Virtual-First Health Care Plans Flooding the Market

In the continuing quest to reduce health care costs and make care more accessible, a new type of health plan has been taking shape: The virtual-first health plan.

These rapidly evolving plans integrate virtual care delivery models into a comprehensive health plan that encourages enrollees to access virtual care with their doctors before resorting to an in-person visit.

These plans are coming to market as Americans have gotten use to virtual visits with their doctors during the last three years of the COVID-19 pandemic and virtual care becomes more common even in traditional health plans.

While the uptake is still quite small — 6% of employers surveyed in 2022 offered these plans — it’s expected to grow quickly over the next few years.

All of the major health insurers in the U.S. have already announced various tie-ups with virtual care providers and tech vendors to improve their telemedicine offerings, and the uptake will continue growing as employers and their workers grow more comfortable with the plans.

A recent survey by Mercer found that, among organizations with 500 or more employees:

  • 52% plan to offer virtual behavioral health care in 2023.
  • 40% plan to offer a virtual primary care physician network or service in 2023.
  • 21% already offer virtual specialty care, like for dermatology, diabetes or musculoskeletal issues.

There are a number of benefits to virtual-first primary care:

  • Easier access — Virtual care is ideal for people with health problems that make it difficult to see their doctor or who do not live near a hospital or doctor’s office.
  • Reduced costs — Telemedicine visits cost less than in-person visits, and they can yield additional savings through technological efficiencies.
  • Convenience — Enrollees don’t have to drive to the doctor’s office, contend with traffic or sit in the waiting room — and they can meet with their doctor from the comfort of their home.
  • Better health outcomes — Virtual first plans will often put a premium on health records integration across the care spectrum to ensure that care team members have access to them, which can help them provide better clinical and administrative support.

How they work

Virtual-first health plans include the same coverage as traditional health plans, including fee-for-service, health maintenance organizations and preferred provider organizations, but they focus on directing enrollees to telemedicine options for their doctor’s visits.

The key difference is that they aim to significantly reduce costs by incentivizing enrollees to seek out virtual care first through plan design, incentives and advocacy. Consultation sessions can often be performed virtually, saving both the patient and doctor time, while reducing the costs for each visit.

Virtual-first plans incorporate the same arrangements as traditional health plans, except that most doctor’s visits will be online, or via a smartphone app. When a patient needs to see their doctor, they’ll schedule the visit on their account — and they’ll need to opt out of a virtual visit if they feel that they need to see the doctor in person.

Additionally, if possible, specialist visits can also be conducted on the app or website.

The takeaway

Virtual-first care plans are an evolving product and it’s important to find a plan that can truly save you money while not sacrificing quality of care.

These plans are still in their infancy and are hitting the market in increasing numbers. But because they are new, there is no uniform standard for them. The most important aspects to look for in these plans are strong member engagement and seamless integration to ensure quality of care.

Give us a call if you’re curious about these plans, to find out if carriers in the area are offering them and, importantly, whether they are a good fit for your organization.

Why Your Staff Needs Short- and Long-Term Disability Coverage

No one plans on becoming disabled and missing work, but it can happen. An illness or an accident could cause one of your employees to be unable to work for months, or even years.

While their health insurance will cover their medical expenses, it won’t cover the cost of living while they recover.

Only 30% of American workers in private industry currently have access to employer-sponsored long-term disability insurance coverage, according to the U.S. Bureau of Labor Statistics.

That means most workers — and their families — do not have adequate protection against one of the most significant financial risks that they face.

That’s why you should be offering your employees voluntary short-term and long-term disability insurance.

These policies provide income replacement to enable employees who are disabled to pay bills, including mortgages and college expenses, and to maintain an accustomed standard of living.

Disability insurance replaces a percentage of pre-disability income if an employee is unable to work due to illness or injury.

