Medical Advice Through MyChart Messages

How Messaging Works and What It Costs

Messaging your doctor can be a convenient way to get medical advice. You can send a note through MyChart whenever you have time — day or night — and your provider will typically reply in one to three business days. Depending on your needs and schedule, this can be a convenient alternative to an in-person, video or telephone visit.

Cost of Medical Advice Through MyChart Messages

Most messages are free. But starting Sept. 26, 2022, if a response requires medical expertise and more than a few minutes of your health care provider’s time, it may be billed to your insurance.

Your provider will determine whether a message exchange should be billed to insurance. If so,
Houston Methodist will handle the billing on your behalf. (See the “What Counts” sections below for example of what might be billed and what won’t.)

Even if a message is billed to insurance, many patients won’t have to pay for anything. For those who do, out-of-pocket expenses for this type of care vary by insurance plan and are generally low. Here’s what to expect:

• Medicare and Medicaid: For most patients, there’s no out-of-pocket cost. For a small number of patients, the cost could be $3 to $6. 
• Private Insurance: Some patients will have copayments similar to those for in-person or video visits (common copays are $10 and $20). If a deductible applies, the charge is likely to be less than the cost of an in-person or video visit (an average amount is $65.)

To find out your out-of-pocket cost for a medical advice message, contact your health insurance company. If the representative asks for a “CPT code” to help identify this type of visit, the relevant codes are 99421, 99422 and 99423 (these three codes reflect the amount of time your provider may spend handling a particular message). 

What Counts As Medical Advice Messaging

If your doctor, nurse practitioner, physician assistant, optometrist or certified nurse midwife needs to make a clinical assessment or medical decision, order a test or medication, or review your medical history in order to respond to your message — or it takes more than a few minutes to respond — the provider may bill the message exchange to your insurance.

Examples of messages that may be billed to insurance:

• A new issue or symptom requiring medical assessment or referral
• Adjusting medications
• Chronic disease check-in
• Flare-up or change in chronic condition
• Request to complete a form

What Doesn’t Count As Medical Advice Messaging

If your message does not require clinical evaluation or medical advice from a doctor, nurse practitioner, physician assistant, optometrist or certified nurse midwife — or if it can be answered quickly and easily — it won’t cost you anything.

Examples of messages that won’t be billed to insurance:

• Request for prescription refill
• Request to schedule an appointment
• Message that leads your provider to recommend a visit
• Follow-up care related to a recent surgery (within the past 90 days) — with exceptions for some surgeries
• Update for your doctor where no response is required
• Message that takes only a few minutes to answer

Why Are Some MyChart Messages Billed to Insurance?

Messaging health care providers has become a popular way to seek medical advice, especially with the COVID-19 pandemic spurring demand for virtual health care options. Fortunately, insurance companies recognize that virtual care is a valid and important way for patients to get medical advice. They now cover all of the following:

• In-person visits
• Video visits
• Telephone visits
• Medical advice messaging (through MyChart)
  
  

While the majority of messages sent through MyChart are handled quickly and never billed to insurance, those that require time and expertise are a form of virtual care — and it makes sense to treat them as such, alongside other types of care.

We are pleased to offer you all of these options for getting medical care from Houston Methodist, and we will continue to do everything we can to provide our patients with convenient, high quality care.