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

Posted by ejj0320 @ejj0320, 4 days ago

Why does Mayo not accept Quartz insurance? I am wondering why my insurance is not covered at Mayo. I was told by insurance that if I do a prior authorization then it will be more money out of pocket! How do I go to Mayo if they don’t take my insurance? This is so frustrating.

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Profile picture for flrvingbob @flrvingbob

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….

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@flrvingbob

Thanks for that well said message. That makes sense. It is on the insurance. Mine is through the school district and is mainly UW health. It’s sad that Mayo providers want to help me more in so many ways than UW will and it’s sad.

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Profile picture for maeve115 @maeve115

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..

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@maeve115

I love in Madison Wisconsin and go to UW health. They are great in some ways and not so great in other ways. I don’t qualify or have diagnosis related to Carbone cancer center.

I’m trying to get in for GI. I was a patient at the Jacksonville location in 2021 when I lived there and obviously had different insurance. I just wish I could transfer care to Rochester because they want to help me and support me more than UW will. Which is sad.

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Profile picture for flrvingbob @flrvingbob

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”…..

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@flrvingbob

I have tried UW in Wisconsin which is mainly Quartz insurance or who we can see. I’f Mayo won’t take it I don’t think any other states will.

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Profile picture for seniormed @seniormed

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.

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@seniormed

That is understandable. I am being seen at Mayo for post concussion under workman’s comp and it’s been amazing care and I got in way sooner than going to UW health in Madison where I live.

Mayo will support and help me more than UW which is sad and looks bad on UW. I have heard that from so many people.

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Profile picture for ejj0320 @ejj0320

@maeve115

I love in Madison Wisconsin and go to UW health. They are great in some ways and not so great in other ways. I don’t qualify or have diagnosis related to Carbone cancer center.

I’m trying to get in for GI. I was a patient at the Jacksonville location in 2021 when I lived there and obviously had different insurance. I just wish I could transfer care to Rochester because they want to help me and support me more than UW will. Which is sad.

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@ejj0320
It is sad.. Very much so. I wish too that your insurance allowed you to go to Mayo.. I do hope you succeed with "I'm trying to get in for GI. Am not sure what that quite means but dearly hoping you get some solid assistance and relief. Fighting insurance is so hard, and feeling for you right now and for all of us in this insurance mess together.

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Profile picture for maeve115 @maeve115

@ejj0320
It is sad.. Very much so. I wish too that your insurance allowed you to go to Mayo.. I do hope you succeed with "I'm trying to get in for GI. Am not sure what that quite means but dearly hoping you get some solid assistance and relief. Fighting insurance is so hard, and feeling for you right now and for all of us in this insurance mess together.

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@maeve115

Thanks so much. I’m trying to get in for Gastroenterology. Sorry I abbreviated it. It is sad and I wish insurance would be accepted at Mayo and I can be seen. Yeah dealing with insurance is a mess. Thanks so much I really appreciate it!

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