Insurance/Payment Process

Payment Process

The Mayo Clinic payment process is as varied as our patients. There are private insurance companies, managed care plans and government payers such as Medicare and Medicaid. Mayo contracts with some of these insurance companies. There are also some patients who have no insurance. It is your responsibility to consult with your insurance company to determine whether Mayo's bill will be covered in whole or in part, or what portion of your charges will be your personal responsibility.

Insurance

If you are a patient who has insurance, Mayo Clinic will file primary insurance claims in all cases, meaning Mayo sends its bill directly to your insurance company. Because each insurance company has its own benefits plans and requirements, it is vital for you to understand exactly what your health-care insurance policy provides, including whether the company has a contract with Mayo. If you would like an estimate for a specific procedure, see Estimates,which explains Mayo's estimating service.

Mayo physicians order services they feel are necessary for your individual care. However, your insurance company decides which services will be covered under your plan. Some plans do not cover what they consider to be routine, preventive or experimental services. You will be financially responsible for any services not covered by your insurance company.

Your insurance company also decides how much it pays for a medical service by establishing its own fee schedule which they often refer to as a "Usual and Customary" fee. Any balance remaining after your insurance pays is your responsibility.

Example of "Usual, Customary and Reasonable" (UCR):

Example of "Usual, Customary and Reasonable" (UCR): If Mayo charges $3,000 for a treatment, your insurance may pay 60 percent of the "usual, customary and reasonable," or "UCR" amount. In this instance, you would be responsible for 40 percent of the UCR amount, plus any amount not covered by your insurance company.

Example

Mayo 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 ($2,000)	$1,200
Patient Responsibility
Amount insurance does not cover	$1,000
40% of UCR ($2,000)	$800
Total patient responsibility	$1,800

It is your responsibility to consult with your primary insurance company to determine whether Mayo's bill will be covered in whole or in part, or what portion of your charges will be your personal financial responsibility.

If you have secondary or supplemental insurance, you must provide the Mayo Clinic Registration Desk with copies of both sides of your secondary insurance card. For each service provided, Mayo will provide you with a red-and-white claim form which you should send to your secondary insurance company along with your primary insurance company's Explanation of Benefits (EOB) form.

Coverage by secondary insurance companies is generally based on what is owed after the primary insurance company has paid. Checks from secondary insurance companies are normally sent directly to you, the patient – but not always. If Mayo has a contract with the primary insurance company, Mayo agrees to accept the contracted fee schedule. Under this agreement, your out-of pocket costs normally will be lower than if your insurance company is not contracted. The contracted insurance company pays its portion of the total amount to Mayo.

Insurance payments sent directly to you, whether from primary or secondary insurance companies, should be used to pay outstanding charges to Mayo Clinic. Patients are financially responsible for all outstanding charges. Please send copies (retain the originals for your files) of your Explanation of Benefits (EOB) with your payment to Mayo. This will enable your payment to be posted to the appropriate account.