NorthShore University HealthSystem’s Evanston Hospital at Ridge Avenue and Central Street. Credit: Evan Girard

NorthShore University HealthSystem has adopted a new policy charging for some online medical advice. The move may have been inevitable, many patients concede, but not everyone is on board.

Last month, NorthShore – which consists of Evanston, Skokie, Highland Park and Glenbrook hospitals as well as hospitals in Chicago, Arlington Heights, Naperville and Elmhurst – announced a change in policy regarding its electronic portal, NorthShore Connect.

An email dated Nov. 2 sent to all NorthShore patients with the heading, “Changes to NorthShore Connect medical advice messages,” read: “Beginning Nov. 8, 2022, if a response to your message requires medical advice – when a provider provides their medical expertise and more than a few minutes of their time – we may request that you either schedule a visit with us or we will bill your insurance for providing that medical advice.”

The email gave several examples of medical advice messages “that may result in a charge,” including a new issue or symptom, adjusting or prescribing a new medication, a flare-up or change in an ongoing condition or extensive time reviewing a patient’s medical history.

Fees would be billed through the patient’s insurance, the email said, and patients would have several options, including scheduling an in-person or video visit. Patients could also decline their consent to be charged, if they so chose, though it wasn’t clear how they’d get medical advice in that case.

The NorthShore Connect patient portal began charging for select medical advice messages on Nov. 8. Credit: NorthShore

In response to RoundTable questions, NorthShore spokesperson Colette Urban said fewer than 1% “of the 47,000 messages our clinicians answer each week have been billed” since the new policy went into effect Nov. 8. “Most of our patients will be unaffected,” she added.

For those who are affected, fees for Medicare patients range from $3 to $10 while self-pay patients are charged $35. 

NorthShore is not the first local health care system to charge for use of its online portal. Northwestern Memorial Hospital put a similar policy in place in 2019, said spokesperson Chris King. Lurie Children’s Hospital has also been charging for certain online queries.

A NorthShore physician, who asked that his name not be used, said the number of portal questions is “mind blowing. … People don’t realize how much time some of them can take.” 

‘Lawyers always have the meter running’

Reaction to the NorthShore policy change has been mixed.

“I feel absolutely fine about it, it makes perfect sense to me,” said Evanston resident Ruth Rozen. “I realize that determining the complexity of a medical issue can be subjective, but it surely isn’t right to get free time with and advice from a doctor when others are waiting in line at the clinic or properly scheduling a visit, in-person or online.”

Agreed Evanston resident Siobhan Drummond, “It costs money to create [the online portals] and to maintain and operate them. That’s just a fact.”

Also supporting the change was Fred Fitzgerald, of Wilmette. “I take no issue with their new policy, so long as they don’t attempt to abuse it,” he said. “A simple inquiry that takes only moments to respond to should not be billable. However, online inquires requiring a physician’s time equivalent to responding to their time devoted to a brief physician video or teleconference or an in-office visit should be billable.”

“I agree with the policy if the doctor involved spends more than a few minutes responding,” said John DuBois, of Highland Park. “I imagine some patients email their doctors very frequently. I can see where meaningfully responding to these patients could be time consuming. Lawyers always have the meter running – I guess doctors could be the same.”

But longtime health care consultant and Highland Park resident Michael Millenson was critical of NorthShore’s new policy. I thought it was a slap in the face, to be honest,” he said. “They certainly didn’t explain the policy very well, even if they were justified in making the change.”

Millenson added that he understood that doctors “are overwhelmed with portal questions,” but said he felt the issue was whether it was possible to “organize the doctors’ time better to give them more time to answer questions.”

And Reba Meshulam, of Glenview, said simply, “I was not aware of it. I am not happy about it.”

Another possible issue is the lack of definitive guidelines for charging. “The decision to bill or not is always the decision of the provider providing the care,” Colette said. That means some providers may charge to answer a question while other providers, faced with the same question, may not.

Les Jacobson

Les is a longtime Evanstonian and RoundTable writer and editor. He won a Chicago Newspaper Guild best feature story award in 1975 for a story on elderly suicide and most recently four consecutive Northern...

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  1. This policy discourages patients from messaging their care team. I have a family member with chronic degenerative issues and a complex medical profile and I spend hours a week trying to get appointments with specialists — can I bill NorthShore for my time? The appointment setting mechanism at NorthShore is worthy of a surrealistic drama.
    When I finally get someone who is not an answering service, I am told to go to the ER. Then insurance questions the medical necessity of an ER visit. The system has broken, and it is a nightmare for vulnerable sick people.

  2. NorthShore is going downhill fast. Doctors are leaving in droves. MBA-powered management seem to believe that having a good PR campaign is equal to good medical care. The doctors are treated as the sales team and are encouraged to make more money for the hospital. If they don’t, their pay is docked. This isn’t good medicine. This is an example of what happens when a hospital is run by business people, and not by medical people. Doctors and nurses don’t go into medicine to become a sales force. Seems that upper management can’t quite grasp that. Good care is plummeting, good doctors, nurses and staff are leaving. Hospital systems that are run by people who know medicine are doing much better. A road-trip to Mayo might be a better option. Who knows when NorthShore will stop building more buildings, and start putting their money back into good medicine. Until then, you may find them nickel-and-diming you for everything, and your favorite doctor may be gone.

  3. NorthShore in-person visits are expected to be 15 minutes. The administration expects many of their providers to see 4-5 patients per hour. Fifteen minutes is not health care, it’s assembly line/bottom-line care.

  4. It makes sense on a corporate level — the MBA’s have spoken… Since I got no response from my caregiver’s team for more than 10 days after I simply let them know I had tested positive for Covid, it has CERTAINLY increased the distance I feel between myself and the physician — a far cry from the original NorthCare days.

  5. I happen to be a power user of North Shore and its patient portal, and I did not get any email from them Nov. 2nd or any other day with the subject-line “Changes to NorthShore Connect medical advice messages’. Just sayin”

    1. I agree with Nancy that I didn’t receive anything from NorthShore informing me of their decision to start charging their patients for NorthShore connect service for medical advice. The plan to charge us needs to be clearly stated for what and how long it took staff to prepare their response and be fair with the cost. How will we determine the charge is fair…

  6. As a client of what is now North Shore University Health System for over 50 years, it’s clear to me that the system is understaffed. I feel for the medical and other staff who are stretched very thin. Triage methods are called for and immediate care can fill some gaps, but it’s sad not to be able to call in and talk to a nurse or a doctor and ask an easy question. You cannot call immediate care for any question, even after you have seen someone, and messaging takes days. Resources that used to be local now require a lot of travel, difficult for many clients. I have loved my doctors but two have left and the replacement I found left before I even saw her. I like telehealth, but their suggestion that people stop messaging and try tele-health with their doctor is ridiculous unless you can wait months for the appointment. Regular appointments are 6 or more months out. Many doctors have left and there are unfilled positions. Overextension and understaffing is part of the problem.