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More doctors are charging fees to respond to patient messages

• throwaway118899 3y ago
  [flagged]
• gnicholas 3y ago
  Getting a doctor to respond through our digital messaging platform is practically impossible. Unless you're extremely persistent and specifically ask for the doctor's input (and send 3-4 messages back and forth with the nurse, whose responses are less relevant than a google search), it's impossible. I wonder if charging for these messages will make doctors more likely to respond. I wouldn't mind a modest copay for these. But if I pay $30 for an appointment, a quick message should be under $15. There would also have to be some sort of SLA, or the ability for a patient to specify that a question/email has expired and no longer requires an answer. I've had situations where I waited for a doctor's callback so long that I ended up calling a friend who was a physician assistant, watching a youtube video about how to fix the problem, and taking care of it myself. The only way that process could be any worse is if I got a reply after I had fixed it — and a bill for the message.
  • devin 3y ago
    I've never had a problem across several doctors on getting a direct reply to my message. For me, there is an SLA. They explicitly state I'll receive a reply within 24 hours. That has been true across multiple health systems I've used. Edit: In no way am I saying "American healthcare is just fine!" only that I actually have had a really good experience using messaging to communicate with my care teams.
    • NegativeK 3y ago
      Are you, by chance, using concierge doctors?
      • devin 3y ago
        Negative.
        • NegativeK 3y ago
          Wild. I've never seen anything remotely close to an SLA with the healthcare professionals I've seen.
          • thereticent 3y ago
            I don't know what is happening elsewhere I suppose. I'm a PhD clinician at a US public academic medical center and respond to patients within 24 hours even if it's to say "let me check on that...it may take a week to get the answer/letter/etc." I'm pretty sure that's the expectation for all our MD/DOs and other clinicians. We don't bill for it, and it doesn't contribute to our targets, but it just seems like it falls under a salaried expectation to me. It's for the patient. That said--hospital management, driven by the insurance world, tries to wring as much uncompensated labor out of the medical workforce as possible. Doctors (including my MD colleagues) do not get together to limit the number of doctors available. That's baseless conspiratorial thinking that doesn't withstand a moment's scrutiny when you understand the incentives at work in American healthcare.
            • DANmode 3y ago
              > Doctors (including my MD colleagues) do not get together to limit the number of doctors available. There are limited slots each year at the accredited schools you must attend in order to acquire your role. Nobody's accusing you of doing it - but the number of doctors is limited
              • thereticent 3y ago
                Not everyone is accusing the doctors involved, but when I wrote the comment, there were numerous armchair expert opinions squarely blaming the doctors, including at least one who said that doctors limit the number of training slots available to keep their prices high. Thankfully, those perspectives have been addressed or at least outpaced by better thought out criticisms since then. Ultimately, the number of training slots in the current system is limited by MHA and MBA administrators who see training and instruction as subservient to profits, not the doctors who make up the departments and training faculty. Or, more broadly, they are limited by the healthcare operations not being legislated in a saner way. I was just clarifying.
  • smallmancontrov 3y ago
    > I wonder if charging for these messages will make doctors more likely to respond. I wouldn't mind a modest copay for these. How long until administration figures out that they can juice revenue by shitting up the emails to increase back-and-forth traffic?
    • FireBeyond 3y ago
      Hah, in MyChart, my provider has started having an MA answer your emails, and then "I'll forward this to the provider". Waiting to see if I get billed for the MA's "effort".
      • ejb999 3y ago
        why are you putting effort in quotes? Do you not think there is any 'effort' involved? Why do you think someone else's 'effort' should be free?
        • FireBeyond 3y ago
          This is an absolutist take. No-one's saying it takes zero literal effort. Just "Should I be billed by the practice $25-30 for an MA to get my email and say "I have forwarded your question to the provider"?", and then a subsequent $100+ for the provider's response to my question. Why should that not be part of the intrinsic baseline officework and not a billable service? Especially when it's a 100% artificial roadblock inserted by the practice? After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider".
          • wighty 3y ago
            > After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider". That is semantics, could be changed to "Message the office" but that isn't going to be the most clear title for the majority of people to understand what it is doing. It's the same as calling the office, 99.9% of offices (basically all outside of concierge/direct care) are going to be triaged by an MA/nurse first. As far as the payment requirements I've heard of, I have never seen anyone bill just for the MA reply.
  • pants2 3y ago
    While waiting 6 weeks for an appointment with a specialist and suffering in pain, my mom diagnosed herself, created a treatment plan, ordered prescription pills from some Chinese site, and started treating her condition herself. She cancelled her appointment because she was feeling much better.
    • wannacboatmovie 3y ago
      This is terrible advice.
      • burnished 3y ago
        It isn't advice
  • NoMoreNicksLeft 3y ago
    > I wonder if charging for these messages will make doctors more likely to respond. Why would it do that? If they get money for messages sent (rather than messages sent by doctors) then some flunky can send a message and you can still be billed. Given how this sounds like a profit center, and doctors are cost centers (imagine if they needed to send more messages... now they have to pay more doctors!), I figure physicians will be kept far away from any such system. If we plot out perverse incentives as a space, I believe that our fate will be to trek through every possible point in that landscape such that we eventually see every single one. This means you will eventually get universal healthcare, most likely as the very last of those perverse incentives.
