If you are seeing per-message transaction fees for Patient Messages on your monthly invoice, you may have not yet linked your Ocean account to your EMR user account.
Linking your Ocean and EMR user accounts will allow you to send messages from the shortcuts in your EMR and ensure that these messages will be covered under your unlimited Patient Messages User Subscription.
To link your accounts, please follow the steps outlined in: "Link User EMR Accounts to Ocean User Accounts".