What insurance companies does Mayo Clinic accept?
Mayo Clinic will file claims to any insurance company you authorize, but your employer and insurance company determines coverage. An insurance contract between your insurance company and Mayo Clinic doesn't guarantee that your claims will be paid in full. You're responsible for payment of services not authorized by your insurance company and any balance remaining after insurance payments and adjustments.
Why did I receive more than one itemized statement for my last visit to Mayo?
If you're hospitalized, you'll receive two itemized statements:
Also, you could receive two itemized statements for some outpatient procedures. The hospital statement will show the fees for use of hospital facility space, and the clinic statement will show the fees for your doctor and medical staff services and tests.
Why is there a usual, customary and reasonable (UCR) denial from my insurance carrier?
Insurance coverage varies among insurers and policies. Many insurance companies limit payments using a fee schedule of "usual, customary and reasonable" (UCR) allowances. Mayo Clinic's fees may differ from insurance companies' fee schedules. Please direct questions regarding UCR to your insurance carrier. You're responsible for payment of your account, including balances due to UCR limitations.
When an insurance company denies part of a claim because of "usual, customary and reasonable" (UCR) allowances, is there an appeal process?
To appeal, you must personally lodge a formal appeal with your insurance company. You typically must appeal within a set time. Mayo Clinic can't advise whether you should file an appeal and doesn't have the right to file an appeal on your behalf. Most insurers are required to respond to your request within 30 to 60 days, but it's best to check with your insurer about its appeal policy.
Does Mayo Clinic send my doctor's referral letter to the insurance company?
No. Mayo Clinic doesn't provide this information to your insurance company because it files claims electronically whenever possible.
My insurance company won't pay until it receives my doctor's referral letter. What should I do?
Ask your referring doctor to send a copy to your insurance company on your behalf.
How do I file supplemental insurance claims?
Attach a copy of the explanation of benefits form that you received from your primary insurance company to a copy of the itemized statement that you received from Mayo Clinic. Send both documents to your supplemental insurance company.
It's your responsibility to coordinate billing and payment information between the two insurance companies.
What are the differences between a guarantor number, a Mayo Clinic number and a visit number?
Does Mayo participate with the Medical Assistance program?
Mayo Clinic participates with the state Medicaid programs of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin. This participation allows Mayo Clinic to provide treatment and bill the programs of these states, with some restrictions. Individual coverage may depend on your obtaining a written pre-authorization from your state Medicaid program.
If you have coverage through a state or Medicaid-sponsored managed care health plan, you also may need a referral from this health plan to receive coverage at Mayo Clinic. Check with your state's Medicaid office or your managed care health plan to verify authorization requirements before your appointment.
Mayo Clinic is unable to provide service (except in emergency situations) to Medicaid patients from states other than those listed. A pre-service deposit of the estimated charges will be required for services not pre-authorized, or from people of nonparticipating states.