Employers may offer short-term disability coverage, long-term disability coverage, or integrate both short- and long-term coverage. Here’s what they cover:

  • Short-term disability policies: These policies have a waiting period of zero to 14 days, with a maximum benefit period of no longer than two years.
  • Long-term disability policies: These policies have a waiting period of several weeks to several months, with a maximum benefit period ranging from a few years to the rest of your life.

Disability policies have two different protection features that are important to understand:

Non-cancelable – This means the policy cannot be canceled by the insurance company, except for non-payment of premiums. This gives your employees the right to renew the policy every year without an increase in the premium or a reduction in benefits.

Guaranteed renewable – This gives your employees the right to renew the policy with the same benefits and not have the policy canceled by the company. However, the insurer has the right to increase the premiums as long as it does so for all other policyholders in the same rating class as your employee.

Other options

In addition to the traditional disability policies, there are several options that you can also offer as part of the voluntary benefit package:

  • Additional purchase options: The insurer gives your employees the right to buy additional insurance at a later time.
  • Coordination of benefits: The amount of benefits your employees receive from the insurance company is dependent on other benefits they may receive because of their disability. The policy specifies a target amount they will receive from all the policies combined, so this policy will make up the difference not paid by other policies.
  • Cost of living adjustment (COLA): The COLA increases disability benefits over time based on the increased cost of living measured by the Consumer Price Index. Your employees will pay a higher premium if they select the COLA.
  • Residual or partial disability rider: This provision allows your employees to return to work part-time, collect part of their salary and receive a partial disability payment if they are still partially disabled.
  • Return of premium: This provision requires the insurer to refund part of the premium if no claims are made for a specific period of time declared in the policy.
  • Waiver of premium provision: This clause means that your employees do not have to pay premiums on the policy after they are disabled for 90 days.

Centers of Excellence Save Money, but Have More Benefits Too

As health insurance and health care costs continue rising, more employers and health plans are turning to centers of excellence to manage patients with chronic conditions.

Centers of excellence are unique operations that focus on containing costs and delivering quality and coordinated care from diagnoses to treatment and recovery for patients with acute or chronic conditions. These centers will typically offer bundled-payment programs for high-cost procedures in orthopedics, cardiology, oncology and organ transplants.

A study by the Rand Corporation looked at three major surgical procedures and found that centers of excellence with bundled-payment programs reduce the cost of surgeries by more than $16,000 per procedure.

Centers of excellence are available in certain health plans, and employers with workers who have chronic conditions that are costly to treat may be able to control their plan costs better if they chose a plan that has one. Additionally, many self-insured and partially self-insured employers contract directly with these centers to reduce their overall cost outlays and improve their workers’ health outcomes.

The good news is that there are other benefits to centers of excellence besides controlling costs. These include:

Reducing the chances of unnecessary operations — Physicians in centers of excellence will not instinctively opt for surgery for their patients, and may instead refer them to treatment paths that don’t require going under the knife.

Additionally, one study published in the medical journal Arthritis & Rheumatology found that one-third of knee replacement operations were later deemed unnecessary, and an additional 21% were inconclusive.

As well, medications can be just as effective as inserting stents or conducting a bypass operation in many cases, according to research published in the U.S. National Library of Medicine.

There are many benefits to diverting patients to less invasive procedures that are as effective as surgery:

  • The employee benefits from not having to undergo surgery, not having to deal with anxiety and pain after the procedure, as well as lower out-of-pocket costs. They also don’t have to deal with recovery after the fact.
  • The employer and/or health plan saves money by not having to shell out thousands for surgery that could have been avoided.
  • The employer benefits from not having an employee off work recovering from surgery.

Happier employees — If an employee feels like they are getting top-shelf treatment from doctors that are skilled at helping them manage a chronic condition, they’ll be happier.

Additionally, workers are demanding more from their health plans, including improved tools to help them better manage their health.

Centers of excellence also allow patients to skip the processes of comparing different providers and trying to figure out how much they will be paying out of pocket. Since service costs are bundled and preset, they’ll know exactly what they will pay in advance.

