What does in-network access at Mayo Clinic mean?

@caretakermom In an ideal world, the answer would be simple - in network clinic, everything is OK. But the reality of our complex insurance systems is that you need to check. It is best to do this in advance of care. Make a call to Member Services at your own insurance company for the best answers.
Sue

@sueinmn, I have already checked with member services of my insurance. All they can say is that Mayo Clinic Az has a contract with our insurance and members have in-network access. They were not able to elaborate anything further. Unfortunately, member services is not always as simple as you think if you want to get an accurate answer. Many times you have to get to the source (supervisor and above)who has may be helpful but that's not an easy thing these days, esp when your insurance is a national company with thousands and thousands of members.
My post is to those who have in-network access and are current patients of Mayo Clinic to share what their experiences have been at Mayo in regards to having in-network access. Have they ever been charged out-of-network rate at Mayo even though they have in-network access? If so, under what circumstances? I can tell you this has happened to me with some, not all, hospitals/institutions. Under our insurance, most not all, ERs will be out-of-network, even though the hospital associated with the ER is in-network. And some physicians who have privileges at an in-network hospital can charge out-of-network rate. This is called surprised billing, because you don't know who you're end up with at the hospital under emergency situations. And we have had to deal with surprised billing once before!! The only institution I know of with no surprised billing is UCLA. My family and I have in-network access at UCLA, and that means services (including ER) and physicians associated with UCLA are in-network.

Hi everyone,
For those of you who have insurance that is in-network with Mayo Clinic(Az, Florida, Minn), what services do these include? Does having in-network services mean all services and providers at Mayo are in-network? We have in-network access at Mayo Clinic Az verified by our insurance Member services and the Mayo website list of insurance contracts.
Am wondering if Mayo providers/services can charge out-of-network rate at an in-network facility. Would appreciate feedbacks. Thank you!

@caretakermom You are smart to ask these questions. I asked them too before I had surgery at Mayo Rochester. I was told everyone at Mayo is an employee, not an independent contractor, so the providers who did neurological monitoring during my surgery would be in network because all the services at Mayo were employees. You can also call the billing department and ask. Other hospitals can contract a service like this, which adds a surprise out of network charge. I think they do need to provide an estimate before a procedure. The doctor doesn’t always know because they don’t do the billing.

Hi @jenniferhunter, so glad you chimed in. I was told the same thing as you, that if your insurance has in-network access then all the providers who work at Mayo Clinic are also in-network because they work exclusively for Mayo. So far I have not found the Billing Dept to be very helpful in clarifying this. The billing superisor was astonished when I told her what my understanding of in-network(with respect to Mayo) was/is!! Billing has been submitting out-of-network claims to our insurance with in-network access at Mayo. Member service from our insurance has verified Mayo is in-network, as well as the list of insurance contracts on the Mayo website. The billing supervisor said she would look into it. Meantime, I was thinking of contacting the pre-certification department or hope that they can steer me to someone who can help resolve this issue. We've run into billing issues since we found out about it in early May of this year. Other than Billing, are there any other dept you think might be able to help me resolve this? We have dealt with billing issues before at other institutions but Mayo is by far the most difficult to work with because their billing is a black hole!!

@caretakermom - I am sorry for your insurance issues. I took the liberty of contacting our operations manager, Chris, in Arizona to see if he has a suggestion of who you can speak with. He said to contact the nurse team at 800-344-6296 during regular business hours. Once they know what your precise issue is, they can help you contact the right team to help. I hope this is helpful for you to get this insurance coverage figured out. Let me know if you aren't able to connect with them. Thanks!

@keggebraaten, I have already spoken with our nurse coordinator and she said to talk to Billing which I already have and they have not been helpful. I need to talk to someone who is in charge of the claims submittal to insurance and find out on what basis they are using to bill out-of-network. It's as though they totally disregarded our benefits that our secondary insurance provides. How do I get in touch with the people who does the claim submittals? Are they located in Rochester?

@caretakermom

I am confused with the statement "Billing has been submitting out-of-network claims to our insurance with in-network access at Mayo." and "secondary insurance provides"

Are you on Medicare, Medicare Advantage plan or type of private insurance.

Is Mayo billing wrong insurance company or are they billing correct insurance company and your insurance company is rejecting as out of network.

Mayo bills the insurance company and the insurance companies decides if in network or not.

Do you have two insurance policy (secondary)? If have two insurance companies listed in your Mayo record, Mayo submits to primary. I had problems once when they submitted to secondary prior to primary and secondary rejected. Mayo just resubmitted to primary.

Good luck
Laurie

@caretakermom - would you be able to send me an email (or private message) so we can discuss this and I can provide you with names and direct phone numbers? I would need the name of the patient and date of birth or clinic number as well, which is the purpose for the private message. I work for the Transplant Center in Rochester, but am able to connect you with Arizona or Florida teams as well, depending upon where the transplant occurred. My email address is: transplant-rst@mayo.edu. Thank you!

@roch,
My husband is the patient. He has Original Medicare A&B and BCBS of Calif as secondary(not supplemental) which is has in-network access to Mayo Az(confirmed by member service as well as list of in-network contractors on Mayo website). Our 2ndary is an employer insurance so I'm on the plan as well.

Mayo is submitting the claims to our 2ndary insurance as out-of-network because they are using out-of-network NPIs. Our 2ndary can only process the service as in-network if the provider, uses in-network NPIs. So it's not true that the insurance decides if in-network; it's a contract between the provider and insurance company. The question is why is Mayo billing our 2ndary with out-of-network NPIs.

We(member services and I)had a conference call last week with the billing supervisor last week and she had no response to the question. Billing supervisor said she would look into it but I have yet gotten a response. I've asked the nurse who else we can talk to about this but she has no idea. It's very frustrating when you're not able to speak to the people in charge of processing the claims directly.

If you have Medicare as primary, have you ever had a service denied under Medicare? Do you ever have to sign ABNs which is a Medicare waiver? We are occasionally asked to sign it because Medicare may/may not cover a service. We are dealing now with a situation where Medicare denied a service and the balance is forwarded to our 2ndary and the claim is billed out-of-network. I believe Mayo should re submit the claim to our 2ndary as in-network. I have already spoken to Billing and they had no explanation about the out-of-network billing. I hope to get an explanation from them soon.