The Cleveland Clinic announced that its previously free patient-provider messaging system, which is offered via the widely used MyChart patient portal will now cost up to $50 for certain messages. The policy change has left many wondering whether the practice will become commonplace and fearing what other charges might surface in the future.

In a notice released to its patients in November, the Cleveland Clinic stated that it will start billing for responses that require a “provider’s clinical time and expertise” and “typically take five or more minutes for your provider to answer.” The hospital said quicker messaging—such as refilling prescriptions, scheduling an appointment or checking in as part of follow-up care—will remain free.

Cleveland residents expressed differing views on the new policy. While some acknowledged that such messaging can be a burden for clinicians, others worry that the policy could lead to the charging of additional fees and prompt other health systems to adopt similar policies.

Ohio State University Wexner Medical Center told Fierce Healthcare that it already charges between $50 and $160 for some messages. Other health systems in Ohio, including University Hospitals and ProMedica, said they are considering charging for messaging.

“We don’t believe charging for electronic messaging will deter patients seeking care,” ProMedica told Fierce Healthcare. “The fees would likely still be lower than a standard office visit with a provider.”

Founder and chairman of price transparency nonprofit Cynthia Fisher called these policies “the latest attempt by hospitals to put profits over patients and pad their historic revenues that often feed Wall Street–style private equity arms.”

Fisher called upon providers to treat patients as “valued customers who can take their business elsewhere” and to be transparent about pricing. “Ultimately, electronic messages should be treated the same as customer service in any other part of the economy, as a companion courtesy covered by the original bill,” she said.

Experts warn that the rise of digital tools within the health system may negatively impact low-income patients, who might not be able to afford the fees or have the means of accessing electronic messaging options.