Also, they will usually have a single point of contact in the center, from the point of first examination through treatment and recovery. This helps the individual feel like they have an active role in their treatment.

Improved recovery time — Employees who require surgery, if they are kept in the loop about their treatment and feel informed and part of the decision-making, are more likely to recover from their operation sooner and have less complications.

One key aspect of centers of excellence is coordinated care, which is often missing in general health care settings. It starts with initial diagnoses through treatment and recovery. And often the post-operation period will be bundled into the costs of treatment.

In many centers, your employee will receive assistance in scheduling follow-up appointments and any rehab treatment they require. This close coordination involves patients more in their health care journey. That in turn ensures that they can be on a path to recovery or managing a chronic condition.

The takeaway

Due to demand and the success of centers of excellence, more health plans are including them in their networks. While these programs can reduce costs for the plan and employees, they can greatly improve your workers’ health outcomes and ability to recover from surgery.

And if your employees feel like they have a say in their health care while dealing with a chronic condition, they will be more productive and, hopefully, more loyal to your organization.

‘Family Glitch’ Fixed by Regulations That Took Effect for 2023

Thanks to new regulations that took effect Jan. 1, it will be easier for dependents of an employee with employer-sponsored family health coverage to seek out coverage and subsidies on the Marketplace if they are in a plan that is deemed unaffordable under the Affordable Care Act.

The new rules, issued by the Department of Treasury and the IRS, are aimed at fixing what’s become known as the “family glitch,” which is tied to the affordability test of employer-sponsored coverage.

The ACA affordability threshold for employer-sponsored coverage is 9.12% of income for 2023, meaning that if an employee is spending more than that for their portion of the premium, the coverage would be deemed unaffordable and they would be eligible to seek out coverage on an exchange and qualify for subsidies.

Under the family glitch, affordability of employer-sponsored coverage for a family member of an employee was determined by the affordability test for self-only coverage. And because of ACA rules, even if the family coverage was more than 9.12% of household income for the worker’s family members, they would be ineligible for premium credits (or subsidized coverage) on the government-run exchange.

Some 5.1 million individuals are affected by the family glitch, according to the Kaiser Family Foundation. It estimates that 85% of them in 2022 were enrolled in employer-sponsored plans and paying more than they would if they qualified for subsidies on the exchange.

Another study estimated that these individuals could be spending on average 15.8% of their income on their employer-sponsored coverage.

Example of the family glitch:

An employer pays 100% of the $7,500 premium for an employee’s self-only coverage, but doesn’t pay anything towards the individual’s family members’ coverage, which is an additional $8,500 per year.

As a result, the worker’s dependents would be considered to be enrolled in affordable employer-sponsored coverage, which would prevent them from qualifying for tax credits on the exchange.

The new rules

Under the new rules, the worker’s required premium contributions for self-only and family coverage would be compared to the affordability threshold of 9.12% of their household income.

If the employer offers multiple plans, the affordability test is applied to the lowest-cost plan, regardless of if the employee chooses a plan that costs them more than 9.12% of household income.

If the cost of self-only coverage is considered affordable, but the family coverage not, the employee would not be eligible to apply for subsidized coverage on an exchange, but their dependents would be.

In your communications with your staff, it may be a good idea to let them know of this new rule as it could allow some of them with family coverage to secure subsidies for their dependents on the Marketplace and pay less in premium for the coverage.

As Health Care Costs Bite, Here’s How You Can Help Your Workers

Recent studies have highlighted an alarming trend in American health care: More and more people are struggling with medical bills and many are delaying care due to high costs.

The most recent poll by Gallup found that 38% of those surveyed said they or a family member had delayed care in 2022 due to high costs. That’s up from 26% in 2020 and 2021. The rapid increase occurred in a year where inflation was at a 40-year high.

Last year’s spike in delayed care was the largest over one year since Gallup first began tracking these data more than two decades ago and it illustrates the breadth of the problem, which likely stretches into the ranks of your own employees.