    • gnicholas 3y ago
      Interesting point. That could make for some awkward conversations if the patient thinks messages were coming from their doctor but then the director had no memory of the messages. It would also seem fraudulent to have messages signed by the doctor when it wasn’t actually sent by that doctor. I think it’s much more likely that doctors will end up sending AI-autocompleted messages that take very little time to complete but seem like took much longer.
      • NoMoreNicksLeft 3y ago
        I have not used a medical messaging system, but if it's anything like the messages my bank or my insurance company sends on their own systems then these will look much more like text messages and less like emails. No place to "sign". No need to risk it looking like fraud. As for awkward conversations, I'd be shocked if many people don't experience circumstances where their doctors act as if they don't remember previous in-person conversations. They're seeing 25 patients a day for 3 minutes at a time after all. The standard will evolve to something like clinic staff sending the messages which will be overseen/supervised by a medical doctor (who won't be involved in composing the messages or spend any time looking at them before or after they are sent). We'll see trials where the doctor who was supposed to be keeping an eye on the messages wasn't, and some flunky kills a patient by suggesting that drinking used engine oil will cure the sniffles. Keep in mind that the messages can be sent from anywhere too, technically no need to keep that onshore. May eventually get legislation that would guarantee that, but only after a wild west period that lasts a few years.
  • qudat 3y ago
    > I wonder if charging for these messages will make doctors more likely to respond. Physicians won't see a dime of that money unless it's through RVUs and even then it's marginal at best. The real money is in procedures.
    • wighty 3y ago
      There are some codes that can be used for asynchronous portal messages, but to be honest the AMA is still pretty broken as far as how much time we need to spend for things... the codes are 99421 (5-10 minutes over 7 days), 99422 (11-20 minutes), 99423 (21+). It is not clear to me how well these codes are actually paid for by private insurance. In a wRVU system a PCP may get paid like $5-13 for the first code, $15-30 for the 2nd, $24-44 for the 3rd. This is a lot less than a visit... and you must spend the minimum 5 minutes on the portal message or you are billing it fraudulently. I can cover an in person level 4 visit (99214) in 5 minutes in some cases, which pays something like $100.
      • AbstractH24 3y ago
        If there are codes like this why don’t all doctors use them already?
• helsinkiandrew 3y ago
  https://archive.is/KtTeA https://archive.is/KtTeA
• CharlesW 3y ago
  Here's American health care: • I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doctor first. • Fine, but I couldn't accommodate an in-person check-in. I chose a "video visit" that, due to logistics, I had to do while away from home. Because they were a half-hour late, I was effectively forced to do this from the couch of a Costco floor display so I could still pick up my kid on time. • The appointment was 8m, at an out-of-pocket cost of $160+. I was not warned that I'd be forced to pay $20/minute for the privilege of being blessed with refills. Land of the fee, baby.
  • danielschonfeld 3y ago
    American healthcare is the epitome of capitalism run amok. It’s terrible and the only thing worse than the exorbitant fees is the complete and utter lack of consideration to the patient’s time.
    • DaveExeter 3y ago
      [flagged]
      • cratermoon 3y ago
        Ah yes, of course, https://bitworking.org/news/2008/01/the-free-market-fairy/ https://bitworking.org/news/2008/01/the-free-market-fairy/
        • moralestapia 3y ago
          He's right, though. I moved to Canada recently and caught a flu that I didn't take care of and, in turn, developed into pneumonia. It took me FIVE days to be able sit down with a doctor and get an antibiotic prescribed even thought it was more than evident I needed immediate care. I could have died if I waited another day. But was it free? ... ehrm ... yeah. In Mexico, doctors are as free market as it can get, downsides and upsides of that considered; with cash in hand you can get any kind of attention you need in the exact moment you need it. And it's not even that expensive, after converting MXN <-> USD. I could've dropped by with any of the 1,000s doctors that are available, many of which don't even require appointments. I would've got the attention I needed and the antibiotic prescription in 2-3 hours. That would had cost me ~60 USD.
• chadash 3y ago
  I met with a new accountant yesterday. He told me that if I email him and ask if I can expense a lunch and it's a 1 minute answer, he's not gonna charge me. But if it's gonna take him a good amount of time to respond, then he will. And I think that this is completely fair. I'd expect the same from a doctor. If I am asking a very occasional and non-urgent question with a quick answer (e.g., can I take my medicine and drink alcohol safely) then yeah, I'll be annoyed if I get a $25 fee. But typing out responses to question might take my doctor 30 minutes, so it's fair if they charge me, so long as I get a good answer in a reasonable timeframe. Obviously there's exceptions. If it's a brain surgeon who just made $25,000 on a single procedure and I have a 15 minute followup question, it seems a little nervy to bill me $25 more, but not if I'm emailing my kid's pediatrician a picture of a rash.
  • burkaman 3y ago
    Several issues with your analogy: 1. The accountant will tell you that pricing up front, so you can make a decision before you send an email. No doctor in America will answer any question about pricing ahead of time. 2. The vast majority of Americans know precisely when they need to pay taxes and roughly how much work they will be, how many accounts they're dealing with, what types of questions might arise, etc. It is extremely rare for most people to ever have an urgent question for an accountant. Healthcare on the other hand is inherently unpredictable, and urgent questions are very common. 3. Most people don't have, and never will have, an accountant. Every single living human of any age needs at least one doctor, and often quite a few. 4. If you don't like your accountant's pricing, you can easily shop around for a different one. You can't do that with a doctor (see point 1). You can sort of do it with insurance, but that isn't the same thing, can only be done once a year, and the options are very limited for most people. 5. If you don't like dealing with an accountant at all, you can just get a normal job and never talk to one again. It's entirely within your control. If you don't like dealing with doctors, you're out of luck unless you want to die.
