During the pandemic, the frequency and volume of electronic messages patients sent to physicians increased dramatically, which contributed to physician burnout. As a result, CMS expanded billing options for healthcare providers, including allowing physicians to charge patients for “e-visits” or asynchronous patient portal messages. San Francisco-based UCSF Health was among the first to charge patients for online portal messages to clinicians. Now, more than 20 health systems have adopted similar measures with various levels of fees. For example, at the University of Washington Medicine healthcare system, e-visits may cost as little as $7 for Medicaid beneficiaries. Messages subject to fees also vary by institution but generally include messages requiring updated or new medical advice or assessment. Most recently, on December 12, Minneapolis-based Allina Health announced they would start charging patients $49 for certain messages.