Seniors with Medicare, is Mayo worth the hassle?

Posted by Paul @phoenixpal, Mar 7 9:07am

If your answer is "yes", please share: How do you do it ?!?

We have been with Mayo for almost 4 years. It has been wonderful service.
I've also had a great BCBS PPO that was practically seamless. I never saw a bill, just an occasional $20 copay.

And then, I turned 65, went on Medicare, and the billing nightmares began. Without a chronic illness, it has taken 18 months for me to realize how difficult this is going to be from now on. In April my wife turns 65, so the billing/paperwork dysfunction will double.

Example: Last October my Mayo primary care prescribed a colon cancer screening colonoscopy. It had been 10 years since my last (paid for 100% by BCBS). While there, they found 2 polyps worthy of biopsy. (They were negative.) Mayo filed with Medicare first, as my primary insurance. It turns out that the two procedure codes conflict: one a screening test, the other a diagnostic procedure (the polyp biopsy). Because of the code conflict, Medicare will only pay for one of the two parts. I now have to appeal to Medicare by re-submitting all of Mayo's medical notes myself. Whatever Medicare declines to pay, the secondary (my BCBS) automatically declines to pay as well.

Now, two weeks ago I had a $48,000 TKR. I am sure that the surgery was first rate, world class at Mayo. But, I am now watching the billing itemization role in to Medicare. There was, for example, a $3 blood draw charge, an $18.30 EKG for which Medicare has now sent me a $2.98 check to pay Mayo etc etc … up to $48K

Sure, Mayo has a great reputation. But as a patient having to deal with these Byzantine medical billing and coding issues, and having to manually pay Mayo with the checks that Medicare sends me, is it worth the time and headaches? I am sure that in a big city like Phoenix, there are plenty of good, qualified doctors who work with Medicare. Why would we stay with Mayo?

I see a lot of seniors over at Mayo. How are they dealing with this ?!?

Hi, @phoenixpal – it does sound like things have gotten more complex with your Mayo Clinic billing process now that you're on Medicare.

@peck1944 @amkaloha may have some input as you weigh your options regarding Mayo Clinic with Medicare coverage, and perhaps also @jenniferhunter and @johnbishop will have some input on whether navigating the complexities of Medicare in the state of Arizona.

Have you perhaps spoken with the Mayo billing office to see if there's anything that might simplify things?

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Hi. I just spoke with Mayo in Jacksonville yesterday and I still cannot get an appointment in the GI department. I asked if there might be a possibility at Mayo in Phoenix and they didn’t know. I live in Jax and I don’t have confidence in the other facilities here to treat my gastroparesis. The Nissan Fundaplication from 5 years ago is failing and I have another hiatal hernia. Medicare is my primary insurance and I also have BlueCross BlueShield. Mayo doesn’t want Medicare patients. I am just trying to manage on my own. No medical care is better than poor medical care. I hope you are successful in getting Mayo to take you.

Liked by Paul

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Hi, @phoenixpal – I have been a Mayo Clinic patient in the Rochester, MN area since the late 1970's but I did have some billing issues for a short time when my employee HMO did not have Mayo Clinic as my in network provider. Once I switched over to a plan with Mayo as the in network provider I had no problems. I really think a lot of the billing issues are due to the insurance companies. I'm now 76 and have a Medicare Advantage plan (MN UCare) and it is great. I have a $20 copay for regular appointments and recently had a TKR which was covered really well and didn't cost much out of pocket for me. My wife also has Mayo Clinic as her in network provider but has BCBS through her job but her coverage is not very good…but then with her good health it isn't quite as important for her.