  • unsupp0rted 3y ago
    You've painted a picture in which doctors charge for time. This is (or should be) incongruous with what a doctor is for. Doctors charge for identifying and telling you things non-doctors can't, with a high degree of non-harm-doing. They've already put in the 10,000 hours to know which bolt to turn.
• HumblyTossed 3y ago
  I don't mind paying for my Dr's time. If my insurance starts doctor blocking by making me chat with an AI first AND charging me for that? No, that's not going to be acceptable.
  • gnicholas 3y ago
    Yeah that wouldn't be a good outcome. How would you feel if the doctor were messaging you through a platform that had extensive predictive text features, possibly trained on that particular doctor's past messages, and allowed her to send a message in 30 seconds that would have taken 10 minutes to type out? If you used that system for years and paid for it happily, would you be upset to learn that the doctor was spending so little time?
    • Macha 3y ago
      The difference here really is that the doctor is reviewing what is being sent in some practice. Sure, there's some possibility that the doctor is over influenced by the suggestion and goes "it seems right", but that's true even if they effectively google it as GPs often do today. Whereas a LLM trained on the internet at large seems about as useful as WebMD, which sometimes feels like it would tell you bleeding after an accident chopping food is a sign of cancer.
    • devilbunny 3y ago
      Most EMR's allow for certain boilerplate things to be inserted easily. My wife is a neurologist; it's very common for her to dictate a note saying "insert seizure precautions" and it puts in a paragraph of things that you can't do if you have seizures: take a bath, drive, get on ladders or other elevated surfaces, that sort of thing. I've customized the hell out of my own hospital's Epic system (I'm an anesthesiologist) to make notes as easy as possible. 95% of the things I do are done the same way, every time. Back when we used paper, they had all of that in checkboxes on forms. Basically a way to say "yes, I did this legal and proper" very quickly. It was very useful because you knew that if you skipped over that and went straight to the written description on an old record, you'd actually get the important information. Before billing criteria took over medical documents, doctors could do more because a board-certified pediatrician doing a well-baby visit could just write "18 mo WM, PMH NC, PE WNL, f/u 6 mo" (18 month old white male, past medical history noncontributory, physical exam within normal limits, follow up in six months). We had "skeletons" for reporting the most common labs in notes - just a graphic representation so you didn't have to write "Sodium 139, potassium 4.3, chloride 122, bicarb 24, BUN 9, creatinine 1.1, glucose 85". 139 | 122 | 9 / --------------- 85 4.3 | 24 | 1.1 \ The paper medical record was subject to handwriting, but it was extraordinarily space- and time-efficient.
• buran77 3y ago
  In some countries in Europe, if you have private insurance they'll pull off the "call charge" trick as often as they can. Need to make or reschedule an appointment? Make a call. Did some blood test and need the results? Call to get them. They call you to tell you they can't make the appointment and need to reschedule? You still get charged. If it's not a call it's a fake shot. Fake disinfection charge. And so on. The principle is "anything that can be charged, will be charged". The level of insurance fraud with this is ridiculous.
  • hiddencost 3y ago
    [flagged]
    • smallmancontrov 3y ago
      A user named "hiddencost" doubts that privatized healthcare follows its incentive to create hidden costs. Chef's kiss.
    • buran77 3y ago
      > they tend to not be well supported by the number Personal opinion or did you ever talk to anyone investigating these things? First of all, the fraud is committed by the patient, they're the one submitting the claim to their private insurance without validating it. Secondly, it will always be called a mistake if you object to it. But nobody does because remember, private insurance pays anyway. On top of it once you object and have a few arguments with them you may even find yourself having difficulties to get an appointment if it's a desired doctor with a queue at the door. There are no numbers because this is not investigated, there just aren't resources for this. Nobody with a private insurance bothers reporting a $5-10 shot they never received and nobody wastes resources to investigate it. I've seen attempts to swindle me out of 5 digit sums of EUR that would have otherwise been blindly paid by the insurance. I actually checked everything, I objected, it was called a system error. I have acquaintances who work with the authorities and they confirmed that even if you find a pattern it's impossible to prove intent, so it never goes further than "we correct the mistake for those who report it". Politician corruption is basically non-existent, and Al Capone just didn't pay tax. According to the numbers.
• tonymet 3y ago
  I worked for a mature healthcare company and much of our marketing centered around healthcare provider surveys of doctors and nurses. The results were unsettling. Extremely high rates of burnout, typically due to administrative overhead. Horrifying medical error rates. Doctors should be compensated for the amount of time to send an email. Every other industry is capable of restructuring support to satisfy demand. It's up to the healthcare providers to manage this channel properly as any other would. The real question is: what would it take for the healthcare industry to restructure itself to actually function?
  • pydry 3y ago
    >The real question is: what would it take for the healthcare industry to restructure itself to actually function? Strike the words "over 65" from the medicare bill.
