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We miss our Mayo Phoenix... Ever since Medicare kicked in
Visiting Mayo Clinic | Last Active: Nov 10, 2022 | Replies (37)Comment receiving replies
Wow, thanks @caretakermom for that detailed response. I hope that your husband's recovery is going well.
You are the 1st person that I've met in these discussions that has an identical situation: Traditional Medicare A&B and out of state BCBS, and mine also is carried on into retirement from my employer.
So are you saying that you also received dozens and dozens of random amount checks from Medicare and sent that amount to Mayo, and Mayo was happy? And that BCBS was ok paying the remainder?
My wife tells me that she read on Mayo's site that out of state BCBS is considered in Network. Our's Empire (NY) BCBS was specifically listed.
Interesting that you said Mayo filed yours as out of network...
I just reread what you wrote and indeed it sounds like you are in our billing nightmare of 2 years ago.
We even insisted on multiple 3 way conference calls between ourselves, Mayo billing , and BCBS.
In the end, a year and a half later we just payed the thousand or so dollars remaining as Mayo was threatening to send it to a collection agency.
And we haven't been back to Mayo since.
Replies to "Wow, thanks @caretakermom for that detailed response. I hope that your husband's recovery is going well...."
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@phoneixpal, as far as I know (and I just spoke to our nurse coordinator this morning), Mayo Clinic Az does accept Original/traditional Medicare A&B. They do not accept the Medicare Advantage Plan(HMO).
My husband has Original Medicare A&B and is still currently employed full-time with employer insurance as secondary- BCBS of Calif PPO. He is under 65 yrs old but qualifies for Medicare because he is ESRD(End Stage Renal Disease). Our sec insurance is out-of-state but it has in-network access with Mayo Clinic Az(listed as in-network on Mayo Clinic's website and also confirmed by our member services). Our sec insurance is NOT just a medigap; it is another(extra) insurance that may cover what Medicare doesn't cover, based on the employer insurance plan policy.
For services and labs covered by Medicare, Medicare sends payments to Mayo as does BCBS. We do NOT ever get checks from Medicare; Medicare sends payment electronically to Mayo. Most of the services/labs my husband gets at Mayo Az are covered by Medicare but occasionally we do get some that are NOT covered by Medicare. So for non-Medicare covered services/labs, Medicare will deny coverage and an out-of-network claim is then sent to BCBS. The question I have for Mayo is, why is Mayo billing BCBS of Calif PPO out-of-network, when Mayo has a in-network contract with BCBS of Calif PPO? I believe Mayo needs to file these kinds of claims as in-network because our employer insurance has in-network access. Our employer insurance is independent of Medicare and coverage is based on the employer policy plan. This means that anything Medicare doesn't cover, our employer insurance may still cover it but it must be submitted properly to get the proper coverage, i.e. submit the claims as in-network to get in-network coverage.
I have called Billing about this and ask for an explanation. Of course even the billing supervisor couldn't answer my questions. She promises to get back to me but I have yet to hear from her.
I hope you understand what I'm trying to say. It is all very confusing!!