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Ability to self-refer to Mayo with Traditional Medicare
Visiting Mayo Clinic | Last Active: Jun 9 10:44am | Replies (10)Comment receiving replies
I am not an insurance expert, but I tried to do some research on this seeing I am a Medicare patient that goes to Mayo.
The DCE programs appears to be something that continues to change, there were some announcements in March 2022 from Medicare about changes and new programs, but if you just got notified, the program your providers are participating in must still be valid.
I did find a Medicare document called: Accountable Care Organizations and You:
Frequently Asked Question (FAQ) for People with Medicare. Dated 2011.
https://downloads.cms.gov/medicare/pdf/11588.pdf
At bottom of document, there is list of places to get additional information.
In document, there is a question / answer related to your concern:
Question: If my doctor’s in an ACO, can I still see whatever doctor I want?
Answer: Absolutely—if your doctor participates in an ACO, you can see any
healthcare provider who accepts Medicare. Nobody—not your doctor, not
your hospital—can tell you who you have to see.
I would contact your clinic and / or Medicare to verify that information above is still correct.
Laurie
Replies to "I am not an insurance expert, but I tried to do some research on this seeing..."
Additionally, while my current clinic is a very large network, with specialists in every area, they do not have the capability/expertise to provide all surgical options or other treatments for cancer care. For example, I have lung cancer and at Mayo, I had Video Assisted Thoracic (VAT) surgery to remove a cancer mass and I was home in two days living independently. I was off pain meds in less than a week. If I had had open chest surgery, which they may not even offer to me because of my age, the time in hospital and recovery time would have been a very different situation!
Here is the link to the Medicare website on ACOs, although it could change over time. This is an issue I will personally follow and write to my representatives in Congress.
https://www.medicare.gov/manage-your-health/coordinating-your-care/accountable-care-organizations.
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Thank you for your reply. I have contacted Medicare and my provider, and yes they say that I can still see a provider outside my network. But this initiative by Medicare is being done in stages (without approval from Congress). The question for you and me is what happens in the next stage. I was alerted to the implications by an article on Morningstar, an investment site (Title "Big Changes May Be Coming to Traditional Medicare" ). Here is the article :
https://www.morningstar.com/articles/1088562/big-changes-may-be-coming-to-traditional-medicare