Connect
Seniors with Medicare, is Mayo worth the hassle?
If your answer is "yes", please share: How do you do it ?!?
We have been with Mayo for almost 4 years. It has been wonderful service.
I've also had a great BCBS PPO that was practically seamless. I never saw a bill, just an occasional $20 copay.
And then, I turned 65, went on Medicare, and the billing nightmares began. Without a chronic illness, it has taken 18 months for me to realize how difficult this is going to be from now on. In April my wife turns 65, so the billing/paperwork dysfunction will double.
Example: Last October my Mayo primary care prescribed a colon cancer screening colonoscopy. It had been 10 years since my last (paid for 100% by BCBS). While there, they found 2 polyps worthy of biopsy. (They were negative.) Mayo filed with Medicare first, as my primary insurance. It turns out that the two procedure codes conflict: one a screening test, the other a diagnostic procedure (the polyp biopsy). Because of the code conflict, Medicare will only pay for one of the two parts. I now have to appeal to Medicare by re-submitting all of Mayo's medical notes myself. Whatever Medicare declines to pay, the secondary (my BCBS) automatically declines to pay as well.
Now, two weeks ago I had a $48,000 TKR. I am sure that the surgery was first rate, world class at Mayo. But, I am now watching the billing itemization role in to Medicare. There was, for example, a $3 blood draw charge, an $18.30 EKG for which Medicare has now sent me a $2.98 check to pay Mayo etc etc ... up to $48K
Sure, Mayo has a great reputation. But as a patient having to deal with these Byzantine medical billing and coding issues, and having to manually pay Mayo with the checks that Medicare sends me, is it worth the time and headaches? I am sure that in a big city like Phoenix, there are plenty of good, qualified doctors who work with Medicare. Why would we stay with Mayo?
I see a lot of seniors over at Mayo. How are they dealing with this ?!?
Like
Helpful
HugInterested in more discussions like this? Go to the Visiting Mayo Clinic Support Group.
Connect
Quite right!!! I meant the patient portal which is accessed through the Internet!!!!
-
Like -
Helpful -
Hug
1 ReactionIs it Mayo policy that all doctors there will accept Medicare? Are any of them able come after you for the shortfall if your supplement policy allows them to do so?
-
Like -
Helpful -
Hug
1 Reaction@goldwingmine Thank you for this! I go to Mayo in AZ and just went on Medicare two months ago. I have been digging into Advantage and Supplement plans. I am not eligible for supplement plans due to my age, but I will steer clear of Advantage plans since Mayo services is my #1 requirement for healthcare.
-
Like -
Helpful -
Hug
1 Reaction@bajjerfan
I have a supplement N plan which allows providers to come after any shortfall, but I have yet to see that materialize. When my supplement carrier pays what they are going to pay they often note that the patient responsibilty is $0.00
@azginny Agreed. My wife and I found a number of advantages (for us) with Medicare Advantage but except for rare circumstances ( some special contracts with some insurance providers , some employer sponsored plans grandfathered in) they do not take Advantage and only Medicare supplements. Sounds like you are on the right track. Best of luck.
-
Like -
Helpful -
Hug
1 ReactionI had a TKR in June 2026 which was scheduled in March by Mayo Rochester. My estimates pre surgery showed I would owe nothing since I already met my deductible. I have traditional Medicare, and AARP UHC Plan G+ . Mayo has been paid 100% by my insurers already.
Time for another lesson in "personal responsibility" and "Self-initiative". Medical care, regardless of the source starts and ends with YOU, the patient. I regularly read this forum and come away with an (well deserved) impression many are only looking for a "positive" medical result with little or no self-investment.....and insurance is one of those choices "YOU" make, not the provider. The Medicare and Advantage Plans (and be clear Advantages plans are NOT CMS Medicare, regardless of what Joe Neimeth says) are two different animals. Mayo accepts Medicare and related medigap plans with arms wide open.....within the confines of the rules and policies of Medicare.....and they are darn good at it. Mayo only accepts Advantage Plans in MN....not FL or AZ....partially due to agreement with the state. If on CMS Medicare and IF you are paying attention and concerned with coverage, Mayo is very good at pre-determination if asked. Also, once in and other orders are placed by your providers, the system will automatically determine coverage and when you check in for "what ever...blood work, imaging, etc.), if there is a potential coverage issue, you be asked to authorize a waiver or decline the service....easy-peasy.
As per CMS Medicare rules, if a service is rendered and is on the CMS Medicare approved list, you will owe nothing more than co-pay and/or deductible. Your medigap policy by law is required to cover as your plan terms allows, anything Medicare covers. This is all dependent upon coding and people do make mistakes...not often, but it happens. In most cases, all it takes is a call to Medicare and they will explain the issue and then a call to Mayo's finance office and typically the issue gets resolved.....but there in lies the rub. YOU have to participate and whether you like it or not, it's part of your ownership of your healthcare.
My wife and I have been gratefully using Mayo Jax for 37 years. There have been the occasional "bump", denied claim, etc. BUT we "get on it", contact the coverage provider, sort out their issue, take it back to Mayo and almost every time, it gets fixed. This has been over the course of private insurance, self-insurance, CMS Medicare and more. The term "hassle" in the OP's comments to me is offensive....if you don't want to deal with "hassle" as you put it, you can make the choice to go elsewhere. On the other hand, if you wish access to the best medical care available, instead of getting on a forum with your grievance, deal with it head on. Make the calls, gather the documents, do the work. In the time spent detailing out for everyone to see, your medical history (TMI), you could have spent that time working to constructively resolve the issue. You complain about the "byzantine" system.....it's not Mayo, it's insurance companies,...and with Medicare, the systems they have adopted to somewhat conform to the existing systems.......none of this is the provider.
In the 37 years of our Mayo use, we have learned "relationships" with providers and their staff members pays. If you are prepared, cooperative, polite, patience, understanding, check the emotions and over-expectations at the curb, life will be good.....and learn that the Patient Portal" is you best friend if used appropriately.
I am sure I will take "heat" (I'm used to it) for this tome, but if everyone would take personal ownership and apply their energy to constructive issue investigation and resolution and less energy "blaming", all would be better off. It may take some time, but that's the investment you may have to make to gain the medical outcome you desire. I will say, Mayo's finance office and individual departmental staff are great as "getting things fixed" if it's on Mayo's end....again, time and effort on your part.
As the two YouTube docs in Canada say...."You are in charge of YOUR health".....and in this case dealing with the insurance and related payment issues are part of that responsibility.....
Oh, see the OP was on a PPO/HMO....thus never seeing detailed billing. The rest of the medical insurance billing world works like Medicare and you see what is being billed.....it's just the way it works. Maybe get on an advantage plan at open enrollment......and limit your access to true medical centers of excellence..... Let this be a lesson....
-
Like -
Helpful -
Hug
4 Reactions