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Autonomic Disorder and Coverage for Mayo's Pain Rehab Program
Depression & Anxiety | Last Active: Nov 28, 2023 | Replies (10)Comment receiving replies
Hi @kari3057, I can see that you are concerned about coverage to be able to take advantage of Mayo Clinic's Pain Rehab program. You posted multiple messages in several groups, which I have merged into one discussion that appears in the Chronic Pain, Depression & Anxiety and Visiting Mayo Clinic support groups simultaneously. That way you don't have to monitor 3 different discussions.
The best ways to get direct answers about billing and coding related to Mayo Clinic and your insurance is to contact Mayo's Billing & Insurance department on Monday https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/contact-us
In the meantime, let me connect you with other graduates of the Pain Rehab Center (PRC) at Mayo, like @rwinney @sophiaaa @skier @boltz7555 and others so they can share their experiences both with paying for the program as well as their outcomes.
Which location are you and your son hoping to attend?
Replies to "Hi @kari3057, I can see that you are concerned about coverage to be able to take..."
Hi Colleen, thank you (and I thanked you in a related response to my post)
My son wants to attend the Rochester program. (and bring his snowboard for the weekends :). We have family in the Twin Cities and Madison so we could see them as well.
in the meantime, I've spent more time researching and on phone calls.
I need Mayo to submit a formal preauthorization request to my insurance company. They haven't done this. Without a formal request, CareFirst BCBS has nothing to consider/authorize. Our week of Mayo appointments in early October were fully covered. (my only bill is a $35 copay.) which is why this is so bizarre.
We have a case manager. She and her higher ups are willing and able to help but they can't do anything without Mayo's precertification request. They can see a precert request from another provider from the spring. But BCBS has no record of a Mayo precert request.
I spoke with Mayo's precert team and was told they couldn't make a request. But BCBS evaluates preauthorizations/pre cert requests. and they make redeterminations if denied. They can't do anything without a formal pre-cert request.
I can't make the request. My case manager and her bosses also can't.
How do I get Mayo to do it?
thanks,
Kari
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Hi @kari3057, my apologies for the delayed response to your question about Mayo insurance coverage and your daughter attending the Pain Rehab Center.
First off, I'm sorry to learn your teen is going through this at such a young age, but how incredibly proud you must be that she understands this early in the game that medicine alone won't fix things. So very true.
While I don't have experience with financial assistance at Mayo, I did have to wait to attend the PRC program until my insurance open enrollment time when I switched to a plan that covered out of network care as I'm from NY and went to Florida's PRC. Which PRC is your daughter looking to go to?
You mention coding being the problem. I agree with Colleen, dig right in and contact both your insurance company and Mayo to understand as much as possible and find out what needs to be done to make it work. I can attest that having your daughter attend the PRC program will be a life changing experience for her. It is an amazing program that really helps turn lives around.
Have you had a chance to contact Mayo's billing and insurance yet? How'd you make out?