Denial of mayo visit

Posted by nancyeburford @nancyeburford, 5 days ago

I have been denied a visit to Mayo with loads of testing and labs. No diagnosis and different med trials. I thought Mayo took complex cases with a team approach. They would not tell me the real reason for denial. My GP encouraged it. Anyone have a thought on this?’

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All normal have read my results over and over. did drink but now almost none since this all started

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I can’t find any triggers and believe me I have wracked my brain. I am off everything even supplements to see if that restores my nervous system.

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@jenniferhunter

@nancyeburford Here is the page for insurance information for Mayo that I'm posting for everyone who is wondering. The best bet is to call the Mayo Insurance & Billing office and ask if your insurance is accepted before requesting an appointment. Medicare "Advantage' plans tend to look at claims that were already paid and re-evaluate them. They may deny them after the fact, and then come back to the provider for reimbursement. That's why a lot of providers won't accept them. If a provider is in the network of the "advantage" plan, it is a bit like being an HMO provider and they dictate what the provider is able to charge for the care often at a lesser rate. I can understand why Mayo doesn't accept them because it is a risk that they will loose money if claims are reassessed and denied. This is the reason I stayed with real Medicare because that is accepted at Mayo and elsewhere in the country.
https://www.mayoclinic.org/billing-insurance/insurance

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Not only Mayo does not take Medicare Advantage plans (except for a few situations in MN) but Medicare Advantage plans are constantly being dropped by other providers across the United States.
Unfortunately, the insurance companies advertise incessantly on TV about Advantage plans
"getting all your benefits" without telling people the real truth - YOU LOSE CHOICE! You have to go to their doctors or pay $$$. They deny coverage frequently because that is their business model to increase profits by not providing services. There are many complaints against Advantage plans, and people should call their Representative in Congress about it.
AND once you are in an Advantage plan, and you want to go back to Original Medicare so that you can go to the doctors you want, yes you can go back to Original Medicare BUT to purchase the Medigap insurance plan to cover the 20% that Medicare does not cover, you are in trouble. Insurance companies no longer have to accept you, or they can charge you a higher premium than you would have paid in the beginning.

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Mayo is not all it is cracked up to be. Find another facility.

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WOW. That sucks. My boyfriend keeps telling me to go there because they removed some kidney stones for him at 1/10th of the cost had he done it at home here in Denver, CO. Can you tell us what it is you wanted to go there for? I think that’s key to answering your question?

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@vic83

Not only Mayo does not take Medicare Advantage plans (except for a few situations in MN) but Medicare Advantage plans are constantly being dropped by other providers across the United States.
Unfortunately, the insurance companies advertise incessantly on TV about Advantage plans
"getting all your benefits" without telling people the real truth - YOU LOSE CHOICE! You have to go to their doctors or pay $$$. They deny coverage frequently because that is their business model to increase profits by not providing services. There are many complaints against Advantage plans, and people should call their Representative in Congress about it.
AND once you are in an Advantage plan, and you want to go back to Original Medicare so that you can go to the doctors you want, yes you can go back to Original Medicare BUT to purchase the Medigap insurance plan to cover the 20% that Medicare does not cover, you are in trouble. Insurance companies no longer have to accept you, or they can charge you a higher premium than you would have paid in the beginning.

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Rochester told me they would accept my Medicare advantage

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@nancyeburford

Rochester told me they would accept my Medicare advantage

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Consider yourself fortunate, what is your plan? And what are your requirements for preapproval for visits and tests??? What are your copays?
And every year you must check to see if your providers are STILL in your plan.
....I have original Medicare with a Medigap plan and am a patient at Mayo. I self-referred myself to Mayo when my local CT scan showed possible lung cancer. I went from an abnormal chest x-ray to lung cancer surgery at Mayo in only seven weeks with Thanksgiving and Christmas in-between. I do not need preapprovals for anything, and I self-refer to a specialist for any health issues I have, I have never seen a bill. My Medigap premium while expensive is well below the max about $6000 out of pocket costs with a Medicare Advantage plan. With my health issues I would go over that max!!! I do not need to check my plan annually because I can go to any provider in the US who takes Medicare, no network issues!
Follow Beckers Hospital Review...they track providers dropping Medicare Advantage plans

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@mikaylar

Mayo is not all it is cracked up to be. Find another facility.

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@mikaylar Is your comment related to insurance coverage? If so, please understand that being in network with insurance is a contract between the insurance coverage and the provider. Mayo will need to answer what insurance they accept. They can't take a risk of denial of payment for services with their huge operating costs, and they need to get reasonable reimbursement rates to be able to stay in business. That is not unique to Mayo. It is everywhere at hospitals. A patient might be limited to coverage at facilities only within the state where they live with an "advantage" plan. Mayo is a destination medical facility, so having insurance that covers nationwide access to health care is important if you want to be a patient there.

Here's another comment about health insurance. Many independent doctor practices are offering subscriptions to patients. I just saw one that wanted $160 a month cash billed every month, and did not take any insurance , and have a limited amount of appointment time and testing in their plan. Extra time is billed extra in cash.

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@vic83

Not only Mayo does not take Medicare Advantage plans (except for a few situations in MN) but Medicare Advantage plans are constantly being dropped by other providers across the United States.
Unfortunately, the insurance companies advertise incessantly on TV about Advantage plans
"getting all your benefits" without telling people the real truth - YOU LOSE CHOICE! You have to go to their doctors or pay $$$. They deny coverage frequently because that is their business model to increase profits by not providing services. There are many complaints against Advantage plans, and people should call their Representative in Congress about it.
AND once you are in an Advantage plan, and you want to go back to Original Medicare so that you can go to the doctors you want, yes you can go back to Original Medicare BUT to purchase the Medigap insurance plan to cover the 20% that Medicare does not cover, you are in trouble. Insurance companies no longer have to accept you, or they can charge you a higher premium than you would have paid in the beginning.

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You are 100% correct! I managed medical practices for 25 years for specialty offices where 80% of our patients were Medicare. Medicare advantage plans are a nightmare. My husband and I both have Medicare and a supplement. For all the reasons stated in this thread, that is the way to go.

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@tkr1

You are 100% correct! I managed medical practices for 25 years for specialty offices where 80% of our patients were Medicare. Medicare advantage plans are a nightmare. My husband and I both have Medicare and a supplement. For all the reasons stated in this thread, that is the way to go.

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I had occasion to speak to the Prior Authorization Coordinator at one of my provider's offices yesterday. It was near the end of her workday and it was obvious that she was exhausted and frustrated, yet she was pleasant as could be.

After we concluded our business, I asked her how things were going and she told me "2025 has been a nightmare so far" saying medications and procedures that patients had been having for years were requiring prior authorization - even if they had not changed plans. And many were coming back "Denied" even when the patient met ALL criteria as I did. She said she spent the entire day yesterday filing appeals, and knew all would be granted in the end. She is worried, especially about many of her older patients, who are less savvy about the crazy new processes.

PS. This is even beginning to "bite" many of us who have traditional Medicare with a supplement.

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