Billing and Insurance

Patient Account Services

Patient Account Services is Mayo's customer contact center to answer billing inquiries and resolve personal balances due the Mayo Clinic.

Patient account representatives are available to assist you with the financial aspects of your care at Mayo Clinic. We are located at the following:

Mayo Clinic – Gonda Building, Lobby Level East

Rochester Methodist Hospital – Eisenberg Building, Lobby Level

Saint Marys Hospital – Mary Brigh Building, Main Floor

Billing and Insurance Topics

Authorization to Release Information Form

Your registration materials include a form that authorizes Mayo to release information to your insurance company. Accurate and complete authorization forms help assure that your claims will be promptly paid. Please complete a new Authorization to Release Information any time your coverage changes.

Bills

Mayo Clinic includes Rochester Methodist Hospital and Saint Marys Hospital. Within Saint Marys Hospital are the Mayo Psychiatry and Psychology Treatment Center and the Mayo Eugenio Litta Children's Hospital. You will receive one monthly statement for all services, but each facility will provide you with a separate itemized statement.

If you are hospitalized, for example, you will receive two itemized statements:

• One from the hospital for your room, meals, nursing care, laboratory services, and other related services.
• One from the clinic for your physician services and tests.

Fee Estimates

If you need an estimate of charges for services you know you will be receiving, please contact the Patient Estimating Service at 507-284-4024.

During your visit, you may speak with an estimator at Admissions and Business Services, Gonda Building, Lobby Level.

Disability Insurance

Mayo Clinic will file your disability, waiver of premium, or loan payment claims for you.

Note: Please give the claim form to a Registration and Business Services representative at Admissions and Business Services, Gonda Building, lobby level; or send it to the Disability Insurance Department, Billing and Insurance Collections. Your physician will determine the length of your disability based on your medical condition. Discussing specific details with your physician may help speed the processing time of your claim.

Do not leave the claim form with your physician.
Telephone number: 800-660-4582 (toll-free)

Charity Care

Mayo Clinic has a long history of providing care to patients regardless of their ability to pay. Our primary value is "the needs of the patient come first."

Mayo Clinic provides services to meet the needs of patients who are unable to pay for care. These services include:

• Helping patients find sources to fund their care, including opportunities to work with outside agencies.
• Using fair and consistent collection practices that are in the best interest of all parties involved.
• Providing individualized payment plans, medical services at reduced rates or at no cost — based upon the patient's ability to pay.
• Providing emergency care to stabilize patients, regardless of ability to pay.

Mayo Clinic has developed a process for directing patients to alternative sources of funding for their medical care. Mayo Clinic determines a patient's need for charity care based on financial information and the medical services needed. The financial information includes the patient's individual and family income, assets, employment status, family size and availability of alternative sources of payment. Mayo Clinic's charity care policy requires that the medical services must be extraordinary and unique to Mayo (i.e., services that are not readily available at medical centers closer to the patient's home).

If you are experiencing financial hardship, please contact Patient Account Services at 507-266-5670 or arrange to meet with one of our financial counselors, who can talk with you about options such as a payment plan or government assistance. Visit our offices in one of the following locations:

• Eisenberg Lobby
• Rochester Methodist Hospital
• Gonda Lobby East
• Gonda Building
• Mary Brigh Main
• Saint Marys Hospital

Our staff may ask you to complete a Mayo Clinic Financial Statement form (PDF), which will help us evaluate your eligibility for charity care. Note that until your financial statement has been reviewed and approved by our financial counselors, you will be financially responsible for your medical care.

HMO or PPO Written Authorization

Managed care plans such as health maintenance organizations (HMO) and preferred provider organizations (PPO) may deny payment or reduce benefits if medical care is obtained outside of the established network or authorization of the plan. A preservice deposit may be required for visits not authorized. To avoid denial or reduction of benefits, it is to your advantage to contact your insurance company representative or your primary care physician to determine plan requirements or limitations to receiving care outside of the network. A preservice deposit will be required for visits not authorized. To verify if Mayo has received your authorization, you may contact Pre-Appointment Insurance Review at 507-284-4366.

