> “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 thes

> “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).