Your Mayo Clinic medical claims will be filed if you are in hospital, and you will receive a Medicare Summary Notice while processing your claim.
Health clinic services
Regardless of whether or not they participate with Medicare Part B, all Mayo Clinic locations will be billed by Medicare for all services rendered. Claims will be made to Medicare Part B and supplementary or secondary insurance companies on your behalf. In some instances, you may get Part B and supplemental or secondary insurance payments directly. However, this means that patients are responsible for reimbursing Mayo Clinic for any expenses they receive and unpaid balances.
In accordance with federal regulations, it is necessary for the medical centre to support Medicare assignments for certain services (for example, clinical laboratory, drugs, and biologicals).
Medicare supplemental insurance crossover
If your claims did not transfer over from Medicare to your additional or Medigap insurance, please contact the agency that administers your supplemental or Medigap insurance.
Medicare patients must complete an Advanced Beneficiary Notice (ABN) which discusses payment restrictions and estimates medical costs before receiving specific services. Signing the ABN conveys financial liability if Medicare denies payment. Eye exams, foot care, hearing aids, preventive care, and elective treatments are free from the ABN requirement however, individuals are responsible for all non-covered services.
You can call 800-633-4227 for non-covered service and item questions (toll-free).
Privately contracted Medicare Advantage plans cover all of your Medicare Part A and Part B benefits. Generally, Medicare Advantage plans provide prescription drug coverage, too and Medicare Advantage plans fall into five broad categories;
- Medicare Medical Savings Account.
Out-of-network plans mean higher out-of-pocket expenditures. Typically, Medicare Advantage plans to process the same as Medicare and Mayo Clinic campuses have restricted specific Medicare Advantage options.
- Mayo Clinic’s Arizona campus: All Medicare Advantage Plans except PPO/Cost share/HCPP contracts may not be seen and self-pay patients are not eligible.
- The Mayo Clinic in Florida: Medicare Advantage HMO patients without authorization will not be seen and they do not allow self-pay patients.
- Rochester, Minnesota’s Mayo Clinic campus: Medicare Advantage HMO plans without authorization may not be seen by patients and they cannot examine patients on a self-pay basis.
You must obtain authorization from your health insurer before scheduling visits at the Mayo Clinic.
The Mayo Clinic’s campuses in Arizona and Florida have refused to work with non-contracted Medicare Advantage plans due to administrative and financial difficulties. Please see your Medicare Advantage plan for a list of in-network doctors.
Decisions by Medicare on reimbursement
To dispute a Medicare denial, please call Mayo Clinic’s Patient Account Services.
- 800-660-4582 (toll-free)
- Arizona: 480-301-7033
- Florida: 904-953-7058
- Rochester, Minnesota: 507-266-5670
You can appeal a disallowed charge if the notice under “Appeals Information” on the last page of your Medicare Summary Notice tells you how to do so. Within six months of receiving notice of refusal, an appeal must be made with the appropriate administrative law judge. Generally, the Mayo Clinic is unable to advocate on your behalf on Medicare non-assigned services.
You will continue to receive monthly statements until your account is paid in full, and patients must apply for public medical assistance (Medicaid).
Bundled Payments for Care Improvement program
Mayo Clinic is helping implement the Bundled Payments for Care Improvement Advanced Model, although the program is only now in effect, and all affected patients were contacted for feedback, you wouldn’t be eligible to receive care in a participating region if you did not receive a letter.
Our mission is to provide high-value and high-quality care.
- Visit the CMS BPCI Advanced Website at http://www.innovation.cms.gov/initiatives/bpci-advanced
- Mayo Clinic Patient Account Services 1-844-217-9591
- Call 1-800-MEDICARE-1 (1-800-663-4227). For TTY callers, contact 1-877-486-2048
Additional Information about Medicare
To learn more about Medicare, see the Medicare website. You can also inquire about your Arizona Medicare Part B claims for health services by calling Medicare at 800-633-4227. (Toll-free).