answer so at least I decide. It's just bonkers.

[thayne]

> about same as a regular doctor visit (about ~$20 or so here in Norway)

In the US, a regular doctor's visit can cost hundreds of dollars.

[vladgur]

I recently was informed that the question to my doctor over messaging qualifies as “e-visit” and was giving 3 different CPT codes(differing by time physician would spend answering it) The CPT is how services are identified for medical billing and I called my hospitals financial assistance line to find the contractual “allowed amount” they would charge my insurance(and therefore me since I did not hit my deductible)

The cost for this e-visit message would range from $65 if it took less than 10 minutes to $438 if it took more than 25 minutes.

With absolute zero accountability on how this time was spent.

Lawyers are way more transparent than medical billers

[Aeolun]

So the doctors only respond late in the evening for all that free extra cash?

[codemac]

If my actual doctor responded to my messages within some SLA (2 days?) then I'm more than happy to pay much more.

Now a days what happens is I send a message with photos or many details, and some poor nurse who is assigned message triage is going through many and responds with generic pointless text for my issue.

Then I get charged $15.

[bombcar]

I read your post.

You owe me $3.99

[qudat]

My wife works at an academic hospital and bills for messages sent through the portal. If it hasn't arrived yet, it will. Patient care specialists (nurses, physicians, etc.) are spending a ton of time everyday responding to patient "text" messages.

[NegativeK]

A friend is a vet and frequently rolls their eyes when I mention that I'm going into a doctor's office to review lab results. But in that meatspace discussion, we talked about dietary changes, upcoming medications and potential interactions, how my primary should get some records from another doctor, and I was able to ask about if an elective medical procedure was advisable, given my medical history. It was easily 20 minutes of relaxed discussion about an actual medical plan.

If it was three minutes of "these are your lab results; you should/shouldn't come in for a follow-up," I'd agree that it should be a phone call that's covered under the cost of the original appointment. But given that vet friend is constantly pressed for time and doesn't get to bill separately for those callbacks, I can't imagine why my primary doctor would want to do the same.

I don't want medical professionals responsible for my care to squeeze things in when they have time. Insurance is likely to be even more of a pain in the ass, and cramming in tasks because they're unpaid means lower quality of care.

[ultra_nick]

Same, my wife works a 10 hour day, comes home, gets yelled at by neurotic patients for an hour, then does paperwork for another hour.

We're not even making money yet due to student loans. Sucks.

[pests]

I mean you are making money, just spending it all.