Medicare pays for much, but not all, of your health care. Your out-of-pocket expenses depend on whether your doctor or supplier of health care equipment and supplies agrees to "accept assignment" (the Medicare approved payment amount). To obtain the most current information, visit Medicare's website or call 800-MEDICARE (800-633-4227) (toll-free).
Although Mayo Clinic provides medical services to Medicare patients, Mayo Clinic doesn't accept assignment from Medicare for professional and physician services. In other words, Mayo Clinic doesn't accept the Medicare-approved payment amount as full payment. Mayo Clinic follows an established fee schedule based on the federal guidelines for Medicare patients, which allows health care organizations to charge up to 15 percent above the Medicare allowable fee. You're financially responsible for the portion above the Medicare allowable amount.
This example shows how Medicare calculates your benefit:
|Example of Medicare Benefits at Mayo|
|Mayo Clinic charge||$1,150.00|
|Medicare approved amount||$1,000.00|
|Medicare pays 80% of approved amount||$ 800.00|
|Secondary insurance pays 20% of approved amount *||$ 200.00|
|Total paid by Medicare and secondary insurance||$1,000.00|
*The secondary insurance reimbursement may vary depending on your Medigap policy. Some policies may cover additional charges than in the example. For more information, please visit the Medicare website.
Are there services for which Mayo Clinic must accept assignment from Medicare?
Yes. Those services include:
Example: Room and board, operating room, some drugs
How can I tell if Medicare assignment was accepted for a particular claim?
Each of your Medicare Summary Notices (MSN) will indicate whether Medicare paid your provider — Mayo Clinic — or you.
Is there a difference in the way Medicare processes assigned and unassigned claims?
Yes. Some of the differences are:
Are there services Medicare doesn't cover?
Medicare pays for much, but not all, of your health care. Your out-of-pocket expenses depend on several factors, such as the type of service, diagnosis, frequency of service, and so on. Medicare doesn't pay for certain services such as regular dental care and regular eye exams. Medicare may or may not pay for services or procedures that it considers routine or preventive. An example of a noncovered service is the routine or preventive component of your annual checkup. An itemized statement of charges showing two charges for one office visit may raise questions. This can happen because Mayo Clinic must bill the routine and preventive portion of your visit separately. Please refer to the federal government's Medicare website for more information.
There are other specific instances in which Medicare may deny payment. In such cases, you may receive an advance beneficiary notice (ABN) from your doctor, other providers or suppliers to let you know in advance that Medicare may not cover the service. The ABN will tell you:
You also can write to Mayo Clinic at:
13400 E. Shea Blvd.
Scottsdale, AZ 85259
Please include a copy of the Medicare Summary Notice referring to the denied charge.
If you have designated Medicare as your secondary insurer, you should send copies of the primary insurance company's explanation of benefits (EOB) and any payments you receive to:
13400 E. Shea Blvd.
Scottsdale, AZ 85259
Mayo Clinic may accept the amount paid by the primary insurance company as payment in full or submit claims for the balance to Medicare.
The laboratory that performs your tests automatically bills Medicare.
Many laboratory tests can be performed on a single blood draw or sample collection. Most laboratory testing on samples drawn at Mayo Clinic is performed on site. If you have a specialized test ordered by your doctor, your sample may be sent to a reference laboratory that is outside of Arizona. If you have a specialized laboratory test performed outside of Arizona, you may receive more than one Medicare Summary Notice and more than one itemized statement of charges. Mayo Medical Laboratories in Rochester, Minn., is a specialized laboratory commonly used by all Mayo Clinic locations.
For questions about charges billed under Mayo Medical Laboratories, please call 800-447-6424 (toll-free). You may also send correspondence to:
Mayo Medical Laboratories
3050 Superior Drive NW
Rochester, MN 55901
Medicare Advantage Plans are plans offered by private companies that contract with Medicare to provide all of your Medicare Part A and Part B benefits. In most cases, Medicare Advantage Plans also offer Medicare prescription drug coverage. There are various types of Medicare Advantage Plans, including HMO, PPO, cost based, HCPP, Medicare Medical Savings and Private Fee-For-Service plans.
Mayo Clinic in Arizona sees only people who have Medicare Advantage Plans that are contracted with Mayo Clinic in Arizona. Mayo Clinic doesn't agree to the terms and conditions of noncontracted Medicare Advantage Plans due to administrative and financial challenges. Your Medicare Advantage Plan can give you a list of in-network providers.
More information about Medicare is available at the Medicare website.
For questions regarding your Medicare Part B claims for services that you incurred in the state of Arizona, call 800-633-4227 (toll-free).