How did you manage continuity of care when changing insurance?

Posted by jdd @jdd, Oct 11, 2022

I was diagnosed with gastroparesis at Mayo in Arizona in August of last year. To be brief, after following all recommendations I got a GJ tube in May, which has at least stopped the weight loss, but am still severely nauseated daily.

Three months ago I started have severe muscle tension (fishing line tightness) on the right side of my body, along with pain and weakness in my right calf, which has since spread to all my limbs.

I’ve already received a clear MRI at a local facility, and am scheduled for more testing at Mayo in November, but my Cobra coverage is going to expire before then.

Everything we’ve been able to find on the health exchange marketplace puts anything out of state (Mayo) out of network. Does anyone know of/have recommendations for elsewhere to look for private coverage for an individual? It’s overwhelming to think of having to start care over somewhere else in state and start with new doctors in a totally different system.

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@jdd, I adjusted the title of your discussion to reflect more accurately the primary question about having to change insurance provider, how might you maintain continuity of care.

You may find some good information in this related discussion:
- Does Mayo Clinic take Medicare? https://connect.mayoclinic.org/discussion/does-mayo-clinic-take-medicare/

I agree that it would be overwhelming to start over again with new doctors in a different system. Have you considered calling Mayo Clinic's Insurance & Billing (https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance) to ask about private insurance options accepted by Mayo Clinic?

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Thank you Colleen.

We already spoke to Insurance and Billing and were told they cannot give us a list/recommendation, but that “there are plans available out there, you just have to look”.

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@jdd

Thank you Colleen.

We already spoke to Insurance and Billing and were told they cannot give us a list/recommendation, but that “there are plans available out there, you just have to look”.

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Dang, I guess that makes sense that they can't recommend insurance providers. However, the website lists plans that Mayo accepts, which may help as you shop around.

Let me tag a few members who may have some thoughts or experiences to share and next steps you might try regarding finding an insurance plan that will ease the continuity of care like @roch @naturegirl5 @mikaylar @jenatsky @amkaloha @ess77 @jenniferhunter.

@jdd, have you considered consulting with a social worker? They can help wade through insurance stuff.

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How frustrating it is when insurance company controls where and who you go to for medical care. I am not insurance expert, but will share what I do know. Based on comments, I am guessing you are under 65 and not on Medicare.

- Every state is different, there is no universal rules / policies. It really depends on state you live in and state where the clinic you want to go to.
- Even though your COBRA is ending, do you have option to continue same policy paying a higher rate? When I had used up all my COBRA, I was able to pay higher rate and stay on similar policy. I worked for large international company and though laid off, was considered retired without medical insurance.
- Does the insurance company that you have for your Cobra insurance also sell individual policies with similar coverage?
- Do the company's you are looking at have exceptions for referrals to specialist?
- When shopping for insurance companies and trying to figure out if Mayo is in network, it is important to make sure the insurance company is looking at correct Mayo location. Each Mayo location has separate insurance rules and Tax ID. It is my understanding that best way to determine if in network or not is by Tax ID. When I was shopping for in-network coverage before I went on Medicare, the representative ask me for Tax ID. You can find Mayo Tax ID per location at https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/faq

Maybe ask on forum what non-employee insurance policy people have that live in your state and go to Mayo Arizona that are not on Medicare.

Good luck,
Laurie

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@colleenyoung

Dang, I guess that makes sense that they can't recommend insurance providers. However, the website lists plans that Mayo accepts, which may help as you shop around.

Let me tag a few members who may have some thoughts or experiences to share and next steps you might try regarding finding an insurance plan that will ease the continuity of care like @roch @naturegirl5 @mikaylar @jenatsky @amkaloha @ess77 @jenniferhunter.

@jdd, have you considered consulting with a social worker? They can help wade through insurance stuff.

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I received a letter from Mayo that Mayo is not in network for any Medicare Advantage plans. They accept regular Medicare and Medigap supplementals. My research found that Plan G (open to anyone who pays the premium) or F (special qualifiers based on when you turned 65 and applied). Checked Forbes and Consumer Reports and determined for my husband and me, Fla Blue, United Healthcare or Humana had the best options. You should do some research as many insurance providers have plan G. We based it in coverage (most are comparable) and cost. Still have not chosen the winner.

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@colleenyoung

Dang, I guess that makes sense that they can't recommend insurance providers. However, the website lists plans that Mayo accepts, which may help as you shop around.

Let me tag a few members who may have some thoughts or experiences to share and next steps you might try regarding finding an insurance plan that will ease the continuity of care like @roch @naturegirl5 @mikaylar @jenatsky @amkaloha @ess77 @jenniferhunter.

@jdd, have you considered consulting with a social worker? They can help wade through insurance stuff.

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Where does one find a social worker? I need one for my disabled son. Can’t seem to find an advocate to help with medicaid application. The online process is a joke. One needs an advocate.

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@gaildw67

I received a letter from Mayo that Mayo is not in network for any Medicare Advantage plans. They accept regular Medicare and Medigap supplementals. My research found that Plan G (open to anyone who pays the premium) or F (special qualifiers based on when you turned 65 and applied). Checked Forbes and Consumer Reports and determined for my husband and me, Fla Blue, United Healthcare or Humana had the best options. You should do some research as many insurance providers have plan G. We based it in coverage (most are comparable) and cost. Still have not chosen the winner.

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Did not see you were not on Medicare. This is not applicable response.

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@gaildw67

Where does one find a social worker? I need one for my disabled son. Can’t seem to find an advocate to help with medicaid application. The online process is a joke. One needs an advocate.

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There are a few places you might try for finding help. Sometimes the "expert" you need to help you is not a social worker.
If you or your son are affiliated with a religious organization, try reaching out to them - they often have volunteers who can help. When I was making an application for my Mom, Catholic Social Services had a retired social worker who helped me over the rough spots, knowing exactly what language to use and what paperwork I needed.
If your son is part of any group or network related to his disability, that is another place to ask, they often have connections.
If not, reach out to you state agency on disability - they should be able to provide a list of resources in your immediate area.

I hope I have given you some places to reach out to - sorry not to be more specific, but Medicaid is different in every state, so there is no single answer.
Sue

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@gaildw67

Where does one find a social worker? I need one for my disabled son. Can’t seem to find an advocate to help with medicaid application. The online process is a joke. One needs an advocate.

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Gail, @sueinmn’s response was a lot more helpful than mine. I agree that you are probably already connected to organizations that can help wade through the insurance questions and specifics.

You may have access to a social worker through your PCP or health care facility where your son receives care.

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@gaildw67

Where does one find a social worker? I need one for my disabled son. Can’t seem to find an advocate to help with medicaid application. The online process is a joke. One needs an advocate.

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Hello @gaildw67
To apply for Medicaid for your son, you will need to apply through your state. I work for the Iowa Dept. of Health and Human Services (HHS) formerly DHS. I would search online for your State’s website. In Iowa you can apply online, and I would think that would be the case in other states. Depending on whether or not your son is an adult or minor, there may be resource (asset) limits, as well as income limits. There are various programs he may qualify for, but you really need to file an application to start the process. If your son is disabled make sure to indicate that on the application. They will likely send a request for information for verification of income and possibly resources after the application is filed and you should get the phone number of the worker who will process his case at that point. There should be a phone number on the website as well for general questions. A hospital social worker may have paper forms available as well. Hope this helps.

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