Many providers in the Medem Network offer Online Consultation™, a secure online fee-based clinical consultation service that saves patients time and money. Online Consultation™ is used for non-urgent medical advice that does not require a physical examination.

Online Consultation™ can be used to:

• Get advice on changes in a particular medical diagnosis
• Gather information on treatment options
• Explain and interpret test results
• And more

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2. How do I start using Online Consultation?

Find your doctor online. Call Medem at 1-877-926-3336 and ask if your doctor has a Medem Web site or go to www.medem.com and click Find a Physician. You can search and see if your physician is on the Medem Network already.

If your doctor is not already offering OC:

• Click here to provide the names of your family's doctors. Your doctors will be contacted and can join the Medem Network easily. We'll help them get set up.

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3. What types of messages can I send using Secure Messaging?

There are two basic types of messages you can send with Secure Messaging:

• Administrative questions (appointment requests, prescription renewals and general questions)
• Online Consultation is for specific clinical issues related to your health care.

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4. What are some of the uses of Online Consultation?

The Online Consultation service should be used for non-urgent clinical but questions you have for your physician that don't require a face-to-face visit or a physical exam. Questions about medication, treatment or diagnostic alternatives can, at times, be better addressed through an Online Consultation where a physician has many patient education and reference materials at his/her fingertips and patients read and review the written answers to their questions. For example:

• My child has had recurring ear infections. Are "tubes" for his ears an option and, if so, what are the benefits and the risks?
• Given my family history of breast cancer, should I be on hormone replacement therapy? What are the reasons for and against?
• I just turned 50 and wanted to know if I should get a colonoscopy. What are the pros and cons and what are the alternatives? Does "dark-lumen colonography" work?

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5. What's wrong with conventional e-mail for communicating with my physician?

Standard e-mail does not live up to state and federal laws for patient privacy nor does it conform to medical liability carrier guidelines. It is not encrypted nor password protected and often uses employer-sponsored e-mail networks thereby making the messages the property of the employer. You would not trade stocks, pay bills or even buy a book online using standard e-mail. Your communications with your physician are too important and private to risk on standard e-mail. You will, however, receive notifications in your regular e-mail account when you have received a secure message from your doctor or his/her office. The message will contain a link that allows you to directly access your secure message from your physician so you will not have to check more than one e-mail account to find all of your messages.

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6. Is there anything that I should avoid using an Online Consultation for?

Medem's Secure Messaging services, including Online Consultation, should not be used for emergency, urgent, high-sensitive or high-risk health care issues. Subjects of concern may include treatment for, or information regarding, acquired immune deficiency syndrome (AIDS), mental health issues, substance abuse, etc. Specific topics to avoid should be worked out directly with your physician.

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7. What is the difference between an Online Consultation and messages that I can send using Medem's Secure Messaging service, and how do I use each?

Secure Messaging is intended for questions of an administrative nature (appointment requests, prescription renewals and general questions), which the physician's staff may handle. Online Consultation™ is for posing non-urgent clinical questions/concerns to the physician. Online Consultation™ allows physicians to add links directing patients to Medem's Medical Library of medical society-provided content; offers integrated charge capture/billing; and features other tools that make secure online communications safer, more comprehensive, and more convenient for both patients and physicians.

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8. Is an Online Consultation communication directly with my physician? Is he/she the one that responds?

An Online Consultation comes from your physician. He/she is the one who receives, writes and approves responses to OC requests.

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9. How do I get permission from my physician to do Online Consultation with him/her?

If your physician has not talked with you about OC or Secure Messaging, and you would like to use the service with him/her, you should bring it up in your next communication with the office. To facilitate this communication, you should go to your physician's Web site on the Medem Network and register as a patient. This will notify the practice that you are interested in using their online services.

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10. Can I do an Online Consultation for someone other than myself, like my child, my spouse or my elderly parent?

Yes. The form for completing an Online Consultation allows you to identify and communicate with the physician regarding a patient other than yourself, assuming that you are the patient's guardian, or otherwise have legal permission to communicate on the patient's behalf, and have previously established this relationship with the physician.

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11. Who sets the charge for an Online Consultation?

