@John85259
Mayo Clinic have specific ways they treat different Medicare plans especially in Florida and Arizona - traditional Medicare or varieties of Medicare Advantage plans.
Read this link
Mayo Clinic - About Medicare - Billing and Insurance at Mayo Clinic
It does not sound like they take Medicare Part B under the traditional program for the clinic and associated physicians on an ASSIGNMENT basis EXCEPT for certain services. They do take both Medicare Part A and B for hospital services.
If you have traditional Medicare and are looking for the clinic or affiliated physicians to act as your primary physicians, since they don't accept assignment, Medicare will only cover part of the fees for their services for many things. You will have to sign an ABN ( Advanced Beneficiary Notice of Non-Coverage ) acknowledging this and they will send you a bill of what is due.
Do you understand what it means if a doctor or other health care provider takes or does not take "assignment" in Medicare? It means that by taking assignment the agree to accept the Medicare payment amount for their service - then Medicare pays their 80% of this amount and the beneficiary or their supplemental plan picks up the remaining 20%. If they don't accept assignment then the beneficiary may have to pay what they charge over and above that amount.
Yes, it can also go by specific services too.
From the link:
Hospital services
If you are hospitalized, Mayo Clinic will file your Part A (hospital inpatient and outpatient services) and Part B (physician services) claims for you. You will receive a Medicare Summary Notice from Medicare when it processes your claim.
Clinic and physician services
Although Mayo Clinic doesn't participate with Medicare Part B in Arizona and Florida, Medicare will help pay for services provided at all Mayo Clinic sites regardless of whether they participate with Medicare Part B. Claims will be filed to Medicare Part B and supplemental or secondary insurance companies on your behalf. In some cases, Medicare Part B and supplemental or secondary insurance payments may be sent directly to you. When this happens, patients will be responsible for reimbursing Mayo Clinic for any payments they receive and any balances not covered by their insurance.
Medicare assignment
Mayo Clinic is required to accept assignment for Medicare Part B for certain services designated by government regulations (for example, clinical laboratory, drugs and biologicals).
Medicare supplemental or Medigap insurance crossover
If you expected your claims to cross over from Medicare to your supplemental or Medigap insurance and this did not occur, please contact your Medicare supplemental or Medigap insurance organization to inquire.
Medicare Advance Beneficiary Notice
Before certain items or services are provided, Medicare patients may be asked to read and sign an Advance Beneficiary Notice (ABN) that explains Medicare payment restrictions and estimate of charges. By signing the ABN, you assume financial responsibility in the event Medicare denies payment.
Noncovered services, such as eye refractions, foot care, hearing aids, screening exams, preventive medicine services and elective procedures, do not require prior notification and are not subject to the ABN requirement. Patients are financially responsible for all noncovered services.
Any questions regarding a noncovered item or service should be directed to Medicare at 800-633-4227 (toll-free).
Medicare Advantage plans
Medicare Advantage plans are plans offered by private companies that contract with Medicare to provide all of your Medicare Part A and Part B benefits. In most cases, Medicare Advantage plans also offer Medicare prescription drug coverage. There are various types of Medicare Advantage plans, including HMO, PPO, cost-based, HCPP, Medicare Medical Savings Account and private fee-for-service plans. If your plan is considered out of network, your out-of-pocket expenses will be higher. As a general rule, Medicare Advantage plans should process the same as Medicare.
The following Mayo Clinic campuses limit access to some of the Medicare Advantage plans:
Mayo Clinic's campus in Arizona. Patients covered by any types of Medicare Advantage Plans (exception Cost share/HCPP) that are not contracted may not be seen. Patients cannot be seen on a self-pay basis.
Mayo Clinic's campus in Florida. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.
Mayo Clinic's campus in Rochester, Minnesota. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.
Medicare Advantage HMO plans require authorization prior to scheduling appointments at the Mayo Clinic site that is contracted or that has accepted your plan; without authorization, the patient will be financially responsible.
Mayo Clinic's campuses in Arizona and Florida do not agree to the terms and conditions of noncontracted Medicare Advantage plans, due to administrative and financial challenges. Please refer to your Medicare Advantage plan for a list of in-network providers.
read more at the above link -
It's Always Something . . . . Roseanna Roseannadanna
