Portal Billing

When you have a medical question, sending your doctor a message through the portal is a very convenient way to receive your care. Regardless of time of day or your location, you can still securely reach out with a portal message to speak freely and start a conversation.

In recent years, non “face-to-face” options have assumed a larger share of our lives in many domains, not just medicine. Since COVID, the number of messages providers have been answering has more than doubled.

We all agree that staying connected in a timely manner is helpful, and we are committed to responding to your needs within three business days. Most of these messages are free. However, going forward any responses that significantly require your provider’s clinical time and expertise to fully answer may be billed to your insurance. Based on the policy of the insurance company you chose; a co-pay may be sent to you.

Why are charges occurring for previously “free” services?

The Centers for Medicare and Medicaid Services (CMS) has placed a high priority on value-based virtual care and DE-emphasized in-person visits. Despite high rates of inflation, they have cut actual reimbursements year over year for in-person care and “shifted” reimbursement to virtual care, which includes portal use and phone messages. They expect that to financially survive, primary care doctors will be forced to offer and begin the complex and cumbersome process of billing for digital or virtual care.

As traditional commercial insurance for average working Americans have tied their reimbursements to copycat what Medicare allows, this means health insurance companies are lowering actual payments (let alone adjusting for inflation). These actions financially force our hands to bill for virtual care (portal messages and phones calls) or risk going out of business. By adapting to the government and insurance directed policies, we aim to survive these requirements and continue to provide the highest level of care you have come to expect from Treasure Valley Family Medicine.

What to expect if your message is billed to insurance

The highest amount that you could be responsible for paying is purely based on the policies of your insurance carrier; doctors are required to document our time spent on your behalf, and insurance companies decide what the “allowed” payment will be. For example, if your message is billed to your insurance, you may not be charged at all or you may see an out-of-pocket cost determined by your carrier. 
 
Bottom line: the dollar amount a provider bills to insurance is based on the amount of time spent reviewing the medical record, researching any relevant information, completing any forms, and providing advice. Providers will only bill for messages that require 5 minutes or more of clinical expertise and training.

If you are curious regarding your individual situation, reach out to your insurance payer to learn the specific out-of-pocket costs for your specific plan. For phone visits, the relevant CPT codes are 99441- 99443 and for digital/portal message service, the CPT codes are 99421-99423 for commercial insurance and G2061-G2063 for Medicare.

What types of messages can be billed to my insurance?

Messages that will be billed require a licensed clinicians’ medical expertise (physician or physician associate) and take longer to answer —five or more minutes.

Examples of messages that could be billed include:

• Medication changes
• New symptoms or concerns
• Changes to long-term or established conditions
• Surveillance/evaluation of long-term conditions that may require therapy adjustments based on current status
• Requests to complete medical forms

What messages will be free?

It’s important to know that not every message you send to your provider will be billed to your insurance. An easy question to ask yourself is does this message require time and expertise to complete.

We typically will not bill for messages about:

• Scheduling an appointment
• Sending a prescription refill request when no changes are required
• Asking questions that lead to an urgent appointment being booked
• Clarifying questions about issues discussed at an in-person visit occurring in the previous 7 days
• Giving a quick “FYI” update such as “feel much better after receiving my last treatment”

Other than portal messaging, what other non “face-to-face” care does insurance cover?

Telehealth has made connecting with your doctors easy and convenient. You don’t need to drive in for a doctor’s appointment to chat on the portal. As this option for care gains awareness and popularity, you may ask what else is insurance allowing?  Most all insurance plans now cover:

• Audio-visual visits, like Zoom, FaceTime, or Face Chat
• Phone call conversation (audio only) > 5 minutes

Please remember, most of the messages you send over the portal are quickly handled and will not be billed to your insurance, but messages that take significant time and expertise to complete are considered telehealth; these services will go to your insurance plan for payment, per the reimbursement policies dictated by your insurance company.