1. < Visiting Mayo Clinic

Seniors with Medicare, is Mayo worth the hassle?

Posted by Paul @phoenixpal, Mar 7, 2020

If your answer is "yes", please share: How do you do it ?!?

We have been with Mayo for almost 4 years. It has been wonderful service.
I've also had a great BCBS PPO that was practically seamless. I never saw a bill, just an occasional $20 copay.

And then, I turned 65, went on Medicare, and the billing nightmares began. Without a chronic illness, it has taken 18 months for me to realize how difficult this is going to be from now on. In April my wife turns 65, so the billing/paperwork dysfunction will double.

Example: Last October my Mayo primary care prescribed a colon cancer screening colonoscopy. It had been 10 years since my last (paid for 100% by BCBS). While there, they found 2 polyps worthy of biopsy. (They were negative.) Mayo filed with Medicare first, as my primary insurance. It turns out that the two procedure codes conflict: one a screening test, the other a diagnostic procedure (the polyp biopsy). Because of the code conflict, Medicare will only pay for one of the two parts. I now have to appeal to Medicare by re-submitting all of Mayo's medical notes myself. Whatever Medicare declines to pay, the secondary (my BCBS) automatically declines to pay as well.

Now, two weeks ago I had a $48,000 TKR. I am sure that the surgery was first rate, world class at Mayo. But, I am now watching the billing itemization role in to Medicare. There was, for example, a $3 blood draw charge, an $18.30 EKG for which Medicare has now sent me a $2.98 check to pay Mayo etc etc ... up to $48K

Sure, Mayo has a great reputation. But as a patient having to deal with these Byzantine medical billing and coding issues, and having to manually pay Mayo with the checks that Medicare sends me, is it worth the time and headaches? I am sure that in a big city like Phoenix, there are plenty of good, qualified doctors who work with Medicare. Why would we stay with Mayo?

I see a lot of seniors over at Mayo. How are they dealing with this ?!?

Interested in more discussions like this? Go to the Visiting Mayo Clinic Support Group.

Paul | @phoenixpal | Mar 10, 2020
In reply to @IndianaScott "My experiences with Medicare are the same as yours, @johnbishop I've never gotten a check from..." + (show)
@IndianaScott

My experiences with Medicare are the same as yours, @johnbishop I've never gotten a check from Medicare, they pay everything direct and I only get statements of what they paid to the provider. I also pay the same way via my SS.

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Thanks Scott. I'm assuming that like John, you are also dealing with the Rochester Mayo.
I guess I need to hear from any Arizona Mayo seniors about their Medicare/Mayo experience.

BTW, another complicating factor for me, although again, it wasn't that big of an issue pre-65/medicare, is that my BCBS policy is out of state, not an Arizona BCBS. But again, with all the retirees here in AZ, I'm sure I have a lot of company on that score too.

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dandl48 Dave | @dandl48 | Mar 10, 2020

@phoenixpal Having an out-of-state BCBS shouldn't be a problem. I've lived in So. Oregon for 2.5 years and have gotten treatment in OR, CA, MT. & Minn with BCBS from Montana.

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natiel1 | @natiel1 | Apr 11, 2023
In reply to @phoenixpal "Thanks Lisa. Have I spoken to the Mayo billing office? Oh yes, phone calls and emails..." + (show)
@phoenixpal

Thanks Lisa. Have I spoken to the Mayo billing office? Oh yes, phone calls and emails to Customer Service via the portal (good to have written record of things said), and calls with BCBS (originally thinking they were to blame for the mess), and calls to Medicare.
In January Mayo Customer Service agreed that there was a problem with the 2 different codings for the colonoscopy and that it would be sent for review. I just found out that the review was done and the coding stands. I owe Mayo $1000, and can only challenge it through Medicare.

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Thank you for posting your problem with Mayo. Wish we had seen your post before the visit. We are in the process of making an appeal to Medicare. Medicare is not paying for a consultation visit, which Mayo required before my husband could get his colonoscopy (screening) procedure done. Medicare will pay for the procedure, but not the consultation that was coded by Mayo as medically not necessary. I am also sending a message about the issue via patient portal as recommended by the Medicare agent.

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1 reply
dlynn1210 | @dlynn1210 | Apr 12, 2023
In reply to @natiel1 "Thank you for posting your problem with Mayo. Wish we had seen your post before the..." + (show)
@natiel1

Thank you for posting your problem with Mayo. Wish we had seen your post before the visit. We are in the process of making an appeal to Medicare. Medicare is not paying for a consultation visit, which Mayo required before my husband could get his colonoscopy (screening) procedure done. Medicare will pay for the procedure, but not the consultation that was coded by Mayo as medically not necessary. I am also sending a message about the issue via patient portal as recommended by the Medicare agent.

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I called Mayo to schedule an appointment in Dec 2022. I was asked three questions - name, date of birth, and insurance info. When I told them Aetna Medicare I was told “We don’t accept that insurance”. No mention of self pay as an option.

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1 reply
bernese53 | @bernese53 | Apr 12, 2023
In reply to @dlynn1210 "I called Mayo to schedule an appointment in Dec 2022. I was asked three questions -..." + (show)
@dlynn1210

I called Mayo to schedule an appointment in Dec 2022. I was asked three questions - name, date of birth, and insurance info. When I told them Aetna Medicare I was told “We don’t accept that insurance”. No mention of self pay as an option.

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Do you have Aetna Advantage? I am under the impression that Mayo does not accept the Medicare Advantage plans.

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2 replies
dlynn1210 | @dlynn1210 | Apr 12, 2023
In reply to @bernese53 "Do you have Aetna Advantage? I am under the impression that Mayo does not accept the..." + (show)
@bernese53

Do you have Aetna Advantage? I am under the impression that Mayo does not accept the Medicare Advantage plans.

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No we have Aetna Medicare.

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1 reply
tra418 | @tra418 | Apr 13, 2023
In reply to @dlynn1210 "No we have Aetna Medicare." + (show)
@dlynn1210

No we have Aetna Medicare.

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so do we,think we may be grandfathered in
Started Cancer treatment prior but not sure .Was told Cancer patients will be treated.

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hbp | @hbp | Apr 13, 2023

For years I had a good medicare advantage plan and before cancer I was ok with it. However, with cancer, I was not as comfortable as before with an advantage plan. I spoke to my experienced medical insurance agent and she was able to get me into a Medicare supplement plan. Switching from a medicare advantage to a medical supplement can be difficult and the supplement is more expensive, but it does open up expanded treatment centers and medications for me. At this time of life and with the difficulties of PC I suspect that I made a good choice for me.

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cmael | @cmael | Apr 13, 2023

I had a kidney transplant 5 years ago in Rochester. At the time I had a Humana Advantage plan. It was great as far as I’m concerned. I even had a $10,000 allotment for housing, gas and parking, good for 1 year. For the past two years I’ve had United Health Care advantage plan due to Humana no longer serving our rural area. Last years annual checkup was covered well, even though at the time Mayo was not in network. This year Mayo is in network for UHC. I’ll be going in for my 5 year checkup in 2weeks.

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hbp | @hbp | Apr 13, 2023

sounds great and congratulations That is better than the situation that I have experienced in CA

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