@hello1234, do you mean to speak with the ESRD Specialist in Mayo Billing? I don't believe there is such as a specialist at Mayo. Do you know of the name of the person from Mayo Patient Experience who may be able to help?
I believe Mayo automatically assumes that our secondary insurance is just a supplement, as the majority of Medicare patients have. Mayo doesn't know how to handle EMPLOYER insurance as a secondary to Medicare. It isn't implausible that there are some, not all, people who continue and has to work, even with ESRD(kidney transplant is included in this category). I spoke to a Medicare specialist in ESRD(he is employed by the state of Az and was recommended to me by a Mayo Clinic Az SW) during hubby's transplant recuperation in Az. The ESRD specialist says for people with employer insurance as as secondary to Medicare, the secondary insurance is subject to the employer insurance health plan coverage. Therefore, denial from Medicare is not an automatic denial from the secondary insurance. But apparently Mayo refuses to abide by this rule. Again, all of our other local providers do not have an issue with billing our secondary insurance. Our local providers all bill Anthem correctly(as in-network), except for Mayo Clinic Az.
Incidentally, my hubby did see a Mayo provider prior to transplant(when Anthem was still primary). At that time, Mayo billing sent the claim to the wrong(L.A) office but fortunately, someone at Anthem actually looked at the claim and had to forward the claim to the appropriate Blue office so that it could be processed as in-network. I bet you that's the culprit.
I think this is something Anthem has to help get to the bottom. I worry each time we seek services from Mayo and we're asked to sign an ABN(Advanced Beneficiary Notice) for certain services that Medicare will not cover. Usually that happens if the incorrect diagnostic code is used. And then we have to make a choice to go ahead or refuse these services. If we go ahead with the services then we'll get an out-of-network bill from Mayo. If we refuse the services, then the providers won't be able to give proper care to hubby because we're refusing the services the providers order! We always choose to do the latter, thinking our secondary will cover whatever Medicare doesn't. Instead, we get an out-of-network bill because Mayo billing isn't processing our claims properly!!
All of the services we get from Mayo are ordered by physicians, and not something we're doing voluntarily or convenience. So if the proper diagnostic code is used then Medicare will cover it and therefore the secondary will also regardless if in/out of network. So far I have been able to resolve all the Medicare denial issues by getting the provider to change the diagnostic codes but that takes a lot of time because it has to go thru a different person/dept to make the change. And that's a whole other story that took 3 months to resolve, which Mayo Billing refused to do on our behalf. Fortunately our nurse coordinator is very accommodating and understands my insurance situation and has been able to provide proper coding each time so far. We run into billing issues each time we seek services at Mayo in person. That is why I'm dreading this one-year follow up appointment we have coming up at end of Feb. It will be a 3 day appointment and I'm fully expecting something hubby to sign ABN for some services!!! Sorry for ranting again but it's most stressful not knowing you may get an out-of-network bill!!! I would have better peace of mind if I knew that our secondary would be billed as in-network provider!!

Jump to this post