Even if you are providing them with a robust plan, there are often out-of-pocket cost-sharing and deductibles to contend with. For employees in high-deductible health plans, the costs can be steep.

What you can do

Fortunately, there are steps you can take to help them reduce their out-of-pocket expenses for health care:

Emphasize the importance of preventative care — The best way to prevent or stave off major health issues is through preventative care, such as going to routine checkups and having blood work done as recommended. The COVID-19 pandemic worsened the problem of delayed care and health care providers and patients are still catching up on all that missed care.

But it’s not just regular checkups. Many people are not getting regular care for chronic conditions. Many preventative services are covered with no out-of-pocket cost-sharing, but checkups usually are not.

Depending on the type of plan an employee has, routine and preventative care costs can add up. Some experts suggest creating a cash-assistance fund for workers who may struggle with the costs of those visits.

Highlight digital tools — Digital tools are growing in number, from apps and telehealth options to those that can help your employees manage chronic conditions.

Many insurers and/or providers have apps to help people access care and manage their health. The apps will notify patients when it’s time for checkups or other routine services. These portals typically include telehealth options, which can be a less expensive way to meet with their doctor or a specialist.

On top of that, there are digital tools to help people monitor and manage chronic conditions, like high blood pressure and diabetes — and even rate genetic conditions. They are an inexpensive way to keep a look out for symptoms and changes in vitals that may require a visit with their doctor. Your workers should ask their doctor about any tools that they can be using.

Don’t cut back on health benefits — With the rising health insurance premiums, it may be tempting to offer high-deductible health plans with even higher deductibles. This may keep your premiums where they are compared to the prior year, but it saddles your employees with the potential for even more out-of-pocket expenses.

Urge any employees in HDHPs to sock away funds in their attached health savings accounts for future medical expenses. These accounts are funded with pre-tax dollars and can be saved up for future use. Funds are not taxed when withdrawn, either.

HSAs are portable if the employee changes jobs, and the funds can be invested, much like a 401(k) plan.

More Employers Offer Flexible Spending Accounts

As health insurance and treatment costs rise and recognizing the potential for tax savings and other benefits, more employers have started offering flexible savings accounts to their employees.

FSAs are also an important way to enable employees who are not enrolled in high-deductible health plans with attached health savings accounts to save money over the year for medical and related expenses.

A study by the National Business Group on Health predicts that 66% of employers will be offering FSAs to their employees in 2023, up from about 60% in 2018 and 52% in 2015 and making for an increase of 27% in less than a decade.

The study predicts that uptake will continue growing as employers look for ways to help their employees put aside funds for medical services, pharmaceuticals, copays, coinsurance and other medical items.

Also, the total amount saved in these vehicles was $30.7 billion in 2020, up 8.7% from the year prior, according to medical equipment supplier AvaCare Medical. The average amount of money placed into FSAs has increased every year since 2015, reaching an average of $2,400 in 2022, according to the IRS and the Bureau of Labor Statistics.

While they have always offered tax savings and other benefits for individuals and businesses, the increasing popularity of FSAs is likely due to the rising cost of health care.

Contributions

Participating employees can contribute up to $3,050 in 2023, up $200 from 2022. Amounts contributed are not subject to federal income tax, Social Security tax or Medicare tax. The limit only applies to how much an employee can contribute to their account.

If the plan allows, the employer may also contribute to an employee’s FSA.

Employer contributions (including non-cashable flex credits) generally cannot exceed $500 per plan year for the health FSA to maintain excepted benefit status. That means that the maximum health FSA available in 2023 will be limited to $3,550 ($3,050 maximum employee contribution + $500 maximum employer contribution).

Another important note: Health FSA eligibility cannot be broader than the major medical plan eligibility to maintain excepted benefit status, under the Affordable Care Act. That means that a health FSA should never be available to an employee who is not also eligible for a major medical plan.

Carryover

Under the law, enrollees must use up the funds they set aside during the year or forfeit the remainder, unless their employer allows part of the funds to be carried over.

