Medical Advice Through MyChart Messages: How It 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 typically you will receive a reply in one to three business days. Depending on your needs and schedule, this can be a great alternative to an in-person or telehealth visit.

Please note: MyChart is to be used to communicate with your healthcare team for non-urgent medical advice. You will generally receive an answer within 1-3 business days. Please note that MyChart should not be used for urgent matters. Please call your provider's office if a situation requires immediate attention or dial 911 if it is an emergency.

Cost of medical advice through MyChart messages

While many clinic messages are complimentary, there are times when the work requires medical decision making and thoughtful considerations. If it is determined that a response requires medical expertise and more than a few minutes of a health care provider's time, you may be billed.

If it is determined that a message exchange should be billed to insurance, Sansum Clinic will handle the billing on your behalf.

What counts as medical advice messaging

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

Here are some examples of messages that qualify as medical advice messaging, and may be billed:

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 be billed.

Here are some examples of messages that won't be billed to insurance:

Request for a 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 when no response is needed
Message that takes only a few minutes to answer
Even if a message is billed to insurance, many patients won't have to pay 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:

Insurance plan	Cost of a Medical Advice Message
Government Insurance (Medicare or Medi-Cal)	For most patients, there should be no out-of-pocket cost. For a small number of patients, the cost could be $3 to $6.
Insurance (not Government)	Some patients may have copayments like those for in-person or video visits (common copays are $10 to $30). If a deductible applies, the charge is likely to be less than the cost of an in-person or video visit. The average cost for a medical advice message encounter would be around $65.*
Self-Pay	For individuals who do not have insurance, the charge is going to be less than the cost of an in-person or video visit. The average cost for a medical advice message encounter would be around $65.*

To learn more regarding your specific out-of-pocket cost for a medical advice message, please contact your insurer. If the representative asks for a "CPT code" to help them identify this type of visit, tell them the relevant codes are 99421, 99422 and 99423 (these three codes reflect varying amounts of time your provider may spend handling a particular message). Note: Medi-Cal uses its own code: G2012.

Why are some MyChart messages billed to insurance?

Messaging your health care provider has become a popular and efficient way to seek medical advice, especially with the pandemic spurring demand for virtual health care options. Thankfully, insurance companies recognize that virtual care is a valid and important way for patients to receive the care and medical advice they need.

They now cover all the following:

In-person visits
Telehealth visits
Medical advice messaging (through MyChart)

At Sansum Clinic, we value and offer all of these modalities of care (In-person, Telehealth and MyChart Advice Messages), and we'll continue to do everything we can to provide you with the timely and excellent care you deserve.

How to get an estimate of what my specific charges might be

If you have a MyChart account, we have set up our estimate tool to help provide you with an individualized estimate based on your situation (insurance, self-pay, etc.).

From the MyChart homepage, select the “Menu” button and scroll down to the Billing option on the menu. Select the “Create New Estimate” feature and choose the category of “Electronic visit (E-Visits).” You can then review estimates for individual charges.

How to message your Sansum Clinic care provider

When selecting a recipient, you'll see a list of providers available for you to message (the providers for whom you're currently a patient).

If you don't have a MyChart account, go to the MyChart page and look under "Create an account." You'll see the option to sign up with or without an activation code.