I've never had just Medicare insurance with no other coverage as I don't think it's that good (just my opinion). Do you have an insurance adviser that can help explain Medicare billing and charges? Medicare also has some online information that may help:
https://www.medicare.gov/your-medicare-costs/get-help-paying-costs
Also, have you talked to the Office of Patient Experience about this issue? I wonder if they may be of help. Here's their contact info: https://www.mayoclinic.org/about-mayo-clinic/patient-experience

Liked by Lisa Lucier, Paul

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@phoenixpal I have been to Rochester 13 times since 2015 being on Medicare with a BCBS supplement and have been billed a total of $8.00 which I have been paid with BCBS reimbursing me at a later date, so yes it is worth it. I do understand that Phoenix is tougher to get into for Medicare patients. I did ask Mayo, Phoenix and was told that it's about the State laws being different although they couldn't explain it further. I've also been told that it is easier to get into Phoenix if you are first a Rochester patient but that hasn't been confirmed. Once I get my Barrett's under control again, I will be testing out that ease of getting admitted to Mayo Phoenix since I have family in S. Cal which would make visiting Mayo easier because it is now 2100 miles drive from my home to Rochester.

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@lisalucier

Hi, @phoenixpal – it does sound like things have gotten more complex with your Mayo Clinic billing process now that you're on Medicare.

@peck1944 @amkaloha may have some input as you weigh your options regarding Mayo Clinic with Medicare coverage, and perhaps also @jenniferhunter and @johnbishop will have some input on whether navigating the complexities of Medicare in the state of Arizona.

Have you perhaps spoken with the Mayo billing office to see if there's anything that might simplify things?

Jump to this post

Thanks Lisa. Have I spoken to the Mayo billing office? Oh yes, phone calls and emails to Customer Service via the portal (good to have written record of things said), and calls with BCBS (originally thinking they were to blame for the mess), and calls to Medicare.
In January Mayo Customer Service agreed that there was a problem with the 2 different codings for the colonoscopy and that it would be sent for review. I just found out that the review was done and the coding stands. I owe Mayo $1000, and can only challenge it through Medicare.

Liked by Lisa Lucier

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@peck1944

Hi. I just spoke with Mayo in Jacksonville yesterday and I still cannot get an appointment in the GI department. I asked if there might be a possibility at Mayo in Phoenix and they didn’t know. I live in Jax and I don’t have confidence in the other facilities here to treat my gastroparesis. The Nissan Fundaplication from 5 years ago is failing and I have another hiatal hernia. Medicare is my primary insurance and I also have BlueCross BlueShield. Mayo doesn’t want Medicare patients. I am just trying to manage on my own. No medical care is better than poor medical care. I hope you are successful in getting Mayo to take you.

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Wow Peck, sorry to hear that 3 years on you are still in this bind. You are right, POOR medical care is to be avoided. We would love to stay with Mayo if we reasonably can. We were told that Medicare "does not take new patients that are on Medicare". But, since my wife and I were only on BCBS, not yet 65, we were welcomed and then "grandfathered in" when Medicare started.

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@johnbishop

Hi, @phoenixpal – I have been a Mayo Clinic patient in the Rochester, MN area since the late 1970's but I did have some billing issues for a short time when my employee HMO did not have Mayo Clinic as my in network provider. Once I switched over to a plan with Mayo as the in network provider I had no problems. I really think a lot of the billing issues are due to the insurance companies. I'm now 76 and have a Medicare Advantage plan (MN UCare) and it is great. I have a $20 copay for regular appointments and recently had a TKR which was covered really well and didn't cost much out of pocket for me. My wife also has Mayo Clinic as her in network provider but has BCBS through her job but her coverage is not very good…but then with her good health it isn't quite as important for her.

I've never had just Medicare insurance with no other coverage as I don't think it's that good (just my opinion). Do you have an insurance adviser that can help explain Medicare billing and charges? Medicare also has some online information that may help:
https://www.medicare.gov/your-medicare-costs/get-help-paying-costs
Also, have you talked to the Office of Patient Experience about this issue? I wonder if they may be of help. Here's their contact info: https://www.mayoclinic.org/about-mayo-clinic/patient-experience

Jump to this post

Thanks John. I'm glad that it is working for you. So is that your system then, where you deposit every little check that Medicare sends you and then pay that same amount to Mayo, and it nulls out your Mayo bill? Or, does your Medicare Advantage plan work differently?

