Almost made it to the Mayo

@hopenr
What a frustrating experience when insurance limits your ability to seek medical treatment at clinic of your choice. And when get different answers from your insurance company, it does not help. Each Mayo location has it's own list of insurance accepted. And it can change from year to year.

You can find out more about insurance coverage and contact information for Patient Account Services at Mayo at following website:
https://www.mayoclinic.org/billing-insurance/insurance/accepted-insurance

Oh my gosh! @hopenr! How terrible and frustrating for you. I had to get pre-approval as well, and was out of network naturally as I am in California and Mayo is in Rochester. There was some clause in my BC/BS plan that because it was being done at at COE and was not performed routinely anywhere but a few hospitals, it was approved. I ended up paying about $8000 out of pocket though! Ouch!
Perhaps take a deep breath and reach out once again to the link that our Everything Mayo Mentor @roch gave you...it is definitely a brick wall, but maybe there is someway around or over or under that wall.
My surgery was delayed five months due to Covid. October is only four months from now...that is what I would do, but I am not telling you do that, just saying! It is your decision.
You really want the best of the best, not the best of the rest. This is your life and you want to be in the hands of the top few places on the planet that do this surgery.
So re-group. Vent. Re-focus. Don't let this setback stop you from trying again. And again if you must...I am sorry you had to go through such a frustrating deal, but your name is Hope, and that a good thing to have. Faith is a good thing to have too...

I have done a lot of research since yesterday. I can switch my Medicare Advantage plan to a PPO (it is currently an HMO) in October and then wait until January when the new insurance kicks in and be covered at the Mayo. So this time next year I hope to get the surgery I need to be able to live life fully. SIGH!

For every 100 people there are 100 different insurance provisions. Please do not give up in exploring possible options, you and your heart deserve the very best. The Mayo Clinic in Rochester has a fund to help people financially to receive treatment there, I have contributed to it annually ever since I had surgery. My nonprofit Medicare Advantage Plan (PPO) assured me that they cover for any medical facility that accepts Medicare. @hopenr you did not say if you were on Medicare, Mayo in Rochester accepts (I called and asked before I went) all Medicare plans. (Note: Jacksonville and FL in general does not accept Advantage plans as far as I know). Mayo in Rochester is out of network for me, my PPO plan does not require formal referrals, my cardiologist just referred me - sent my test results and other information. I expected to pay $800 copay for out of network hospital but was charged $350 in network charge - there are no places in network that perform septal myectomies. Part of the mission statement is: "...offers access to thousands of top physicians across the country." My total medical costs for this surgery were under $500. (I cannot fathom why this insurance model is rarely found in other localities. I am trying very hard to remain unpolitical about the very uneven burdens we face in paying for the excellent health care we have in our country.)

@hopenr
Sounds like you have a plan and have done your research. When you sign up for a PPO in fall, make sure it is one that is accepted at Mayo location you want to be seen at. Not all PPOs are accepted at all Mayo locations.

Good luck in future.

Yes, I am on Medicare Advantage through United Health. I am on an HMO. The Mayo will not accept it. I have to change to a PPO in October (taking effect in January). That is considered national coverage. I spoke to the Mayo business office for an hour and they did not mention a fund that assists with finances. I am glad that yours worked out to be easy on your wallet, all things considered and feel free to get political with me. Whats happening is a travesty on every level.

Here is the link: https://www.mayoclinic.org/billing-insurance/financial-assistance There were plenty of other expenses - travel, accommodations, meals etc.

You should definitely switch from Medicare Advantage to regular Medicare as soon as you have a chance. I have some friends who do fine with Medicare Advantage but some who have real problems getting the health care they need. I know Mayo does not accept most advantage plans but they do accept regular medicare and a supplement. I think a PPO is still a type of Medicare Advantage. Don't know how it would work for you but I have regular Medicare and a supplement (sometimes called a Medigap plan) and can seek care anywhere I choose. I see a cardiologist at the HCM clinic at Mayo, Rochester and have no trouble with coverage. Figuring out Medicare coverage is a personal choice, but can be difficult. Good luck.

Unfortunately once you have pre-existing conditions on Medicare Advantage you are not permitted to change to Medicare (Medigap also called part G).

I want to add few comments to what @hopenr mentioned.
During the open enrollment plan, you can go from a Medicare Advantage plan to Original Medicare (Part A & B). But, majority of people also purchase a Medigap / Supplemental policy to cover the portion of medical expenses that Medicare does not cover. It is the Medigap policy that is not guaranteed if you do not sign up when become originally eligible for Medicare (usually at 65). It is called Guaranteed-issue rights and ensure that you can enroll in any Medigap plan sold in your state and that you won’t be charged higher premiums based on your health status.

When you switch from Medicare Advantage to Original Medicare, it’s usually the case that you lose your “guaranteed-issue” rights for Medigap. Without guaranteed-issue rights, your insurance company may require medical underwriting before it offers you a plan. During medical underwriting, the insurer looks at your past medical history and current health status. If the company determines the risk of covering you is too high, it can refuse to offer you the plan you want, or it may charge you much higher premiums for the coverage.

In summary, during open enrollment and considering changing your plan, you must look at all your options, coverage and expense.