The scenario is familiar: You wake up with a few aches and pains and, as the day goes by, you try to decide if you should make an appointment to see your doctor, or you leave a phone message and hope the doctor calls back. Patients in some parts of the country may soon have another option: E-visits covered by their health insurers.

While some doctors already use E-mail to answer simple questions from patients or to renew their prescriptions, patients and insurers usually don't pay for those exchanges. But under new programs, health plans and insurance companies are beginning to cover E-visits, which are less expensive and time-consuming than office visits for nonurgent matters. Among these companies are Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Tennessee, and Group Health, a health plan in New York.

Technology and services from hosting company RelayHealth Corp. are at the center of this change, providing a secure Web site and messaging platform that supports electronic interactions between doctors and patients, checks patient eligibility with insurers' systems, and enables electronic financial transactions for payments. Participating doctors pay RelayHealth $50 per month for the service. No special software is required, only a computer and Web browser.

In a pilot program beginning this summer, Blue Cross Blue Shield of Massachusetts will use the RelayHealth platform to pay for E-visits. Among those participating are 200 physicians affiliated with Beth Israel Deaconess Medical Center and their patients. Blue Cross Blue Shield of Massachusetts will pay doctors $19 for each Web visit; patients are responsible for a $5 co-pay.

INSIDE E-VISITS Here's how the RelayHealth platform works: Preregistered patients log on to RelayHealth's secure site via their Web browsers and answer questions about symptoms RelayHealth securely interfaces with insurers' systems to check patient eligibility System creates structured messages for doctors, who are alerted by E-mail to check the RelayHealth site Patients receive E-mails instructing them to access RelayHealth site once doctors' responses are in RelayHealth electronically bills co-pay fees to patients' credit cards and sends billing information to insurers

This $24 E-visit fee is less expensive than the typical $35 Blue Cross Blue Shield-covered office visit, says Vincent Plourde, VP of provider services at Blue Cross Blue Shield of Massachusetts. For busy practices, E-visits can be more time-efficient than office visits, or even than returning patients' phone calls. "There's no phone tag," says Dr. Richard Parker, an internist at Beth Israel Deaconess Medical Center who plans to participate in the program. Doctors try to answer the E-mails within 24 hours.

Dr. John Halamka, chief medical information officer at Beth Israel and CIO of CareGroup Health System, which operates the medical center, estimates that Beth Israel doctors will participate in about 500 E-visits with about 250 patients in the first year. Documentation from E-visits will be stored in patients' electronic medical records.

RelayHealth says seven health plans and insurers in five states use its technology for E-visit reimbursement, and it expects to sign deals with at least two other large insurers soon. Blue Cross Blue Shield of California was one of the first insurers to begin reimbursing E-visits; since last summer, it has signed up 50,000 patients and 200 doctors to use the E-visit program and plans to add more.

Dr. Eric Liederman, medical director of clinical information systems at the University of California Davis Medical Center, says about 11,000 of the facility's patients have signed on for the service since it was launched a year ago. Beyond the payments for E-visits, Liederman says, there's psychological value for doctors involved in the program. "With phone consultations, there's zero reimbursement, so doctors often feel their services, expertise, and time aren't valued," he says.

The American Medical Association recently approved a billing code for online medical consultations. The code becomes effective on July 1 and is a requirement of the Health Insurance Portability and Accountability Act for electronic transactions.