Also, if a cafeteria plan permits health FSA carryovers, the maximum amount that a participant can carry over from the 2023 to the 2024 plan year is $610, up $40 from the maximum carryover amount from 2022 to 2023.

Some employers may provide a two-and-a-half-month grace period during which employees can use their remaining funds.

Regardless of what you decide in terms of allowing carryovers, you should clearly inform your workforce of your current carryover limit and any changes in 2023. That way, you give your staff the ability to avoid forfeiting as much as possible at the end of the year.

What FSA funds can be spent on

Some of the qualified medical expenses that are not covered by health insurance, and for which employees can pay using FSA funds, are:

  • Copays
  • Deductibles
  • Dental and vision care services
  • Eyeglasses and hearing aids
  • Chiropractic and acupuncture
  • Physical therapy
  • Other medical devices
  • Prescription drugs
  • Over-the-counter medications.

Besides Health Insurance and 401(k)s, These Are the Benefits Employees Value Most

Besides health insurance and a 401(k) plan, other benefits that employees value highly are generous paid time off and flexible or remote work, according to a new survey.

But for the first time, the annual study by employee benefits provider Unum found that the younger generations are not on the same page with their older peers when it comes to what they value most in their benefits package.

“A multi-generational workforce is a huge benefit for companies,” said Liz Ahmed, executive vice president of People and Communications at Unum. “With the diversity of background, experiences, and thought employees bring, employers need to make sure there’s something in their benefits package for everyone’s different stage of life.”

Although the generations differ in their top three priorities, when opened to the top five, there is one common denominator: emergency savings.

Emergency savings

Sixty-four percent of employees surveyed said they do not have access to an emergency savings option through their employer. This benefit ranks third for boomers (25%), third for Gen X (32%) and second for Gen Z (37%).

Emergency savings plans can help prepare your employees for unexpected expenses — without dipping into retirement funds or using credit cards.

Employer-sponsored emergency savings accounts help workers save for financial emergencies by automatically deducting an amount from each paycheck and depositing it into a separate account. If they need to cover a bill or cash gets tight, they can draw from this fund to bridge a financial gap.

Also, with mental health support and resources high on the list for younger workers, employers may consider tapping an employee assistance program. EAPs are voluntary, work-based programs that offer free and confidential assessments, short-term counseling, referrals and follow-up services to employees who have personal and/or work-related problems.

You can use the following list as a general guidepost if you are considering adding voluntary benefits to your employee offerings.

These are the top 15 non-insurance benefits for U.S. workers:

  • Generous paid time off program
  • Flexible/remote work options
  • Paid family leave (for childcare or caring for an adult family member)
  • Mental health resources/support
  • Emergency savings
  • Professional development
  • Financial planning resources
  • Fitness or healthy-lifestyle incentives
  • ID theft prevention
  • Gym membership or onsite fitness center
  • Student loan repayment benefits
  • Pet-friendly offices
  • Personalized health coaching
  • Sabbatical leave
  • Dedicated volunteer hours.

A final thought

There are so many voluntary benefits to choose from that it’s important that you opt for ones that your employees actually want. A good way to gauge their interest is to conduct your own survey by asking them which benefits they would like to see and offering them a list to choose from.

Insurance Considerations as Americans Work Past Retirement Age

Americans are eligible to sign up for Medicare when they turn 65, but more of us are staying in the workforce longer than ever before. In fact, the average retirement age has increased three years in the last three decades.

There are a number of issues that Medicare-eligible workers face that your human resources staff may be asked about, such as:

  • Penalties for late Medicare enrollment,
  • Whether the employer plan is the primary or secondary payer of claims, and
  • How Medicare eligibility affects health savings accounts.

The following are considerations for employers faced with workers nearing 65.

Discontinuing group health coverage

If you plan to discontinue coverage for employees who are turning 65, you should communicate with them well ahead of the time they need to sign up for Medicare.

