Mayo Insurance Question

We used Tricare Prime a couple of years ago at Mayo. My husband had surgery for prostate cancer. Tricare requires a referral from your PCP. It is always good to go to your Tricare account and double check that your pre-authorization has been approved before visiting. Here is a link to Mayo's Tricare info: https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance/champus-tricare. Here is the link to all Mayo's insurance information so you can check to see if your present insurance is accepted. You would need to check the Mayo Campus that you plan to visit to see if they contract with your insurance. https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance

@that_girl Thank you i will Check out the links, i do know my current insurance only covered the transplant plus 1 year. So going forward now that im post 1 year is my concern how did the tricare workout after 1 year. Thanks

Tricare approves a set number of visits per referral. If you need more visits and aren't switching to a new physician/group, then the physician's office will usually contact Tricare to cover more visits . If you are switching doctors/groups even if it is for the same medical issue, then you get your PCP to make a new referral. Just remember that every referral must go through your Primary Physician even if a specialist is the one sending you to a different specialist (For example, my husband's urologist was sending him and the medical results to Mayo, but the actual referral still had to be requested by our PCP.).The trick is to be sure that each time you switch doctors/location, you get your PCP to make the referral first. Always follow-up to be sure it is authorized before your first visit. (They do this quickly and you can check the authorization online.) I have also found when I have called Tricare's insurance number with questions or problems they are ALWAYS nice and work to quickly resolve any issues. For example we were referred to a particular physician for radiation. Even though the entire group accepted Tricare Prime, this physician was new and had not yet made it onto Tricare's approved physician list. It was initially denied because he wasn't recognized, but after talking to them on the phone and explaining the situation. it was subsequently approved. I hope this helps. I do know that our insurance is much better than most. Also, thank you for your service!

@that_girl Thanks you have been a great help. Luckily my PCP is a PCM with Tricare and i already ask if he had a problem referring me and he did not see a problem. My only concern is there are 2 options in Arizona for transplant related services but i want to use Mayo. Well we will see im eligible in April so i figure I'll keep my current BCBS and give tricare a few months before stopping BCBS.

Hello everyone. I got accepted to internal medicine and two other departments and my appointment was scheduled for the end of June. Originally I was told by Mayo Clinic in Rochester that they are contracted with blue shield, my insurance provider, so I wouldn’t have to worry about the enormous price tag for a visit. Unfortunately I called Blue Shield to confirm what the copay would be and they ended up telling me that since I have a PPO plan with covered California they would not cover this visit unless it was an emergency room visit which it’s obviously not. I don’t know what to do bc I can’t afford $5,000 which is what I was told the price would be for the 90 minute visit without insurance. I would have to see several departments and get a bunch of labs and tests done so I’m sure that price tag would go up even higher. Are there any other options for getting coverage accepted or am I basically out of luck here. Having this appointment scheduled really gave me a lot of hope and now it’s being yanked away from me due to finances. Anyone else had experience with blue shield of California or other out of state individual plans? Thanks!

@rootcause93 Welcome to Mayo Clinic Connect. I can understand the grief of having so much hope with a scheduled appointment to have it yanked away from you. You will see that I moved your comment to a discussion already discussing insurance questions about Mayo Clinic. I would also like to introduce you to @danab who posed a similar question about insurance above.

I am confused that Mayo gave you the green light and the insurance said no.
When you spoke with Mayo's Central Appointment office, did they take your insurance ID number and run it through the system?

I’m pretty sure they did, but I’m gonna call them on Monday to follow up.

@rootcause93 Hi I hope I can help a bit and I am familiar with your situation very well. I had BCBS of Arizona and only dealt with California a couple of times for unrelated May Care. But for BCBS in general your story sounds very familiar. Based on my research and what I've been told is BCBS does not have a regular contract with Mayo so you probably fall under what is called Non Participating Provider which is 2 to 3 times more expensive than if they did have a contract. Now I was originally transferred to Mayo for a possible Heart Transplant evaluation which is one of the exceptions to the above rule with a catch is BCBS will pay for a transplant and all follow-up up to 1 year and its to the day. So for me that was a huge amount of money and I am thankful for that. But that ran out now over 2 years ago and due to some blood issues i needed treatment after the one year mark. Well like you I was told I was approved for this treatment which is rather expensive each visit is like 9000.00. So I believed at the time i was covered, what i did not know was it was at the non participating provider rate. Now also realize i had secondary Insurance of Tri Care Prime at the time being I'm retired Military which did help but my out of pocket is about 35% of what the insurance doesn't pay. I found this out after the fact and had to bite the cost and I probably would have gone elsewhere but I became eligible for Medicare with a better Tricare for Life plan that pretty much pays 100%.
So bottom Line what will probably happen if California is like Arizona is BCBS will send you a check for what they would be willing to pay for that service at the non participating provider rate which was 35% of the customary charge they recognize for out of network facilities. So It could get expensive if the office visit alone is 5000. I can see you probably paying about 35% or more of that amount. Now an additional question is do you have a secondary Insurance? Sometime the secondary insurance will actually pay more if they have a regular contract with Mayo. Also If I were you I would contact Mayo and get proof of the approval and take that to BCBS. Not everyone I have run into at BCBS or MAYO is an expert on all things financial. I had to go to bat with BCBS a few time on getting treatment when one person say something different than another. If Mayo has proof of the approval than you will have evidence to address it with BCBS. Good Luck I also will state that I did receive lots of support from the social worker folks at Mayo who can help facilitate some of these issues. If this is something that may run into long term care and I personally do Love the folks at Mayo Great people all around. I would say that Mayo is pretty good about working out payment plans also.
I hope this helps and if I can answer any other questions please ask.
Dana

I am in Iowa and go to Mayo in Rochester in a week for testing with the cardiology and pulmonology departments. I was told by Mayo I needed my referring doctor to put in an Out of Network Exception ( I believe it was called) and BCBS approved that the next day. I now have been approved for unlimited evaluation and treatment through June 23 2021.

@rootcause93 , Dealing with insurance on top of medical issues adds additional stress to an already stressful situation.

Each Mayo locations has a different list of insurance plans they have contracts with. and BCBS has countless plans and each Mayo locations has list of specific BCBS plans it accepts. Maybe that is where confusion happen. I have talked to Mayo insurance people few times and it can be very confusing. And when you call Mayo, sometimes the person you are talking to is not located in same location your going to. I had a terrible time once because I was asking about insurance for visit in Rochester and person I was talking to was in Florida and did not understand my question.

You can find a list of plans at https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/accepted-insurance/contracted-health-plans .

Mayo uses a Tax ID when submitting claims, each Mayo location / hospital has separate ID. Mayo told me to use that Tax ID to verify with insurance company. Can find tax ids at: https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/faq

I think your plan to re contact Rochester Mayo on Monday is great idea to clarify.

If you have not created a Mayo portal signon, I suggest you do. Mayo portal also has ability to send messages to Billing / Insurance dept. The turn around is slower then phone (usually more then a few days) but I like to use because I have written record of questions and answers.

But in your case when you need answer so can make travel plans, a phone call will get you quicker answer. As suggested earlier, ask them to send documentation / letter / portal message so have record of what they tell you.

Good luck

Laurie