Insurance Coverage

Your insurance may, or may not, cover the services provided at Mayo Clinic in Rochester. To obtain the most accurate information, please check with your insurance carrier to discuss the benefits provided by your medical plan prior to your visit. If you need further assistance, please contact Patient Account Services toll free at 800-660-4582.

International Patient Services

International patient account representatives are available to assist international patients with any aspect of their care. You also may phone, fax or mail the center:

In person
International Center
Mayo Building, Lobby Level

By phone
507-284-5063

By mail
International Center
Mayo Clinic
200 First Street SW
Rochester, MN 55905

By fax
507-284-3181

International-Sponsored or Embassy-Authorized Payments

If your medical costs are covered by an international organization or government entity, Mayo Clinic should receive a written authorization from your sponsor prior to your arrival. If there are restrictions to your coverage, Mayo Clinic may ask you for payment prior to any unauthorized services, or you may receive a bill for services not covered by your sponsor. Contact your sponsor with questions.

Medical Record Review

There is a charge for the review and interpretation of outside medical records. You will be responsible for any balances not covered by insurance.

Medical and Hospitalization Insurance

Mayo will file your primary and most secondary insurance claims for you. If you have coverage with more than one insurance company, it is your responsibility to coordinate billing and payment information with them.

Insurance coverage varies among individual insurers and among individual policies. Many insurance companies limit payments using their own fee schedule of "usual, customary and reasonable" (UCR) allowances. Mayo's fees/charges may differ from insurance companies' fee schedules. We suggest you check with your employer or insurance agent about coverage. You are responsible for payment of your account regardless of the amount of benefits provided by insurance including balances due to UCR limitations. If you do not have insurance, a pre-service deposit may be requested.

Medical Assistance (Medicaid)

Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin and MinnesotaCare

Mayo Clinic, Saint Marys Hospital and Rochester Methodist Hospital participate with the state Medicaid programs of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin and the state-sponsored program, MinnesotaCare. This participation allows Mayo Clinic to provide services to and bill for patients from these states, with some restrictions. MinnesotaCare and most of the Medical Assistance programs require that some services have prior authorization before payment is allowed. In addition, MinnesotaCare and the Medical Assistance programs typically provide coverage through a managed care health plan. If your coverage is through a managed care plan, you will need an approved referral from the health plan to receive coverage at Mayo Clinic. We recommend checking with your state's Medicaid office or your managed care health plan to verify your health plan's requirements and see that the necessary authorization and/or referrals are completed before your appointment. A pre-service deposit of the estimated charges will be required for unauthorized services. Please call
507-284-4366 with questions.

Medical Assistance (Medicaid) – Other states
Mayo Clinic is unable to provide service (except in emergency situations) to Medicaid patients from states other than those listed. If you are covered by Medical Assistance or a Medical Assistance Health Plan sponsored by a state that is not listed above, a deposit of the estimated charges will be required. Please call 507-284-4366 with questions.

Medicare

Medicare has two billing parts. Medicare Part A (Hospital Insurance) helps to pay for inpatient hospital services. Medicare Part B (Medical Insurance) helps to pay for clinic services, physician fees and outpatient hospital services

Hospital services
If you are hospitalized your Part A (hospital inpatient) and Part B (hospital outpatient) claims will be filed to Medicare for you. These Medicare payments will be sent directly to the hospital. You will receive a "Medicare Summary Notice" from Medicare when they process your claim. If you have supplemental or Medigap hospital insurance, a claim will be filed to this insurance for you. In some cases, the claim is sent directly from Medicare to the other insurer; however, in most cases, the claim will be filed by the hospital. Hospital claims to supplemental and Medigap insurance are filed AFTER Medicare has made payment.

Clinic services and Medicare assignment
Although Mayo Clinic does not participate with Medicare Part B, Medicare will help pay for services provided by Mayo Clinic and claims will be filed to Medicare Part B for you.

Dental services are non-covered by Medicare. Claims for these services will not be billed to Medicare. These services will be billed directly to Medicare patients.

Mayo Clinic is required to accept assignment for Medicare Part B for certain services designated by Medicare as mandatory assignment (e.g., clinical laboratory) and for those individuals who are eligible for Medicare and Medicaid/Medical Assistance. In addition, assignment also is accepted for services provided to Minnesota residents. Processing of Medicare claims usually takes four to eight weeks after the claim has been filed. Specific information related to filing of Medicare claims and instructions about supplemental insurance claims will be provided on the Itemized Statement of Charges you receive in the mail.

Medicare secondary payer
If you have insurance coverage that will be primary to Medicare, please provide this information to Mayo at the time you are asked to provide your insurance information.

Motor Vehicle insurance information if services are motor-vehicle related

If your care is the result of a motor vehicle accident, please provide this information at the time of registration. If your motor vehicle insurance benefits are exhausted and you do not have general medical insurance to cover your visit at Mayo Clinic, please call us at 507-284-4366 to discuss financial arrangements.

Other Liability Insurance Information if Accident Occurred Outside of Your Residence

If your care is the result of a non-work related accident or injury, please provide this information at the time of registration.

Patient Account Help

Patient account representatives are available to assist you with the financial aspects of your care. If you do not find the answer to your particular question listed in this section, please contact a representative as directed below:

In person
Admissions and Business Services:

• Gonda Building, Lobby Level
• Baldwin Building, First Floor
• Rochester Methodist Hospital
  Eisenberg Building, Lobby Level
• Saint Marys Hospital
  Mary Brigh Building, Main Floor

By phone
507-266-5670

By mail
Patient Account Services
Mayo Clinic
200 First Street SW
Rochester, MN 55905

By fax
507-284-0688

By email
Send Email

Payment Forms Accepted

You are responsible for payment of your hospital and clinic accounts. Financial arrangements can be discussed at the Admissions and Business Services Desk that is most convenient for you. For your convenience, Mayo accepts cash; wire transfer; personal, traveler's, or cashier checks; bank debit cards; and Discover, Master Card, American Express, Diner's Club, and Visa credit cards.

Telephone number: 800-660-4582 (toll-free)

Pre-certification, Pre-authorization, and/or Second Surgical Opinion

Please be aware of your insurance company's or employer's authorization and pre-certification requirements and coverage limits before your visit.

Your Mayo physician will decide which procedures, tests and other physician consultations you may need. Pre-certification (determination of medical necessity) is required for some tests and procedures before some health plans will pay for them. Examples of services that may require pre-certification are outpatient and inpatient hospital services, invasive procedures, CT, MRI and PET scans and colonoscopies. You are responsible for knowing the pre-certification needs of your health plan.

Prior authorization or predetermination can be initiated by pre-certification staff for procedures that your insurance company may consider experimental, elective or cosmetic. This can take a considerable amount of time (up to eight weeks) and often requires pre-certification staff to supply photos and medical-necessity information to your insurance company.

Before scheduling a second-opinion consultation at Mayo Clinic, you should address any second-opinion requirements with your insurance company. The insurance company can tell you if pre-certification is required.

Assistance with pre-authorization and pre-certification requirements is available at Admissions and Business Services, Gonda Building, Lobby Level, or by calling PreAppointment and Business Services, 507-284-0390. Pre-certification is not a guarantee of payment. You are responsible for payment of services not authorized and covered by your insurance company.

Prescription Plan Cards

Following your surgery or appointment your physician may prescribe take-home medications. You may choose to have your prescriptions filled at the Mayo Clinic Pharmacy or a pharmacy of your choice.

Mayo Clinic Pharmacy accepts cash, checks or credit cards for your copayment. Please bring all current insurance cards and drug benefit cards.

Prescriptions from Mayo Clinic physicians are filled and shipped throughout the world.

Pharmacy Telephone number 800-445-6326 (toll-free).

Preventive Services

Insurance coverage for preventive services varies among insurers. It is important to check your individual policy and address any questions to your insurer. Medicare provides limited coverage for preventive services.

Workers' Compensation

Mayo participates with some state Workers' Compensation programs. Please contact Mayo's PreAppointment Insurance Review Unit at 507-284-4366 to find out if Mayo participates with your state program. If Mayo does participate, you should still contact your Workers' Compensation carrier to determine if any prior authorization is required. Additional questions may be directed to the PreAppointment Insurance Review Unit.