    • tonymet 3y ago
      that's a poor excuse. We can provide much better care for the elderly. the bulk of the operating cost growth in the past generation has been from administration.
    • dragonwriter 3y ago
      > Strike the words "over 65" from the medicare bill. If you mean "universal single-payer", its worth noting that Medicare is very much not single payer and striking the population restriction for Medicare would not produce universal single payer (or even a single comprehensive plan for each individual, unless they are opting for privately-provided, publicly subsidized main insurance -- otherwise hospital [Part A], outpatient [Part B], and prescription drug [Part D] are separate insurance systems, and only the first two are public.) Medicare is a particularly complicated implementation of partially publicly subsidized private insurance with an (incomplete) public option.
    • Projectiboga 3y ago
      Medicare only covers 80% and the providers are specifically prohibited from waiving that copay. Yes we need single payer but the Trojan horse of expanding Medicare to lower the age incrementally is just PR it is a way for insurers to reduce the average age of their insured cohort.
• medmunds 3y ago
  Every time my lawyer replies to my email, it costs me $35. At least. That's just for one or two line responses. Anything that requires research or (gasp) looping in a partner gets a lot more expensive, very quickly. This doctor sounds like a good deal.
  • strangattractor 3y ago
    $750 dollar office visit for a GP for 20 minutes no procedures performed ($2250 per hr) sounds even better. Welcome to US healthcare.
  • rpearl 3y ago
    Typically, when you are talking to a lawyer, you have signed a contract, paid a retainer, and have an explicit hourly rate negotiated for interactions with that specific firm.
    • freeAgent 3y ago
      Yeah, and typically when you do the same with a doctor the fee you pay has been negotiated with your insurance provider. This is no worse than anything else billing-related in healthcare.
      • deleted 3y ago
        [deleted]
      • BobaFloutist 3y ago
        >This is no worse than anything else billing-related in healthcare. I don't think I've ever seen a lower bar.
        • freeAgent 3y ago
          I agree. Im just saying that this is not uniquely bad or unfair in context.
  • JustBreath 3y ago
• achynet 3y ago
  [dead]
• danielschonfeld 3y ago
  Every time the topic gets of healthcare comes up I always wonder how many doctors have tried themselves to interact with their own clinic (has to be their own) Trying to do simple things like: - Setting or getting an appointment. - Calling to sort out their office’s coding error that resulted in me getting an erroneous bill - Trying to get access to their portal or getting results for tests transferred in a realiable manner to another doctor’s office. I truly think that they would be mortified beyond words and wouldn’t believe their name is on the sign up front.
  • freeAgent 3y ago
    Trust me, they are all aware of this. The problem is that, for the majority of doctors now, they do not own or control their clinics. They are either: 1)employees of the health system or 2)partners or employees of a provider's group that essentially contracts with the system to provide doctors. The doctors themselves have no real control over how their clinics operate outside of contractual negotiations.
    • avgDev 3y ago
      The doctors are just cogs in a machine. The problem is that if your compensation is $200k-$1000k why would really want to tackle the issue. Specialists make so much money they can hire a personal assistants to handle all the annoying things. I know several pharmacists, one is highly intelligent and she is the only one who wants to get out of the field because healthcare in the US is toxic and profit driven.
      • freeAgent 3y ago
        Yeah, most of the time when patients send emails, they get responses from a nurse. At least at my wife's clinic, they do not always charge for emails. They only choose to charge when an email is asking something non-obvious or for the doctor to take some action that requires additional work/time outside of just reading and responding to an email.
    • anon-sre-srm 3y ago
• oefrha 3y ago
  > Dr. Lauren Oshman, a family physician and associate professor at the University of Michigan Medical School, says she initially experienced some patient resistance and anger about the prospect of being billed for emails. > Now, she says, patients are typically pleased that they are able to get a direct response from her through a portal message. > “They’re thrilled when they get me directly,” she says. Geez, this could make corporate PR people blush.
  • kergonath 3y ago
    > Geez, this could make corporate PR people blush. Yeah, it’s embarrassing. I am not “thrilled” to talk to a doctor directly. I pay for it, and when I do it’s because I have a reason to, which kind of limits the thrilling aspect. I expect it, and I need it, sure. But it’s not being able to talk to my doctor that elicits an emotional response, and it tends to be anger.
    • skzv 3y ago
      I'm thrilled to be able to message a doctor, even if I have to pay for it. In Canada I had no such option.
    • qudat 3y ago
      Hmm. I'm not sure if this is just a difference between private practice and hospitals, but there is a ton of questions that can and should be serviced by non-physicians (e.g. RNAs, nurse practitioners, physician assistants). Their role in patient care is consistently growing in importance. It's rare for me to send a message through a patient portal and have a physician answer it. It's always someone on the staff.
  • ellisv 3y ago
    It's ironic because I almost never want to message my doctor - there just simply isn't another option. In the Michigan Medicine system the 3 main message options are: refill a medication, ask a medical question, and ask a billing question. If you select "ask a medical question" the next and final choice is whether you're submitting a question in English or Spanish. Most often I want to ask a scheduler (because each office/department schedules differently) or a nurse a question, but for that you have to call. Something as simple as scheduling a flu or covid shot can't be done via messaging.
• annoyingnoob 3y ago
  You think that is bad. Try working with an attorney, they charge you to read your email and not respond at all.