It’s important they understand that they will be dropped from your group health plan and that they have a seven-month window to sign up for Medicare (during the three months prior to the month they turn 65, the month they turn 65, and the three months after turning 65).

If they fail to sign up during this time, they will face a mandatory 10% penalty on all future Medicare Part B premiums for every year they are late in signing up.

Keeping them on the group plan

If you decide to keep them on the company’s plan, how you handle their insurance depends on your size:

Fewer than 20 employees — Employees who work for these firms will need to enroll in Medicare when they turn 65. Medicare will be the primary payer of health insurance claims for these workers under the law.

The group health insurance is the secondary payer.

How it works:

Let’s say your employee has foot surgery:

  • Medicare pays first up to the limits of its coverage.
  • The group health insurance only pays if there are costs Medicare didn’t cover.

20 or more employees — If your organization has with 20 or more workers, the group plan will be the primary coverage as long as they are actively employed. These employees can generally delay signing up for Medicare Part B. They will also not be subject to penalties for not signing up when they turn 65.

That said, workers who are still on your plan should sign up for Original Medicare Part A (hospital insurance) when they are first eligible. Medicare Part A, which is premium-free, provides secondary coverage of hospital expenses that may not be covered by your group plan.

Once they stop working and are no longer on the company’s health plan, your employees have eight months to sign up for Medicare Part B. They can at that time opt for Original Medicare, Medicare Advantage or a Medicare supplement plan.

If they fail to sign up for Medicare Part B after eight months of losing their employer coverage, they will be subject to a premium penalty for the rest of their lives.

Ideally, workers should enroll in Part B at least a month before they stop working or their coverage ends, so they don’t have a gap in coverage.

Health savings accounts

If your firm has fewer than 20 employees, workers who are 65 or older can no longer contribute to an HSA as they are not compatible with Medicare.

At larger organizations where the employer’s health plan is the primary coverage, employees enrolled in an HSA-compatible, high-deductible health plan can delay enrolling in Medicare and continue contributing funds to their HSA.

Employees who are 65 or older should stop making contributions to their HSA six months before they enroll in Medicare or before they apply for Social Security benefits if they are still working. That’s because people who apply for Social Security benefits are automatically enrolled in Medicare.

Those who fail to stop making HSA contributions in that period may face tax penalties.

Employers Prioritizing Enhanced Benefits in New Year, Not Cost-Cutting

Despite group health insurance costs expected to rise 5.4% this year, the tight labor market is forcing employers to prioritize enhancing benefits over cost-cutting measures, according to a new report by Mercer.

With Americans increasingly struggling to pay their health care bills, more employers are shying away from only offering their workers high-deductible health plans (HDHPs) that reduce premiums up front for higher out-of-pocket costs for workers.

Also, with mental health a top concern for workers, employers are seeking out benefits and plans that include virtual mental health services to make it easier to access care.

The expected health insurance cost growth of 5.4% is still less than general inflation, which was averaging just a tad below 8% in 2022. Because of high inflation, employers should be prepared for continued accelerated cost growth in 2024 and beyond, according to Mercer.

What employers are doing

With the tight labor market and health insurance benefits high on employees’ demands, employers are focusing on:

  • Enhancing benefits to improve attraction and retention (84% of large employers cited this as “important” or “very important”).
  • Adding programs/services to expand access to behavioral health care and mental health services (73% said this was important or very important).
  • Improving health care affordability (68%).
  • Enhancing benefits/resources to support women’s reproductive health (55%).

That’s not to say that employers are not concerned about costs. Instead, they are tackling it in different ways than in the past.

“Given the focus on affordability, it is not surprising that, despite expectations of higher healthcare costs, most leaders are avoiding ‘healthcare cost shifting,’ or giving plan members more responsibility for the cost of health services through higher deductibles or copays,” Mercer wrote.

It added that there was little change in the median amount of these cost-sharing features in 2022.

Prior to the COVID-19 pandemic, employers were shifting workers to HDHPs to reduce their costs, but while employees enjoy lower premiums with these plans, if they need care they will pay more out of pocket.

