Mayo Clinic Question
 

I called the Mayo Clinic to make an APPT. and was told they do not particapate with Medicare ! They will send the claim for you to Medicare and medicare will send you the check; in addition they charge an additional 15% over the Medicare approved amount.



I attended the seminar they had here in the Villages a few months ago.
Why would they have a seminar here knowing so many Villagers are on Medicare if they don't accept medicare ?

Has anyone used their services and how did the payments work out ?

(2010) ".....Mayo says it lost $840 million last year treating Medicare patients, the result of the program's low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers....."

Read more:
Medicare and the Mayo Clinic - WSJ.com

Many of the best hospitals won't accept Medicare's low reimbursement rate which is why a supplement is a good idea.

Even now, some of the best docs (the cutting edge surgeons) won't accept any insurance - the guy who did my gastric bypass and was one of the best in the country was cash only and - for a while - Midwest Orthopedics who replaced my hip using outpatient surgery was cash only)..BTW - I carry Blue Cross PPO which is sort of the gold standard of insurance. Once you investigate complications/death rates/success rates of more complex procedures, cost kinda takes a backseat...assuming you have the resources to draw on to pay the bill. Good luck!

Mayo, Medicare follow up.
 

Medicare

This letter was obtained on line.



Mayo Clinic will file your primary claim to Medicare. If you have a Medigap or supplemental insurance, Mayo Clinic will submit a claim on your behalf. If your plan includes an automatic crossover option, Medicare will submit the claim to your supplemental plan without your interaction. If you don't know whether your policy has this crossover feature, contact the company that issued the policy.

Since Mayo Clinic is nonparticipating with Medicare, payments are made to you. Medicare will pay 80 percent of approved charges. Your supplemental insurance may cover a portion of your remaining balance. Most covered laboratory services will be paid in full by Medicare and do not require supplemental filing.

Medicare has utilization limits and medical necessity criteria for certain items and services. Utilization limits restrict how often Medicare will cover certain items and services. These limits are not disclosed to Mayo Clinic. Medical necessity criteria determine which items and services may or may not be covered by Medicare.

Before these items or services are provided, Medicare patients will be asked to read and sign an Advance Beneficiary Notice (ABN) that explains Medicare payment restrictions. By signing the ABN, you assume financial responsibility in the event Medicare denies payment.

Noncovered services, such as screening exams, preventative medicine services and eye refractions, do not require prior notification and are not subject to ABN requirements.

I was told by a local doctor that I HAD to have colon surgery with several days in the hospital afterwards. Went to The Mayo Clinic and they did the procedure edoscopically in hour. An hour later I walked out the hospital and went home. Two days later swam a mile. Their doctors are top notch and, if you have a good medicare supplement most wil be reimbursed. My total bill was over $7,000 and, other than the prep solution, it cost me $5
.00. Very satisfied patient here.

I am considering going to the Mayo Clinic as I can't seem to get any answers locally. Do I have to have a referral by a primary doctor before any one at Mayo will deal with me? I deal with Paramount Urgent Care. I have an ongoing issue with bronchitis.. seems like for whatever reason I am having a reaction to antibiotics so now I have a new script of prednisone. I am so tired of pills and after 2 weeks I still don't feel good. I just feel that there is something underlying going on and I'm beginning to think I need to go SOMEWHERE to get some help. What would you do if you were me?

Call Mayo
 

Obviously, I am not a doctor nor do I have any medical training, but the desperation expressed by your question really hit home.

After 4 hospitalizations in the last 2 1/2 months, 2 picc lines, 2 rounds of home health nurses, constant antibiotics the entire time, all 4 hospital admissions through the ER, one ambulance ride, 1 blood clot and an infection that is just as bad today as it ever was, yesterday I picked up the phone and called Mayo Clinic.

You do not need a referral from a primary care. While everyone's situation is different, just tell them your situation and that you want an appointment. The schedulers may need various things from you in advance, but they are the nicest most understanding people ever.

Some little tips about going to Mayo based on personal experience (I took my husband there 25+ times over several years before we had to make the "long term care" decision.) When you see the appropriate doctor for your first appointment, he will very likely order blood work, x-rays, etc, etc. The scheduler in your first doctor's department will make all these follow-up appointments for you. Do not be discouraged when she hands you a schedule with various things spread out over the next few weeks. Everything has to be on the schedule before anything can happen. There is a wonderful thing called "stand by." Each department at Mayo has their own procedures regarding this, but the bottom line is that you go to the department in question, ask to be on "stand by", then you sit and wait until someone does not show up for their own scheduled time or until you can be worked in. We have done this many times and never had it fail us. Also try to get an appointment on Mon or Tues. The first doctor that you see is definitely going to want additional tests. If your first appointment is on Friday, it is pretty much guaranteed that you will end up staying locally over the weekend or driving back to The Villages and returning the next week.

Several years ago, as we went from doctor to doctor locally for 4-5 months while my husband got weaker and weaker, we finally went to Mayo. An appointment one day, a test the next day, then the phone call that he needed surgery. Two days and we had an answer. Surgery was not fun, but at least he recovered from that condition. (He now has something that surgery and even Mayo cannot fix - but that is another story.)

I hope this is helpful.

You can contact them directly and make an appointment. I'm not sure how fast you'd get in,but wouldn't hurt to call and find out. 904-953-0853
8 a.m. to 5 p.m. Eastern time, Monday through Friday. Good luck.

Thank you so much mommieswamie for your response with great detail & explanation of the routine. I truly appreciate the time you took to give me such a hopeful direction. Guess I am not the only one out there with a " mystery disease". My issues do seem so minimal compared to what you have been dealing with and I do wish you good luck in getting your situation resolved.
mickey...also thank you for your input and the phone number. I will be calling on Monday.

They are the best at discovering unicorns! Since they are in joint practice, referrals are in house and they can pick up the phone and talk to any world expert in mysteries... they don't silo off information, but enjoy helping each other solve mysteries!