The charge for an OC is determined and set by your physician.

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12. Is there any way to do an Online Consultation without a credit card?

Not at this time. A valid credit card must be entered and approved in order to complete an Online Consultation.

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13. Will my health plan or my employer reimburse me for an Online Consultation?

Some health plans and some employers are paying for online consultations. You should contact your health plan or employer to determine/confirm whether an Online Consultation is a covered service. You may, however, be reimbursed for an Online Consultation from a Medical Flexible Spending Account if your employer offers this benefit.

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14. How is Online Consultation cost effective for me?

When you add up all the costs of a visit to your physician (two hours lost from work/other activities, gas, parking and other out-of-pocket travel expenses, your health plan co-pay, etc), the cost of an office visit may far exceed the cost of an Online Consultation.

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15. How secure is Medem's Online Consultation messaging service?

Medem's Secure Messaging service is one of the safest and most confidential messaging systems available today. The messages are stored in a secure server environment that has security procedures and firewalls in place to restrict unidentified parties from accessing the main and backup servers.

A user ID and password are always required to view both patient and physician messages. In other words, the identities of both parties -physician's office and patient - must be authenticated in order for the message to be read.

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16. How secure is the handling of my credit card information?

A critical concern for electronic payment and commerce is the secure transmission of data. To protect consumer data during transmission Medem has hired VeriSign, the national leader in Internet security, to protect your credit card data.

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17. What should I do if I don't hear back from my physician in the designated period of time on an Online Consultation?

Any time you have a concern regarding online communication with your physician or his/her office you should call or contact the office as you would have done prior to using online communications.

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18. Can I communicate back and forth with my physician in an Online Consultation until all of my questions are answered?

Yes. The OC service is designed for you to submit a question to your physician and for your physician to provide you with a response. It is important for you to provide as much information as possible to your physician, to protect you, as well as your physician, from potential miscommunication. If you or your physician has a clarification question related to an Online Consultation, he/she may reply to you and may not charge you for this additional information. However, your physician determines whether a fee is appropriate with each Online Consultation.

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19. How do I submit additional information that I forgot to include after I have sent an Online Consultation?

It is important to be thorough in your communication with your physician. If you feel that your additional information is important before or after you have received your physician's response, you can open a new consultation. As indicated above, your physician has the ability to "no-charge" after reviewing a consultation request.

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20. What if I think I should not be charged after I receive my physician's reply?

If you are not satisfied with your physician's reply, and you have been charged for the consultation, you should discuss this directly with your physician.

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21. What do I do when I have submitted an Online Consultation and then change my mind before I receive my physician's response?

You should call your physician's office and advise them that you wish to recall the Online Consultation. Assuming that your physician has not yet responded, they may "no-charge" you.

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22. What happens if I am in the midst of an Online Consultation and I lose my Internet connection? Am I charged?

Until your physician receives and accepts your Online Consultation, you will not be charged. You will be notified at your regular e-mail address each time a request for Online Consultation has been successfully submitted on the Medem Network.

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23. Will Medem store copies of the Online Consultations I have with my physician?

Medem is a communications service provider — a utility like the phone company — and as such will not store copies of the Online Consultation communications you have with your physician. It is your responsibility to ensure that you maintain copies of your Online Consultations. Your physician will do the same, and your Online Consultations should become part of your medical record.

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24. Do I have to print all of the Online Consultations I have with my physician?

Medem recommends that you maintain copies of all of your medical records. Your OC communications with your physician should become part of your medical record. If you need copies of your Online Consultations and for some reason you do not have them, you should contact your physician's office.

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25. How do I change my personal e-mail notification address for Online Consultation?

At any time, you can change your e-mail notification address by going to your physician's Web site, logging in with your User ID and password, and then clicking on "Update My Profile". All of the information that you submitted to your physician during online registration when you first registered on the Web site also can be changed via this "Update My Profile" link.

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26. How do I get year-end accounting and receipts for all my Online Consultations?

Medem provides a "print receipt" function for you so that you can keep Online Consultation receipts that do not have the actual physician-patient messages on them. You are responsible to keep copies of your Online Consultation receipts throughout the year if you need them.

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