Cost estimates before 2nd insurance is even billed?

@dwwaggoner
I do not work for Mayo, but I can talk about my experience with estimates and billing. I am on original Medicare (A&B) with a supplemental (G) policy.

When Mayo schedules tests, referrals, procedures, they do an estimate to verify that it is covered by my Medicare insurance. This is based on the ICD-10 code used to order. If it is not covered, I am asked to sign an ABN (Medicare Advance Beneficiary Notice) acknowledging that if Medicare does not pay, I will be responsible.

If Medicare approves, then my supplements will also be covered.

Once you have tests or procedures, then it is submitted to Medicare to pay their portion, and the supplemental pays the remaining.

I hope my understanding of the process helps, but you can always call 1-844-217-9591 to speak with a Patient Account Services representative with questions about your bill, financial responsibility, cost of services, and insurance.

@roch It's not the same as you, it's the 20% of the test not already paid by Medicare, that was approved. It's the 20% that my Medigap policy is contracted to pay. It ends up with a zero balance. Apparently Mayo's billing is not seeing the unpaid insurance amount BEFORE it drops the payment due. I already did the math and if Medicare paid, and charges were not declined, I will owe zero balance. Medigap policies only pay when Medicare has approved the charge according to the ICD code. Mayo accepts Medicare payment, and Medigap payments, they just always bill before they get the secondary payment.

@dwwaggoner
Very odd that they would charge you before both policies are processed. I never get a bill until both are processed. Actually, after the deductible is met, I never get a bill. If I look at my billing details, it shows insurance processing.

I strongly recommend calling Patient Account Services at 1-844-217-9591 to verify that they have the correct information about your supplemental on file.

Your charges are being handled differently from mine, and it sounds like we have the same type of coverage.

@dwwaggoner, this must be frustrating and seems unnecessarily confusing. I agree with @roch. Please contact Billing Account Services to see what can be done.

Billing Account Service contact info: https://www.mayoclinic.org/billing-insurance/contact-us

I tell my hubby....medical is the last bill to pay. I just wait til I get a second notice before reacting. Some stuff is denied, and I hand those to my oncologist and his helpers file the appeal for me. So far I have not had any unpaid bills since I met the policy maximum. In January we start over for the first 4000 dollars but that does not take long with chemo and ct scans.

@roch "When Mayo schedules... they do an estimate to verify that it is covered by my Medicare insurance. ... If it is not covered, I am asked to sign an ABN (Medicare Advance Beneficiary Notice) acknowledging that if Medicare does not pay, I will be responsible."
If Mayo (any Medicare provider) does not give the Medicare Beneficiary an ABN before the procedure...then the patient is not responsible for the unpaid charge.
I have traditional Medicare with Medigap plan and usually I never see a bill. But on a small test I did get a bill. It was because it had not been coded correctly...Mayo wrote it off, not worth correcting..but the issue was that the diagnostic code (medical reason) did not justify the procedure code. My medical issues cross boundaries between pulmonology and cardiology and pulmonary hypertension requires cardiology tests. Mayo creates an estimate but the note says they are waiting for other insurance so I wait for the actual amount due.
I talked to the Billing office about the issue and they said to check a day or two before the procedure and if it is not covered but logically should be covered, ask them to check again to be sure coded correctly. There is a Mayo employee who is supposed to do these things. ALSO ask ChatGPT for the codes to a medical procedure ...it will tell one!!!