  • mindslight 3y ago
    That's nicer than my experience! My attorney charged me to respond to my emails without reading them. And when the relationship inevitably ran aground at the 11th hour, he feigned ignorance of everything I had been telling him. I do my own low-pressure legal work now.
  • D13Fd 3y ago
    I honestly think we'd be better off if doctors and nurses charged for their time like the good lawyers and paralegals due. No fixed fees. No per-visit charges. Just bill for the time spent (including pre- and post-visit paperwork) and the direct expenses actually incurred. Everything else is built into the hourly rate. It will never happen, but it would be much better.
  • otterley 3y ago
    Did you ask for a refund of those billings? If they refuse, you should report them to the State Bar if they're doing that. It's unethical to charge for services not rendered.
    • annoyingnoob 3y ago
      https://www.avvo.com/legal-answers/can-a-attorney-charge-for-an-email-that-he-she-rea-4758940.html https://www.avvo.com/legal-answers/can-a-attorney-charge-for... https://lawstuffexplained.com/can-a-lawyer-charge-you-for-emails/ https://lawstuffexplained.com/can-a-lawyer-charge-you-for-em...
      • otterley 3y ago
        Speaking as an attorney myself, I'm not the least bit surprised that a bunch of my peers are claiming that they can charge to merely view emails. Many attorneys -- especially bad ones -- are particularly defensive of the practice. The problem is that without demonstrating somehow that they read it, they cannot prove they actually read that correspondence when they claim to have. This puts them in a difficult position because the client can plausibly claim that they did work they didn't actually do. Perhaps they don't need to send an explicit acknowledgment (even though it's the right thing to do), but if they don't even act like they received and read it, yet charge you for it, that's a real problem. FWIW I've had little trouble getting my attorneys to credit me for activities I didn't ask them to do. Somewhat different situation, but most good attorneys aren't scumbags.
• moal 3y ago
  Doctor-patient written communications (email, whatsapp whatever) can put doctors in legal risk whether they answer or not. Answering in a meaningful way also takes from the physician's time, much of it during their after-hours. The clinic where I practice requires making a telephone number and email available to patients. A lot of patients might use them sensibly but some patients just abuse this. If it were up to me, I would also put a cost on each form of communication as if it were a visit to the office!
  • resource_waste 3y ago
    [dead]
  • distances 3y ago
    > The clinic where I practice requires making a telephone number and email available to patients I wonder if contacting your doctor directly is a US thing? Before this discussion I had never heard of such an option. I definitely don't have any way of directly contacting any medical staff, neither a nurse nor a doctor, it will have to be through an appointment. This might finally explain why this "ask your doctor" is so often repeated online as a realistic option? You definitely won't ask your doctor about every minor thing if it's behind an appointment.
• throwaway2016a 3y ago
  I think the ridiculous thing here is not the doctor charging but that all insurance doesn't cover it. I bet there are a ton of consultants and lawyers (and maybe some accountants) on HN and most of them will charge you for time spent replying to emails. Edit: inserted the word "all" before insurance to clarify my intent.
  • gnicholas 3y ago
    from TFA: > Health plans covered the full cost of about 82% of claims, according to the Peterson-KFF analysis. Patients who shared the cost paid $25 on average. I would be very curious to know if my insurance is paying for the useless messages that my doctor's office sends. I sure hope not — they are next to worthless!
    • throwaway2016a 3y ago
      Regardless of if you feel they are worthless, IMO, the people who create them should not be asked to work for free. I've never found the notes from mine to be "worthless", you may want to find a new doctor. Also, your TFA is kind of unnecessarily vulgar (You do know what the F in TFA is for?) here seeing as it doesn't change the point of my original comment. I did, however, add the word "all" incase someone took my comment to read that I didn't think any insurance covered it.
      • gnicholas 3y ago
        > I've never found the notes from mine to be "worthless", you may want to find a new doctor. Thanks for the thought, but unfortunately our whole system (Stanford Health Care, FWIW) is like this. My doctor is better than my kids' doctor, and my wife's doctor. The incentives are just not there for them to engage, so mostly I get nurse messages that are useless. It appears to be a copy/paste from google (or some internal system), basically. As for "TFA", I do know what it means and see it used here regularly [1] and without meaning anything harsh. It's not like some people say "TA" and some people say "TFA". It's just TFA. Regardless, I didn't meant to offend you or make it seem like I was demeaning you. I was just pointing out that the article addressed your complaint, and indicated that the vast majority of insurance plans don't leave the cost up to the patient. I nonetheless appreciate your feedback and will consider "TFA" more carefully in the future. If you have any equally pithy alternatives, I would welcome them! 1: https://hn.algolia.com/?q=tfa https://hn.algolia.com/?q=tfa
• david422 3y ago
  There's a really interesting clip in the documentary "What The Health" where the interviewer attempts an interview with one of the doctors and gets rejected by the hospital PR person: Transcript: actually i understand that doctor said that you could film here today but 51:04 unfortunately that's not going to be able to happen i know that he advocates for patients changing their diets but the 51:10 hospital makes money off these surgeries and the reality is he does too so we can't do anything that's gonna 51:16 negatively impact the hospital so unfortunately you're not gonna be able to film here today https://youtu.be/obx7cJtk3fE?t=3064 https://youtu.be/obx7cJtk3fE?t=3064
• ericd 3y ago
  A 15 minute email from my lawyer costs about $150, I don’t see why we should be outraged about $25? It’s much harder and more expensive to become a doctor.
