Because there is no cap on costs. The monthly plan gives the impression of being a total cost for the service. The patient/user is expected to understand the total cost is going to be much more.
It is because the copy charge issue is complex that I take issue with MedeFile. They gloss over it precisely in the place I want them to be explicit. It doesnt help that they still ask the physician to provide either faxed or physical records and have no relationship with popular EMRs or PMS systems to extract the records directly. The additional, patient-borne costs comes from limitations in their technology.
The slight of hand comes in because they are not explicit about what those costs might be (on average). They dont even discuss that the copy charges exist on the pricing page, you have to hunt for it elsewhere in the site. Patients who are new to the service or unaware of these costs have no way to know they will be charged additionally -- until later. MDFI also does not give the patient tools to figure out what those costs might be in advance given their particular situation (number of doctors, existing chronic conditions, etc).
Several of my patients have now dropped the service because their copy charges ammounted to several hundred dollars in the first year. MDFI offers no average cost per patient or even attempts to set expectations at the outset. Incidentally, I still recommend this service to patients (with appropriate disclaimers since I am a long investor) and I am not down on it nor am I down on PHRs. I am down on MDFI management.
I suppose they figure that, once the patient is enrolled, they will be committed to pay the fees. This is not a good policy and will lead to dissatisfied users.
In order to combat this issue Medefile must either stop asking providers for physical or faxed records (which is a real pain and part of the reason for the charges), and start integrating with popular EMR programs to draw out information automatically.
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