Over one-quarter of patients receive bills for physician portal responses
April 23, 2025
Summary: Between 25-30% of adults over age 50 on private insurance report that they were charged for this service.
Patient portal use and billing
Source: Liu, et al JAMA Health Forum April 4, 2025. Dual-eligible are those eligible for both Medicare and Medicaid. TM is traditional Medicare, and VA is Veterans Administration.
I love the portal that is available to me through the multispecialty practice where I receive my medical care. I can view the results of laboratory tests before my primary care physician, my entire vaccination record, and all notes written about me by any clinician. I can also send any of my doctors a non-urgent note and receive an answer in two or three days, saving me time on the phone and unnecessary office visits.
As a patient I appreciate this ability to communicate with my physician, but many physicians say that these notes from patients are contributing to “pajama time” (finishing patient work late at night) and burnout. These notes could also diminish practice revenue if they prevent many low-acuity office visits.
Some large medical organizations, including Cleveland Clinic and Mayo Clinic, announced that they would bill for portal visits. The Centers for Medicare and Medicaid Services allows billing for portal visits if they are initiated by the patient, take five or more minutes of clinician time, and are not within seven days of an in-person or telemedicine visit. The Annals of Internal Medicine published a small qualitative study last year that showed that both physicians and patients were confused about when a bill could or would be generated, and patients reported that they would return to phone calls if they received bills for portal messages.
Researchers in JAMA Health Forum this month surveyed 3,212 adults over age 50 and found that over three-quarters (76%) said they had access to a patient portal. Among the respondents who had private insurance, 59% had used a provider portal the previous year, and 29% of those who used a portal reported that they received a bill for these services. Respondents with commercial insurance (first bar in graphic above) were less likely than other groups to use portals, but more likely to receive bills. Veterans Administration patients were most likely to use a patient portal and least likely to receive a bill.
Implications for employers:
Members may receive bills for portal messages answered by their physicians or other clinicians.
Carriers will have negotiated rates for these services, and members should pay after any appropriate discounts are applied.
Members with high-deductible plans who have not yet reached their deductible will owe the entirety of the cost of the portal message.
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Tomorrow: Measles continues to spread, and two deaths reported from whooping cough