  • adolph 3y ago
    Lawyers did pricing better than doctors. Medicine hid costs through a payment plan lumped in with hazard insurance. Now that the game of hide the money has played out, people see real costs and they act shocked.
    • ericd 3y ago
      Yeah, I guess many people started to think of the copay as the true cost, since that’s what they paid most of the time?
    • gnicholas 3y ago
      Perhaps, but doctors get paid through opaque insurance. While that can be a hassle, it also introduces the huge benefit of OPM (Other People's Money). Convince your patients to come in for a 20 minute physical, for which they pay $25, and you get 20x as much from their insurance company. Lawyers don't have that play in their playbook!
  • onlyrealcuzzo 3y ago
    > A 15 minute email from my lawyer costs about $150 Unless your lawyer is an equity partner, he's not getting much of that $150. In the US, the median doctor makes almost 75% more than the median lawyer...
    • ericd 3y ago
      Yeah, they’re a partner. I can believe your stat for specialists, but not for the general practitioners you’re most likely to be emailing.
      • AbstractH24 3y ago
• D13Fd 3y ago
  Honestly, I wish I could pay my doctor $25 after insurance and get a prompt response from him to an e-mail. That would be incredible. As things stand, I have to call. He doesn't take e-mails. If I have a quick question, I can schedule a virtual appointment. There is usually a 2-3 month wait. The appointment is scheduled for a day, not a time, and is limited to 15 minutes. They'll let me know the time about 30 minutes in advance, and it could be any time of day. If I miss or can't make the video call, it's usually another 2-3 months before he has availability again. There are no other doctors with the relevant specialty nearby, so this is what I get.
• BenFranklin100 3y ago
  People talk a lot about prescription drugs, but the real driver of costs are the hospitals, both public and private. Drugs account for 10-15% of total healthcare spending; it’s the hospital reimbursement & compensation framework along with private insurance that is driving the bulk of costs. It’s evolved into a patchwork, opaque, dysfunctional system where the end consumer has little view into the inner workings and is left staring at a massive bill.
  • resource_waste 3y ago
    [dead]
  • Workaccount2 3y ago
    "Non-Profit" hospitals with incredibly bloated administrations paying a CEO $10MM a year to order constant hospital expansions and ever growing outpatient care so they can reliably spend off any possible profits.
  • Buttons840 3y ago
    Last I checked about 15 to 20 percent of all US workers were in the health industry. It's basically a patriotic duty to pay your medical bill, because you have to pay all the insurance industry workers, and all the hospital administrators and CEOs, and all these people, and there might even be a few bucks left over for the doctor in the end. I don't see how healthcare can ever cost less until we simplify these systems and eliminate a lot of jobs (which wont be politically popular).
  • otterley 3y ago
    > Drugs account for 10-15% of total healthcare spending And still, drugs are too expensive in the USA, especially old drugs like insulin and albuterol (asthma inhalant) that seem to find new ways of being re-patented (e.g., through new delivery devices that are just novel enough to be granted a patent, but provide no significant improvement to the patient). If drugs, pricey as they are in the USA, are only 10-15% of healthcare spending, that should frighten you as to how cost-inefficient our health care system is.
• ilrwbwrkhv 3y ago
  Most doctors are pretty dumb and can be replaced with a LLM soon. Waiting for that to happen.
• thaddeusmt 3y ago
  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.
  • ultra_nick 3y ago
    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 3y ago
      I mean you are making money, just spending it all.
  • codemac 3y ago
    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 3y ago
      I read your post. You owe me $3.99
  • matsemann 3y ago
    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.
• antisthenes 3y ago
  American health care is basically about 550,000 parasites in the US economy ensuring their own stream of income by denying people health care and price gouging those who can afford it. The culmination of the American middle-man capitalism.
• notyourwork 3y ago
  [flagged]
  • deleted 3y ago
    [deleted]
• balderdash 3y ago
  $39 a each message seems expensive - but I don't think $39 per thread/conversation is unreasonable with the actual doctor (would not pay not that for staff). I’m making up numbers but if a private practice physician earns $250k/year for 2000 hours that’s $125/hr + taxes and benefits + rent/overhead + nursing and staff, you figure that cost is probably closer to $300/hr then you you assume they have to do ~30min of prep/admin for every patient hour that’s closer to $450/hr that’s ~$37.5 per 5 min of patient time (and none of that is factoring in reimbursement rates), people can disagree as to how those costs should be borne but let’s not kid ourselves as to what the cost of doctors time is…
• chriskanan 3y ago
  This could potentially increase the number of useful questions being asked. My spouse is a physician. Recently she had to answer a phone call from a patient in the middle of the night where they were asking a question from a party about something non-urgent for their child. In another case, she got called by a parent at 2am because their kid was having trouble sleeping but nothing else was wrong with them (welcome to parenthood). If people had to pay, maybe they would _think_ before asking questions. I've been in meetings with healthcare providers about incorporating LLMs into text-based patient-physician messaging to improve triage and routing. It is just overwhelming for many providers. A large percentage are getting burnt out, and much of their time is uncompensated.