That's the first I've heard of the "Office of Patient Experience". I'll have to at least consult with them if we decide to leave Mayo. Meanwhile, as I was told today, I'm on the hook for that $1000 portion of my procedure. And, since it now dates back to October, I need to just pay it before the guys with the baseball bats show up at my door! :-/

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@phoenixpal

Thanks John. I'm glad that it is working for you. So is that your system then, where you deposit every little check that Medicare sends you and then pay that same amount to Mayo, and it nulls out your Mayo bill? Or, does your Medicare Advantage plan work differently?

That's the first I've heard of the "Office of Patient Experience". I'll have to at least consult with them if we decide to leave Mayo. Meanwhile, as I was told today, I'm on the hook for that $1000 portion of my procedure. And, since it now dates back to October, I need to just pay it before the guys with the baseball bats show up at my door! :-/

Jump to this post

Medicare payments don't come to me, they go to through my insurance company. What I pay is what they don't pay on the agreed charges (between Medicare, Medicare Advantage and Mayo). I get the patient owed charges sent directly to me with no checks from Medicare. Medicare monthly cost comes directly out of my Social Security checks.

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@dandl48

@phoenixpal I have been to Rochester 13 times since 2015 being on Medicare with a BCBS supplement and have been billed a total of $8.00 which I have been paid with BCBS reimbursing me at a later date, so yes it is worth it. I do understand that Phoenix is tougher to get into for Medicare patients. I did ask Mayo, Phoenix and was told that it's about the State laws being different although they couldn't explain it further. I've also been told that it is easier to get into Phoenix if you are first a Rochester patient but that hasn't been confirmed. Once I get my Barrett's under control again, I will be testing out that ease of getting admitted to Mayo Phoenix since I have family in S. Cal which would make visiting Mayo easier because it is now 2100 miles drive from my home to Rochester.

Jump to this post

Dan…. lol… your Mayo is 2100 miles away!? Ours is literally 5mi / 12min away! It's worth staying just for the geographic convenience.

Our excellent BCBS PPO group policy from my former employer is still the same policy, but it is now our secondary after Medicare. We used to be embarrassed talking about our BCBS with friends when we watched them struggle with their own almost useless policies with their huge premiums and huge deductibles. Our BCBS group policy is from a large international organization that must have European healthcare standards.

But that wonderful policy doesn't appear to help with the Mayo/Medicare headache.

Does your Rochester Mayo get paid directly from Medicare or do they funnel all the random itemized checks through you? Maybe that's the difference between state laws that you mention… (?)

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@johnbishop

Medicare payments don't come to me, they go to through my insurance company. What I pay is what they don't pay on the agreed charges (between Medicare, Medicare Advantage and Mayo). I get the patient owed charges sent directly to me with no checks from Medicare. Medicare monthly cost comes directly out of my Social Security checks.

Jump to this post

My experiences with Medicare are the same as yours, @johnbishop I've never gotten a check from Medicare, they pay everything direct and I only get statements of what they paid to the provider. I also pay the same way via my SS.

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@IndianaScott

My experiences with Medicare are the same as yours, @johnbishop I've never gotten a check from Medicare, they pay everything direct and I only get statements of what they paid to the provider. I also pay the same way via my SS.

Jump to this post

Thanks Scott. I'm assuming that like John, you are also dealing with the Rochester Mayo.
I guess I need to hear from any Arizona Mayo seniors about their Medicare/Mayo experience.

BTW, another complicating factor for me, although again, it wasn't that big of an issue pre-65/medicare, is that my BCBS policy is out of state, not an Arizona BCBS. But again, with all the retirees here in AZ, I'm sure I have a lot of company on that score too.

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@phoenixpal Having an out-of-state BCBS shouldn't be a problem. I've lived in So. Oregon for 2.5 years and have gotten treatment in OR, CA, MT. & Minn with BCBS from Montana.

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