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dreamingingreen
@dreamingingreen

Posts: 6
Joined: May 17, 2016

Insurance Question

Posted by @dreamingingreen, May 17, 2016

I am scheduled to visit the Rochester Mayo Clinic, which is in my insurance network. This is a question that is specific to how a facility such as the Mayo Clinic works with insurance, so please don’t tell me to contact my insurance company :-), other than telling me is that I’m in network, the information I’ve gotten from my insurance company is lacking.

I have been given only an initial appointment, and told to plan on being in Rochester for a week. I assume the initial appointment will determine what additional tests need to be done during that week.

With all other significant tests (at other facilities) to date, what always happens is the doctors office submits requests to the insurance company for approval, then I wait several days for the approval, and only then are the tests scheduled days or weeks later. Since it appears the Mayo Clinic uses a shotgun approach (I used that term in the most positive of ways), and evidently a lot of tests are all going to happen within this one week, how will I know the tests being done will be covered? In other words, if I’m showing up on Monday, and they’re actually going to be doing tests that week, it seems as though there would not be time for the insurance company to approve the tests? Will the Mayo Clinic be getting approvals, or are they somehow immune from this requirement?

I’ve had very bad experiences with insurance companies and my worst fear is going home and finding out I have a hundred thousands dollars worth of bills my insurance company does not approve.

Thank you in advance for any insight you can provide.

REPLY

Following up on my own post, I should note that it’s possible Mayo has already obtained insurance company approvals for tests, but since so far I’ve only been told about an initial appointment, I just assumed (perhaps incorrectly) that tests were going to be decided on when I arrive. Hence my question about how insurance company authorization will be obtained in such a short period of time. Hopefully my questions/concerns here make sense.

I did call my insurance company but they could only tell me Mayo is in network, and told me they would need codes to approve any procedures.

Hi @dreamingingreen. Welcome to Connect and i’m so glad to hear you’ve chosen Mayo Clinic for your care! This is a great question and it’s very good that you are doing your due diligence and checking this out in advance. I’ve been in one of those insurance situations before (not at Mayo Clinic) and it can make you feel so helpless. Unfortunately though, this is not an area of expertise for me so I can’t answer your question, but if you call Pre-Appointment Business Services at 507-284-0390 the should be able to help. Also, here is a Mayo Clinic site on billing insurance (which you may have already seen): http://www.mayoclinic.org/patient-visitor-guide/minnesota/billing-insurance. Once you talk to them, i’d be interested to know what information they give you since i’m sure others have the same question 🙂

I’m also tagging @christinemack who had a question about this during a visit back in April and she may be able to provide some insight. Hope this helps!

@kelseydm

Hi @dreamingingreen. Welcome to Connect and i’m so glad to hear you’ve chosen Mayo Clinic for your care! This is a great question and it’s very good that you are doing your due diligence and checking this out in advance. I’ve been in one of those insurance situations before (not at Mayo Clinic) and it can make you feel so helpless. Unfortunately though, this is not an area of expertise for me so I can’t answer your question, but if you call Pre-Appointment Business Services at 507-284-0390 the should be able to help. Also, here is a Mayo Clinic site on billing insurance (which you may have already seen): http://www.mayoclinic.org/patient-visitor-guide/minnesota/billing-insurance. Once you talk to them, i’d be interested to know what information they give you since i’m sure others have the same question 🙂

I’m also tagging @christinemack who had a question about this during a visit back in April and she may be able to provide some insight. Hope this helps!

Jump to this post

Thanks so much Kelsey, “helpless” sums it up well. I’ll call the number you listed and in the meantime if anyone who has experienced this can offer input on how it works, or how it worked for them, I’d appreciate it.

Unfortunately, I had one experience of two MRIs getting denied by my insurance company because they were not prior approved. I learned that Mayo does not submit anything for prior approval. I challenged these charges with my insurance company and ultimately my states insurance commission. They ended up covering one of the tests. Turns out the doc made a comment in notes that the other was schedule as a convenience for the patient so no coverage. My assumption is this convenience was to have both tests as once and really was the best decision in my situation. I was definitely on my own to figure out what to do and unfortunately in my position was not best able teo fight it much. Live and learn!

All this to say your concerns are warranted and I do have a suggestion. I ask for codes before every appointment and test scheduled now. They’re easy to get when you ask. I ask for them from whoever schedules and then call their business office. They’ll provide everything, including charges.

I also will say that I firmly believe going to Mayo Clinic saved significant time in my diagnosis, consequently all my expenses were in one plan year. Even with the added expense of my uncovered test I believe it cost me less than elsewhere. They worked with me to either provide a payment plan or discount if I paid cash. They told me they’d offer this one time so I am definitely approaching things differently now.

And…sorry so long…I checked my last appointment out beforehand like I said above. My insurance company handled differently than what they had told me. I had made sure to document who, when, what to go back and address with them if needed My notes prevailed.

All in all I will say that when you’re not sure, ask at Mayo and trust them. They are amazingly efficient and don’t want anything unnecessary as much as you.

I’ve been fortunate that I’ve had little difficulty getting everything paid
for during Mayo visits.There were 2 times when insurance denied, genetic
testing and a test very few centers perform. Mayo sent additional
documentation defending rationale for testing and both were covered without
intervention by me. I’m actually a nurse and started working in Utilization
Management in a hospital shortly before my first Mayo visit and have
learned much about claims, coverage, denial process and physician
documentation. Also, unfortunately it seems lately the trend of insurance
companies is leaning towards denials. I continue to be followed by Mayo
physicians and at times wonder if a test will be paid for, but I wont late
that deter me from proper medical care. Except for MRI, CT scans outpt
testing needs no prior auth with my insurance plan, but that doesn’t mean
it will be covered. Its all based on plan coverage and what is deemed
medically necessary by insurance company’s physician advisor. With the
genetic tests, I did sign a form stating that I would be financially
responsible if not paid for by insurance, but Mayo would assist with appeal
if needed, which they did. Bottom line is, I don’t think there is ever a
guarantee of full payment. In my experience, I’ve not had any unecessary
tests performed during my Mayo visits and continue to trust their judgement.

@jharsh and @jomama thank you for the information, very helpful.

My experience with the Mayo Clinic in Jacksonville is very positive. I would suggest you call the office in charge of billing at your Mayo Clinic and they’ll be able to figure it out. However, it is still best if you get a pre authorization from your insurance company.

Ruth Buchanan

Your concern is legitimate and I know how you feel about insurance companies. I feel the same way. You should be just fine since Mayo is ‘In-Network’ for your plan. We’ve had alot of work done at Mayo with two different insurance companies and everything has been covered. In our case, they contacted the insurance company to get approval for a $10,000 injection. They say prepare for a week, but it usually won’t take that long. Please call and ask what (initial) tests are planned for you and how will you know if they will be covered by insurance.

Has anyone ever dealt with Mayo (Jacksonville) under Medicare and a BCBS Supplement?

Hello @amkaloha, Great question! Thank you for starting a new discussion dedicated to this topic, where our Florida communications specialist was able to get some answers for you.

For anyone else interested, please see this discussion- Medicare and Mayo http://mayocl.in/2iss7GB

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