  • Scoundreller 3y ago
    Did those patients press “4” for “urgent problems to be responded to immediately” or something? > If people had to pay, maybe they would _think_ before asking questions. Be careful, a lot more people might be calling at 4am because they figure it’s okay because they’re paying for it. At least other contractors can give people a “fuck off” quote for work they don’t want to take, but might be difficult to implement that here.
  • linehedonist 3y ago
    Pretty dismissive of your wife’s patients. To your “welcome to parenthood” I might reply “welcome to being a pediatrician.”
• resoluteteeth 3y ago
  I have mixed feelings about this. On the one hand I don't want doctors to charge for an email consultation every time I need a prescription refilled. On the other hand, maybe insurance companies should encourage doctors to do this by paying them (and not charge a copay) because it will reduce the need for office visits which will probably be cheaper for them overall?
  • ejb999 3y ago
    one of the problems is, how can a doctor in good conscience continue to renew your prescriptions, if they don't see you and re-evaluate the need? Maybe they put you on 5MG on amlodipine for your moderately-high blood pressure 18 months ago, but since then you have put on an extra 75lbs and now you have critically high blood pressure - lots of liability if they just keep re-prescribing a low-dose that doesn't match your current conditions. Everyone wants the easy path to getting the pills they think they need - then there is a bad outcome and some greedy lawyer and client come along and want $10Million in damages for the poor care they got.
    • gnicholas 3y ago
      I have used the same allergy and asthma meds for years/decades. I haven't changed any other medications. This used to be no problem — I could renew for 2 years easy. For some reason they started making me come in more often a few years back. Pretty annoying! I get that blood pressure meds or other dynamic issues require different kinds of care.
• astraelraen 3y ago
  I am a CPA with 20+ years of experience. I laugh at the lawyer/accountant/medical analogies, not because they aren't true, mostly for people who insinuate medical professionals should work for free or are obligated to work for free because medical is sacred? I have no problem telling clients these days, if you don't want to pay me for my knowledge/skill/experience, I will go home and spend time with my family or doing something I enjoy. My time is not yours unless we both agree you will pay for it or I give it to you for free out of my own choice. You do not own my time and you do not own your medical professional's time either. PS: To the person who said you can willingly go to the open market and find professional "X" somewhere in this thread. Good luck. CPAs, lawyers, any professional with experience is in such high demand its hilarious. We name our price and chose the clients we want to work with these days. I know people in my industry from a variety of locations across the US, same problem everywhere. If you don't want to pay for experience from any professional industry, go ask ChatGPT or spend half your day watching Tiktok or Youtube videos, good luck. Not saying it to be pompous, it's reality and has been for ~5 years.
  • deleted 3y ago
    [deleted]
  • EVa5I7bHFq9mnYK 3y ago
    >> go ask ChatGPT careful what you wish for.
• xirdstl 3y ago
  If you're in the US, and can afford it, I think direct primary care is the way to go.
• Simulacra 3y ago
  I guess I'm really lucky, my doctor sends me emails and responds to emails, as does his nurses. During Covid my doctor gave me his cell phone number to text him if things got worse. If your doctor charges money for emails, find another doctor or pay the fee. There's plenty of doctors.
• ineedaj0b 3y ago
  The hospitals are poorly run. Please hate your hospitals management more. Or if you are a good manager, convince some friends to run a hospital. Imagine 10 appointments a day, 30 mins each. You have to write /everything/ down the patient tells you. You often have to go over the 30mins because some patients need it. You need to follow up to order extra tests, you need to occasionally google something. You skip lunch often. You need to find time to reply to messages from previous patients. Nurses will mess up something or a patient will show up late. Want to see patients past 5? The nurses have left and you can't legally 'bill' or code the appointment without the nurses. day is over and you review tomorrow's patients. You read through their histories. Now you check the messages. There's between 5-45 a day. You see a lot of patients. Then you're told that your department isn't bringing in enough money. They want you to see 11 patients a day. The reason? They didn't bill people correctly. For the past year. A lot of doctors quit.
  • pseudocomposer 3y ago
    It seems like we just need more doctors, no? The AMA is notorious for trying to limit the number of new doctors. They do that more than much of anything to do with public health.
    • lotsofpulp 3y ago
      Supposedly, AMA reversed course in 2019: https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun... https://www.openhealthpolicy.com/p/medical-residency-slots-congress https://www.openhealthpolicy.com/p/medical-residency-slots-c... But don't know how much is talk versus walk. It is not clear to me why only the US Federal Congress can fund residencies. Surely, with how much doctors can earn, a private underwriter would be willing to finance a residency. https://www.washingtonian.com/2020/04/13/were-short-on-healthcare-workers-why-doesnt-the-u-s-just-make-more-doctors/ https://www.washingtonian.com/2020/04/13/were-short-on-healt...
      • nradov 3y ago
• prirun 3y ago
  Another thing happening is that phone calls to book appointments are sometimes being charged as televisits. I had service lines on one of my insurance EOBs with names of people I didn't recognize and the billing description was "phone support", or something like that. Around here, doctors have been mostly forced to work for hospitals now, because IMO doctor practices can't afford malpractice insurance, clerical staff to deal with all the insurance paperwork, computer systems, and computer software licenses. There are also huge groups of specialty doctors working together to avoid having to work for hospitals. Here it's urology, dermatology, and gastroenterology. In my experience these doctor group operations are run even worse than the hospitals: they have a monopoly on their specialty and know it.
