How can I go to Mayo Clinic if my insurance isn't accepted?

I think any healthcare organization has to weigh the pros and cons of the reimbursement rate each insurance company is willing to pay. I’m assuming (and I know we shouldn’t do this) that Mayo felt the reimbursement rate of the insurance company you use wasn’t enough to work with. This is not unusual, most healthcare facilities have insurance companies they don’t accept.

You should direct the question to your insurance company. All medical providers (Like Mayo) have financial and other requirements that allow them to provide the services. They know their costs as well as processes required to provide their standards of care. Many Insurance companies try to “negotiate” down or otherwise impede the payments as well as via their own internal, mostly profit motivated rules, dictate to the provider how and what care is provided. Maybe that works for lesser providers, but for Centers Of Excellence like Mayo, they are not going to be “managed” by insurance companies. Some insurance companies become a major burden to providers just by their various processes…I.e. claim disputes, pre authorizations, “this. First, then that”…and so on. It’s like you going to the grocery store…. Don’t like the cost, you don’t buy it. Insurance companies operate the same way…they don’t like the costs and Mayo’s rules for care and payment, the insurance company opts for a lesser standard of care. MAYO is not obligated to lower their standards to “make a deal” with insurers. As a business owner, responsible for negotiating coverages for my employees, I too must weigh the various issues and determine what is best both care and financially for everyone. Take Medicare for example. Mayo accepts traditional Medicare at Jax and AZ, but not advantage plans as they notoriously are looking for cheap care and wish to “manage” the provider…and Mayo cannot be managed if expected to provide the level of care they deem necessary. I ask the question,…do you want a computer algorithm or minimum wage clerk telling your provider how to meet you medical needs?.. As I don’t know the particulars of your provider, I can only speculate they are looking at profits over care, or you employer…or possibly you made a choice to select a plan or provider that minimizes premium costs…. It’s the old “pay me now, or pay me later” conundrum. Specific to Mayo Jax, every year patients receive a letter warning them of making changes to managed care (HMO) or advantage plans….they don’t accept them due to their unwillingness to pay Mayo’s fees and/or the problems with navigating approval and process issues with the insurer. The problem is not Mayo, the problem is the insurer….. I will end with a general statement…. Buyer beware when choosing your insurer or plans…they are not your friend so it’s up to you to understand what, where and how they provide coverage….. End of pseudo Rant….

I am sorry to hear that you cannot go to Mayo. Hopefully, you can get to Madison Wisconsin .Neuroendocrine Tumor (NET) specialist who utilizes a multidisciplinary tumor board and accepts Quartz health insurance is the University of Wisconsin (UW) Carbone Cancer Center in Madison, Wisconsin.Quartz is an insurance plan sponsored and co-owned by UW Health. This makes UW Carbone your core, tier-one in-network destination for specialized oncology care. Unfortunately, many (possibly most) State insurances do not cross lines, however the Carbone Center. From their website Dr. Jeremy Kratz, is their main NET man.
I am so sorry that our national medical system is so fragmented and non-effected that State policies do not seem to translate to other locations. Am sorry that insurance companies are denying so much. Feeling for you dealing with this insurance limitations which are so real. Am hopeful that the Carbone Center can be worked with and around..

Oh, to answer the question, How do you go without insurance?.. You do self pay. You can get estimates from Mayo for virtually every service. You can call the clinic financial office and they will explain the process. You may also explore other providers like various university health systems who typically are more flexible as well as having excellent health teams.. Loyola Chicago, U of Chicago, Shanda at University of FL, Tampa General/USF and many others come to mind.

This is a case of having to put personal effort into your care and look at other options……as the two Canadian YouTube docs close every video with….YOU are in charge of your own health”…..

Part of the problem is that the fast moving efficient scheduling and work up done at the clinic doesn’t work with prior approvals and unnecessary hoops that affect quality
of care delivered in a timely manner.
Managed care and HMOs greatly hamper the art of medicine.

@ejj0320, like @flrvingbob said, you might start by directing some of your questions to your insurance company to see if they may be able to work with Mayo Clinic.

For questions about self-pay and insurance coverage, refer to the Billing & Insurance section on Mayo Clinic's main website:
- Billing and Insurance https://www.mayoclinic.org/billing-insurance/insurance

Regarding nderinsured and self-pay, see this section: https://www.mayoclinic.org/billing-insurance/insurance/uninsured-patients

Contact https://www.mayoclinic.org/billing-insurance/contact-us

Isn't Quartz the Gunderson or Emplify insurance ? Will Quartz cover a Mayo referral? I know other Gunderson patients who've gone to Rochester in the past. Maybe things have changed.

@babe2004

That is understandable. I think they don’t accept quartz is because it’s through UW health in Wisconsin and want us to use that system. Which I do and have had some success in certain areas and certain areas I have not. Mayo wants to do more tests and figure things out and help me then UW doctors will. Which is sad.

@sandy8043

Quartz is I think mainly UW health in Wisconsin mainly Madison. They said even with prior authorization that it will cost more out of pocket key than not having a prior authorization. Which is stupid and frustrating.

@colleenyoung

I tried and Mayo won’t work with Quartz and said it’s more money for me if I do prior authorization than if I self pay.