We miss our Mayo Phoenix... Ever since Medicare kicked in

@SusanEllen66
@vic83
Yes we have been Arizona residents for over 5 years. We were grandfathered in to Mayo with medicare when we turned 65 and went on TRADITIONAL, NOT ADVANTAGE MEDICARE, .because we were patients before we turned 65.
We are still in their system. I have made a dermatologist annual screening appointment with them to see how the billing will go.
But I am DEFINITELY not getting anything serious done with Mayo unless and until this billing catastrophe is resolved.

Funny no AZ major medical people have chimed in.

@phoenixpal, Mayo Az does accept Original Medicare A&B. My husband had his kidney transplant at Mayo Clinic Az in March 2022 and are currently doing follow ups at Mayo Az. He has Original Medicare A&B as primary and BCBS of Calif PPO(employer insurance, in-network with Mayo Az) as secondary. Services covered by Medicare have maximum allowable payments set by Medicare and are accepted by Mayo Az. The payments are made by Medicare (80% of max allowable) to Mayo Az. and the rest (20%) goes to our secondary insurance. Our secondary, subject to the deductible, covers everything Medicare covers. The billing issue arises on non-Medicare covered services(not deemed medically necessary by Medicare), Mayo Az submits out-of-network claims to our secondary even though the secondary has in-network access. Transplant requires many services/follow-ups, esp labs, and not all are covered by Medicare. I have confirmed in-network status with member services as well as the list of in-network contracts on Mayo website. Member services say Mayo must submit claims properly(use in-network NPIs, etc) in order of us to get the in-network benefits. I've talked to Mayo Billing but as usual they did not have an answer. The billing supervisor said she would look into it and I have yet receive an explanation. The out-of-network billing came as a surprise to us especially pre-certification and insurance approvals were done multiple times during transplant workup, transplant listing, right before transplant, transplant and post transplant. Like you, I'm trying to find the right contact at Mayo who can help clear up this mess!
We love the services at Mayo Az but the billing has been very confusing to us!!

Hi @phoenixpal, in addition to the responses you received from fellow AZ "zoners" @dandl48 and @caretakermom, allow me to bring @danab @starko @estrada53 @bobvan @dpcarriere @waynen @wrig1jam who have had care at Mayo Clinic Arizona.

You may wish to contact Mayo AZ about specifics with your insurance and situation through your patient portal account or call Patient Appointment Services 480-301-8484

For guidance on Medicare you can contact Medicare at 1-877-839-2675 to be connected with your local Area Agency on Aging where trained counselors can help walk through options.

Thanks. Yes I am planning to call before my upcoming appointment to see what they recommend and if any Mayo/Medicare rules have changed since my TKR in Feb. 2020.

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.

@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!!

Hi Paul and welcome, I too have been in a roller coaster ride when I was originally on BCBS federal which did well with my original transplant year but became out of network after the first year. I had complications unrelated to the transplant itself but stemed from the reduced immusupresion and the recurrence of viruses which required an expensive treatment. So because BCBS was now out if network I would receive the check from BCBS and cash it then send a personal check to Mayo with the Eob and figured it would be applied to the appropriate bill. But this didn't happen and I was now treated as self pay. Well this raised the cost to me of everything. I'm still in negotiations on this matter now 3 years later but it appears it will work out in my favor.
This all happen in 2019 and in 2020 I started getting my National Guard pension which came with it a secondary insurance of Tricare which is an accepted insurance by Mayo but because of the BCBS as primary it fell to secondary. So this added to the confusion as tricare wanted to know what BCBS paid before they would pay anything. But with BCBS not sending EOB to Mayo directly, Mayo billed tricare directly without the amount that BCBS paid and was denied on that bases.
Thats the nightmare I've been going thru for over 2 years now. Finally after many phone calls my account just this year has been frozen to evaluate what happen. I've paid about 13,000 our of pocket and figure they owe me some back. Now realize I had a very expensive transplant of close to a million dollars so I'm not upset to pay some. But in my case I have insurance that will pay but needed additional information which wasn't provided. So in my case it a matter if resubmitting the correct information to the secondary insurance and receiving the money they would normally pay, thus reducing what I owed.
Now I ended up working with Lisa in the Social Workers dept to help navigate this whole area and She helped me alot to get to the right person in the finance dept who has been very helpful in figuring out how to fix this. He is still working on it in my case but it's in the finial stages now.
So to wrap up, I now have Medicare A&B with Tricare for life as secondary and haven't paid anything out of pocket since those became effective. Hope that helps and good luck with your situation. Keep at it is my advice.
Blessings

Thank you @danab for your thoughtful and detailed reply. Man you've got it even more complicated than us with our original medicare and BCBS.

I wish you well in sorting out your billing nightmare!

Thanks everyone for their references on helpful people to contact. I will refer back to this thread for their names next time billing gets all messed up.

Meantime my wife & I are both looking forward to trying simple office checkups.

Cheers All!

WELL WELL WELL... STOP THE PRESSES!!! I have JUST received this reply to my question to Mayo Portal from Patient Account Services. Apparently medicare billing has changed since my 2020 TKR!

"Good afternoon Paul,
Thank you for contacting Mayo Clinic Patient Account Services. We apologize for the delay in responding to your message.

We understand your frustration as we were frustrated as well with Medicare billing. Previously, Medicare paid patient directly; however, this has changed and Medicare now pays Mayo Clinic directly after they receive the claims from Mayo Clinic so you will not have the same frustration as you did a couple of years ago. If you have additional questions, please call Patient Accounts at 844-217-9591.. "

Paul, I really appreciate your sharing the resolution to this complicated issue, and the info for others. ***I'm throwing confetti***