It basically says the same thing I was trying to explain. I know very little about this stuff but I sometimes needed to submit information when a patient's insurance didn't want to pay for things.

The thing I'm not sure about is if Mayo accepts Medicare reimbursement rates or not. Someone told me once that Mayo doesn't.

I know Mayo does a lot of tests and "extensive work-ups" which is good. However, Medicare insurance might not pay for all the tests and procedures.

Many tests and medical procedures aren't considered to be what is "usual and customary" in insurance lingo for the condition being treated. This is where "prior-authorization" comes into play because insurance companies say much of what medical providers do isn't necessary.

This is also where FDA approval for Actemra to treat GCA and Kevzara to treat PMR is so important. These medications are no longer considered to be "experimental treatments" for these conditions which is the usual reason why insurance companies don't cover the cost of certain medications.

Now medical insurance companies might say less expensive alternatives are equally effective and need to be tried first. For example, if methotrexate doesn't work maybe the insurance company will pay for a biologic. That is just another excuse if you ask me. I think insurance companies would prefer people to be treated with prednisone. Many patients think prednisone is the "only medication that works" for PMR/GCA but this is starting to change.