There are many commercial or traditional health insurance plans with which Mayo does not participate. If your insurance plan does not participate with Mayo Clinic, it is difficult to predict what will be paid. You must check with your employer, health plan or other appropriate party about benefits before coming to Mayo. It is important that you know your health plan benefits.
Most health plans have developed their own fee schedule for medical services. This amount is typically called "Usual and Customary" or "UCR" charges. Our fees reflect the cost of services deemed medically necessary based on the examinations and evaluations performed at Mayo Clinic. Unless you are covered by a plan that participates with Mayo, your charges will probably differ from your health plan's allowable amount. You are responsible for our charges in full, regardless of your plan's level of reimbursement. It is very important that you understand what your plan pays. For example:
If Mayo charges $3,000 for a treatment, your insurance may pay 60 percent of the UCR amount. In this example, you would be responsible for 40 percent of the UCR amount, plus any amount not covered by your health plan.
Clinic charges: $3,000
Insurance UCR amount: $2,000
This amount will vary depending on each company's individual determination.
Insurance payment (60% of UCR of $2,000): $1,200
Patient responsibility — amount insurance does not cover: $1,000
40% of UCR ($2,000): $800
Total patient responsibility: $1,800
Under insurance carrier definition, Mayo Clinic is not a hospital. If your insurance policy excludes coverage for outpatient services, your Mayo charges will be denied.
A claim with your health plan is initiated by Mayo Clinic, and timely payment for services rendered is expected. You should review your monthly statements to determine the status of any outstanding balances.
Communication between you and your health plan is strongly encouraged to ensure timely insurance processing and payment. Regardless of your health plan's response, the account balance is your responsibility.
If you have secondary health insurance coverage, Mayo Clinic will file claims on your behalf with that insurance company.
Mayo Clinic in Florida participates in the Florida Traditional Medicaid program. Participation includes coverage for both physician and hospital services. Our unique capabilities in services for transplantation, cancer care and neurosciences represent the majority of care provided to Florida Traditional Medicaid patients.
We do not participate in Medicaid Managed Care Programs (that is, HMO, PSN and others).
Mayo Clinic Health System in Waycross, Ga., accepts Georgia Medicaid.
A pre-care deposit typically ranging from $2,500 to $4,500 is required from uninsured patients. Patients without insurance are also asked for a preadmission deposit at Mayo Clinic hospital if hospitalization is necessary.