Mercer found that fewer large employers are offering only HDHPs than in past years. Very large organizations (20,000 or more employees) had been adopting these plans with gusto until 2018, when 22% of them offered an HDHP as the only option for their employees. That fell to 13% in 2021 and was only 9% in 2022.

Instead, more employers were using salary-based premiums in 2022 (34%, up from 29% in 2021). Under these arrangements, lower-wage workers have smaller paycheck deductions for health coverage than those with higher salaries.

Cost-cutting

Employers are instead looking at other ways to cut costs for themselves and their employees. The Mercer study found that:

  • 35% of large employers are steering employees to high-performing provider networks and other sources of high-value care.
  • 36% of large employers offer telephonic navigation and advocacy service to help members find the right provider based on quality and cost.
  • 17 % offer digital navigation.
  • 24% are focusing on managing costs of specialty drugs.
  • 23% are working with their carriers and pharmacy benefits managers on cost and clinical management strategies. 

More Providers Charging for Some Health Portal Services

As more health services are being rendered through providers’ patient portals and telemedicine, some providers are starting to bill for some of those interactions.

A number of health systems around the country have started billing for certain types of messages, largely ones that are involved in clinical assessments or medical history reviews that take more than five minutes. Those costs will be passed on to health plan enrollees — likely in the form of copays or coinsurance — and insurers.

Online and app-based portals have become increasingly popular, particularly since the onset of the COVID-19 pandemic, as more people grow accustomed to not seeing their doctor face to face for every visit. Often these portals will allow the health plan enrollee to ask their care team questions, and that’s when providers say they are not being paid for their time.

Is a new trend starting?

Patient portals were seeing little usage prior to the pandemic, which spurred demand as patients and providers needed a solution that didn’t require in-person interactions. Studies have shown that more than 80% of patients used telehealth at least once since the start of the pandemic, up from about 10% prior to 2020.

These portals also sometimes obviated the need even for a tele-visit with a doctor and opened the door for patients to message their doctor directly.

The issue recently came to the fore when Cleveland Clinic and a handful of other medical centers started charging for this service. 

Cleveland Clinic in November 2022 said it would start billing patients’ insurance companies for messages requiring at least five minutes of health care providers’ time to answer.

What will it cost?

Sending messages could cost as much as $50 per message depending on the time and skill necessary to answer the request. According to the announcement, people with individual or employer-sponsored group health insurance may be billed an average of $33 to $50 for each message taking more than five minutes. 

In announcing the new charges, Cleveland Clinic wrote: “Over the last few years, virtual options have played a bigger role in our lives. And since 2019, the amount of messages providers have been answering has doubled.”

According to a report in Becker’s Health IT, seven more large health systems around the country have also started billing for some patient portal services: Northshore University Health System in Evanston, Illinois; Northwestern Medicine in Chicago; Chicago-based Lurie’s Children’s Hospital; San Francisco-based UCSF Health; Renton, Washington-based Providence; and UW Medicine and Fred Hutch Cancer Center, which both have their headquarters in Seattle.

These hospitals say they will only bill for certain messages, such as those concerning:

  • Changes to a patient’s medications.
  • New symptoms the patient may be experiencing.
  • Changes to a long-term condition.
  • Check-ups on long-term condition care.
  • Requests to complete medical forms.

Messages may provide information on a treatment plan or recommend that the patient get a test done or schedule an appointment with a specialist. Doctors may often refer to the patient’s medical history and review their records for these communications, for example.

The providers say that other services on portals will remain free, such as:

  • Scheduling appointments.
  • Getting a prescription refilled.
  • Asking a question that leads to an appointment.
  • Asking a question about an issue the patient saw their provider for recently.
  • Checking in as a part of follow-up care after a procedure, such as a colonoscopy.
  • A patient giving a quick update to their doctor.

Experts predict that as more health services gravitate towards providers’ portals, hospitals and doctors will look to generate revenue from these services.

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