Your Medicare Coverage and Claims

Effective Jan. 1, 2003, Mayo Clinic in Jacksonville no longer accepts Medicare assignment for professional and physician services covered under Medicare Part B. The clinic still follows an established fee schedule set by the federal government. Not accepting assignment means patients covered by Medicare insurance pay more out of pocket. Medicare (and most supplemental insurers) will make payments directly to the patient, and the patient is responsible for paying Mayo. Patients with Medicare insurance are not asked to make a payment "up front" unless a service is considered noncovered by Medicare.

Mayo submits insurance claims to Medicare for the patient. If patients have supplemental insurance, Mayo provides them with a red and white Health Insurance Claim Form to be sent to their carrier. They must also send a copy of the Medicare Summary Notice (MSN) with the red and white claim form to their supplemental insurer. Patients should notify Patient Financial Services in person or by calling (904) 953-7058 if Medicare forwards claims to their secondary insurance on the patient's behalf.

Medicare considers some items or services to be routine or noncovered. A few examples are: eye refraction, foot care, hearing aids, cosmetic surgery, routine screenings and annual checkup visits. Patients are financially responsible for these services. In addition, there are other items or services for which Medicare determines payment based on the diagnosis. Patients may be asked to sign an Advanced Beneficiary Notice (ABN) which informs them that one or more scheduled items or services may not be covered. Any questions regarding a specific item or service should be directed to Medicare at (800) 633-4227.

If Medicare denies a claim, patients should follow the instructions at the bottom of the MSN form.

Patients receive an itemized statement each month for items or services Mayo provided. They also receive a statement if an outstanding balance remains on their account. This statement will detail any new items or services and summarize any payment activity that has occurred on the account that month. As a nonparticipating Medicare Part B provider, Mayo does not receive a copy of the patient's MSN. Therefore, patients are responsible for and should verify that Medicare has considered all items or services. Patients can do this by comparing the MSN forms received from Medicare to the monthly statements from Mayo.

Mayo Clinic requests payment in full when patients receive the Mayo statement. Please remember that Medicare payments and reimbursements from most supplemental insurers are sent directly to patients. Mayo accepts personal checks, credit cards or money orders. Payments should be mailed to Mayo Clinic, P.O. Box 31347, Tampa, FL 33631-3347.

For more information

• If you have questions, call Patient Financial Services at (904) 953-7058. Hours are 8 a.m. to 4 p.m. Eastern time Monday through Thursday and 8 a.m. to 3 p.m. Friday. You also can send an e-mail to mcjmedicarehelp@mayo.edu.
• The Mayo Clinic, Medicare and You booklet (PDF version) provides more details. It is available at Registration, Information and Dismissal desks at the clinic. Call Patient Financial Services if you would like a copy mailed to you.
• Detailed information about Medicare coverage is available on the Internet at www.medicare.gov