MyChart Message Billing Update

When you have a medical question about your child, sending your healthcare provider a message through MyChart is one of the most convenient ways to receive your care. It doesn’t matter what time it is — or if you’re in your office or the grocery store parking lot — you can still reach out with a MyChart message to start a conversation with your provider.

Over the last few years, virtual options have played a bigger role in our lives. And since 2019, the number of messages clinicians have been answering has doubled.

Staying connected is important, and your provider is committed to responding to your needs in a timely way — within three business days. Most of these messages are free. However, starting on December 1, 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 Pediatrics Northwest.

Which messages will be billed to my insurance?

Messages that will be billed usually require your provider’s medical expertise and take longer for your provider to answer — typically taking five or more minutes for your provider to answer.

But what kinds of messages could get billed? Messages about:

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

The provider looking at your message might be reviewing the information you sent over and changing part of your treatment plan, or recommending you get a test to learn more. They might need to look at your medical history and do an in-depth review of your records to make sure they give you the best possible advice.

Which messages will be free?

It’s important to know that not every message you send to your provider will be billed to your insurance. The quick rule of thumb is to think of time and expertise. Does your provider need to spend time to fully answer your question? Does it require them to dig into your medical history to respond to your question?

Your provider won’t bill for messages about:

• Scheduling an appointment
• Getting a prescription refill
• Asking a question that leads to an appointment
• Asking a question about an issue you saw your clinician for in the last seven days
• Checking in as a part of your follow-up care after a procedure
• Giving a quick update to your clinician that does not require a response back

What to expect if your message is billed to insurance

If your message is billed to your insurance, you may not be charged or may see a low out-of-pocket cost. Different insurance plans cover different things. Here are a few examples of what you can expect:

• Have Medicare? There’s no out-of-pocket cost for most people. Some might have a small fee of $3 to $8. If you’re a Medicare patient with secondary insurance, you’ll owe $0.
• Have private insurance? Most insurance providers cover these messages at little to no cost to the patient. If you have a deductible, or this isn’t a covered benefit on your plan, you could owe $33 to $50.

Reach out to your insurance provider to learn the specific out-of-pocket costs for your plan.

What parts of telehealth does insurance cover?

Telehealth has made connecting with your provider easy and convenient. You don’t need to leave home and travel to a doctor’s office to chat with your provider on MyChart. As this option for care is getting more popular, you might wonder what your insurance covers when it comes to virtual options. Many insurance plans now cover:

• Virtual visits
• Phone call visits
• Medical advice via MyChart

Most of the messages you send to your provider through MyChart are handled quickly and won’t be billed to your insurance. But requests that take extra time and expertise are considered telehealth, so those services will go to your insurance plan for payment.