• neilv 3y ago
  > “It just feels a little intimidating when you open the portal and the first thing it says is ‘be aware, we’re going to bill,’” she says. “We have to send these messages and we shouldn’t have to think to ourselves, ‘Should I send this?’” If the provider doesn't bill, problems from the patient's perspective: 1. Some patients are reluctant to message when they should, because they don't want to impose when they know the provider isn't set up to charge. Same "Should I send this?" problem. 2. Providers end up needing zealous triage/gatekeeping/diverting on messages, so more messages might end up handled with more generic responses. 3. Providers might have incentive to shift messages to billable nurse calls, just for fiscal sustainability, turning a message into phone tag and/or long hold times. Personally, I'd prefer to pay for good message responses. (Initially I assumed I was, but the charges didn't seem to show up on the EOBs/bills.) Much like with a lawyer, but maybe priced lower than the effective rate for minutes with patient in an in-person appointment (since messages do have more async flexibility, and lower office overhead).
  • meragrin_ 3y ago
    > 1. Some patients are reluctant to message when they should, because they don't want to impose when they know the provider isn't set up to charge. Huh? While I won't challenge these people actually exists, I cannot imagine they are statistically significant. I have never heard of anyone being worried about being charged too little by a health provider.
    • neilv 3y ago
      I don't know. But, just above this in my comment history, someone claimed they'd never seen an English language contraction of "who are". So maybe we're all siloed. Fortunately, fortifying our organizations/circles with a diversity of perspectives can help compensate for our individual blind spots.
    • AbstractH24 3y ago
      I don’t worry about them being charged, but I do about how questions add to an increasingly unsustainable workload and increase the odds of burnout.
• e_i_pi_2 3y ago
  My partner has had issues that could be fixed with a few messages and the doctor just refused to respond and said they have to wait until the next appointment. It begins to feel like malpractice when they're refusing to fix simple issues because of billing limitations. I think the core issue here is that we're trying to make healthcare profitable when it probably shouldn't be. Stuff like healthcare, housing, and education _should_ be losing money because it's an investment in the population. If you have a hospital that's making money that seems like a bad sign
  • ToucanLoucan 3y ago
    The fact that so many messages in this thread are variations on "well this should be covered by insurance" to other stuff like "I understand they need to charge" makes me think we will never see a proper system of any kind in this country because everyone is just too heavily propagandized into thinking healthcare just must be expensive and that any attempt to have the Government in any way pay for it will quite literally destroy the United States, which is of course failing to take into account that insured Amercans spend vast, vast amounts more than anyone else on the planet while receiving... middle-to-low quality care. And that's just what the people spend, the insurance companies when they can be arsed to actually pay what they've agreed to are also paying through the nose for every last service and minute of a doctor's time. The only people actually winning in our health insurance system are the shareholders and the executives. Everyone else is being left worse off than they'd otherwise be. TL;DR: The arguments against socialized healthcare make sense if you believe healthcare actually costs what American providers charge. It doesn't. They just know you have to, you know, not die and that they can charge whatever they want for that service. That's why it's fundamentally unethical for medicine to be a for-profit industry.
    • dumbfounder 3y ago
      Nobody cares about healthcare right now. We got wars and old guys yelling at each other and China all up in our apps and that border stuff going on. Healthcare is so early 2020s.
• atum47 3y ago
  I believe in the near future we gonna have LLMs answering common questions related to medical care. Not gonna get in the merit of saying if it is ok or not, but I believe some already have the capability of answering screening questions and even exams results.
• diebeforei485 3y ago
  I think this is fine as long as it's clear upfront that this is a paid service and the reply actually addresses my concern.
• 1vuio0pswjnm7 3y ago
  Alternative; works where archive.is is blocked: https://www.msn.com/en-us/money/insurance/the-medical-bill-you-never-expected-doctors-now-charge-for-emails/ar-BB1jwATu https://www.msn.com/en-us/money/insurance/the-medical-bill-y... Text-only, no Javascript: tnftp -o'|grep -Eo "\"body\":\".+\"readTimeMin\""' \ https://assets.msn.com/content/view/v2/Detail/en-in/BB1jwATu |(echo "<meta charset=utf-8>";sed 's/\"body\":\"//;s/\\//g; s/\",\"readTimeMin\"//') > 1.htm firefox ./1.htm links 1.htm
• lulznews 3y ago
  That’s ok we have LLMs + ordering direct from China for that now
• fragmede 3y ago
  Ah, yes, the only fans model.
• AbstractH24 3y ago
  As someone with a device implanted in my brain that records my brainwaves and shares them with my doctor, but not me (Neuropace) I have mixed feelings. On the one hand, it’s frustrating to me that I can’t see my own data without first reaching out to my doctor. On the other, it terrifies me that he’ll respond to any question I send him within minutes, because his workload is clearly unsustainable and I’m deeply concerned about burnout. Would a charging me make me message him less? No, but my guilt and concern greatly restricts this and I can’t imagine that’s true of everyone.
• EVa5I7bHFq9mnYK 3y ago
  Email and other forms of telemedicine should be highly encouraged, with the caveat that overseas doctors got to participate. That should bring the prices down big time.