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Mayo clinic are suppose to be the best in the US however it seem they only serve the rich. They don't take Medicare as full payment which means that you could be paying thousands of dollars for a check up. So am I missing something?
Mayo clinic are suppose to be the best in the US however it seem they only serve the rich. They don't take Medicare as full payment which means that you could be paying thousands of dollars for a check up. So am I missing something?
Medicare discusses types of providers - those which accept Medicare assignment and those which don't (nonparticipating), here:
Mayo is a nonparticipating Medicare provider - i.e., Mayo will not accept Medicare assignment but will accept Medicare patients.
As a nonparticipating Medicare provider, Mayo is allowed to charge 15% over 95% of the Medicare allowed charge.
In other words:
$100.00 - Medicare allowed charge
$x95.00 - Nonparticipating Provider Allowed Charge ($100 x 95%)
$x14.25 - Excess/limiting charge allowed by Medicare ($95 x 15%) $109.25 - Total Mayo allowed Medicare charge
$x76.00 - Medicare pays (80% x $95) $x33.25 - Medigap (or YOU) pay the difference
If you buy a Medigap G or F which covers these excess charges, charges for Medicare-approved services at Mayo should be paid in full.
Per another poster on CD, Mayo's procedure is to submit its charges to Medicare and the Medigap. Medicare and Medigap pay you, you pay Mayo. Generally, you should have payment from both entities by the time your bill is due - unless, of course, Mayo wants some type of down-payment in advance. Last I heard, they didn't do that, but things may have changed.
Many of the better facilities and/or specialists are nonparticipating Medicare providers. If you expect to need medical care from a nonparticipating provider, obtaining Medigap coverage for excess charges is a wise move.
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Edited to add: I see from earlier posts you are a user of the VA - so Mayo questions are purely rhetorical, it would appear? You had asked previously about Advantage plans v. hd-F's,
Mayo clinic are suppose to be the best in the US however it seem they only serve the rich. They don't take Medicare as full payment which means that you could be paying thousands of dollars for a check up. So am I missing something?
I think you are missing something.....I'm far from rich and I always go to Mayo or a Mayo clinic...
Mayo Clinic charges more because their services are unique and there is no Usual and Customary for similar providers.
Indeed there is a form of "usual and customary" for ALL nonparticipating MEDICARE providers like Mayo. It is called the "limiting charge."
The "limiting charge" is 95% of the Medicare-allowed charge PLUS 15%.
Medicare prohibits Mayo from charging more than that for any MEDICARE patient.
Per Medicare:
Quote:
If your doctor, provider, or supplier doesn't accept assignment
Non-participating providers haven't signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services. These providers are called "non-participating."
They can charge you more than the Medicare-approved amount, but there's a limit called "the limiting charge." The provider can only charge you up to 15% over the amount that non-participating providers are paid. Non-participating providers are paid 95% of the fee schedule amount.
Outside of Medicare, Mayo can do what it wants. But, OP is talking about Medicare. If Mayo wants to accept Medicare patients, it has to adhere to the Medicare rules.
Last edited by Ariadne22; 05-26-2015 at 02:33 PM..
My husband did his fellowship at Mayo Jacksonville and I remember him referring to the entire "not accepting Medicare" thing (though of course, it is not that cut and dry as PP's point out).
A fair percentage, if not majority, of his patients were from out of state. He had more than one patient that flew in on their own private jet.
I had a mammogram done at Mayo and before I was even allowed to schedule the appointment, I had to meet with a Financial Counselor and go through an entire approvals process, so they could verify my insurance, which was ironic because it was the Mayo insurance plan.
They are the leading private institution that spends most of their time seeing the zebras. They have no shortage of paying patients, including cash paying patients. However, they also do a ton of research and education that benefits all users of healthcare services.
A fair percentage, if not majority, of his patients were from out of state. He had more than one patient that flew in on their own private jet.
I had a mammogram done at Mayo and before I was even allowed to schedule the appointment, I had to meet with a Financial Counselor and go through an entire approvals process, so they could verify my insurance, which was ironic because it was the Mayo insurance plan.
Head of Mayo was on C-Span recently and talked about accepting Medicaid patients - although, based on comments from one caller, not easily. Not sure which of these videos the Medicaid was discussed:
Head of Mayo was on C-Span recently and talked about accepting Medicaid patients - although, based on comments from one caller, not easily. Not sure which of these videos the Medicaid was discussed:
He covered lots of topics. As you said, Mayo is a leader in many areas.
Although the Jax campus opened in the mid 1980s, they only recently built their own hospital. Prior to that, all inpatient activity was through a mid sized community based hospital about 10 miles away, which was Mayo affiliated, but not exclusive, iirc. If a patient were taken to the ER, or presented at the hospital, on a day where a Mayo Consultant happened to be on call, he/she would of course be seen and treated by someone affiliated with Mayo.
So, although my husband and his Attending had patients who flew in on their own jets; he also had patients who were no pays, Medicaid, Workers Comp etc (albeit this was a very, very small percentage of patients). To my knowledge, there was no clinic space at the hospital, so I presume these patients went to the main Mayo Clinic campus for all follow up appointments. So, I am guessing there have always been provisions and situations where a certain number of patients like this have found their way into the system.
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- although, based on comments from one caller, not easily. Not sure which of these videos the Medicaid was discussed:
