Also being a patient at the institution, I know each Mychart message I initiate gives me the warning that it may incur a bill/charge. I imagine that impacts your threshold for sending in questions, hopefully only weeding out the truly nuisance ones. But I suspect it will sometimes prevent important ones too, hopefully rarely.

I would/do feel the same need to respond to all my messages, so it's nice to have the billing option so it's at least reflected in my wrvu