HMO Insurance--Experiences getting care authorized?

It’s simple. You have an HMO for your coverage. HMO’s require pre-authorization for almost all activities that are not referred within their contracted networks and/or are not within their prescribed procedure lists. HMO equals “Managed Health Care’….i.e. they “manage what you can and cannot have done and where you can and cannot go for services..

Again, it’s buyer beware. While HMOs may save you or you employer premium dollars, they also cost the the quality , level and flexibility of care, especially when “things get complicate”. Problem with HMOs is you don’t know exactly how and what they will approve until you need the care.

Now back to the issue. You are responsible to contact your provider and ensure they get what they need to make the decision….. also, no guaranties. The process can go two ways. Your provider via a referral from your in-network prover can make a referral to Mayo and trip your provider to query Mayo. The other side will be YOU can contact the Mayo Financial Responsibility office, provide your managed care information and they “may” request the pre-authorization…. Just be aware Mayo has no obligation to manage the process of getting authorization…it may be done as a courtesy…. Ultimately YOU own all activities related to your care….

I take it you are going to MN. Fact is FL and AZ are clear they do not accept ANY HMO, advantage or other forms of managed care plans….we get a letter every year reinforcing the policy. MN takes “some” managed care due to agreements the clinic in MN has with the state….

@casecor
I have found it very frustrating dealing with insurance companies. Is Blue Care Network in MI a Medicare Advantage plan, or are you under 65?

The previous comment raised a good question: did your provider do a referral, or did you contact Mayo directly? My suggestion is to contact your insurance company and ask about requirements for pre-authorization.