Private Insurance Companies

Private insurance companies can provide either primary or secondary coverage, or they may provide a managed-care plan. In order to receive covered benefits, private insurance companies may require their customers to obtain medical care from specific networks of physicians and medical facilities. If a private insurance company has no contract with Mayo, it may not cover any Mayo services.

If you are a customer of a private insurance company that does not have a contract with Mayo, you can still receive treatment at Mayo. However, you are financially responsible for the total charges and may be asked to make a deposit before receiving services. It is your responsibility, not the responsibility of Mayo, to know what your insurance will and will not cover.

Mayo Clinic may contact patients' insurance plans for precertification and/or authorization of certain services.

Private insurance companies cover charges under their own fee schedule. These covered charges are called allowable charges. Mayo charges are determined by a committee consisting of administrators and physicians. Mayo's charges for care are based on the level of quality our patients expect and deserve, and also support Mayo's research and education initiatives which foster further innovations in medical care.

If there are major differences between your insurance coverage and what Mayo charges, you can file an appeal with your insurance company. Although normally Mayo is not permitted to initiate appeals when it does not have a contract, it will provide any information requested by insurance companies in an effort to bring about resolution. Under any plan, there may be services that are not covered at all because the insurance company considers them preventive, routine or unnecessary.

Blue Cross Blue Shield (BCBS) Primary

Effective April 1, 2007, Mayo Clinic and BCBS entered into an agreement to grant out-of-state BlueCard members in-network access to Mayo Clinic providers and facilities in Arizona. During the course of 2007 and beyond, Mayo Clinic and BCBS will expand the agreement to grant select Arizona-based self-insured employer groups in-network access to Mayo Clinic providers and facilities in Arizona. Patients having in-network access to Mayo Clinic will utilize a new PPO network developed by BCBS. In addition, patients having in-network access to Mayo Clinic will be financially responsible for their coinsurance, deductibles, and copayments as well as any non-covered services as determined by their benefit plan.

The following groups are not included in the agreement and will continue to be out-of-network for services at Mayo Clinic:

• Groups continuing to utilize the existing BCBS-AZ PPO network
• Federal Employee Program
• Corporate Health Services
• BCBS of Arizona fully-insured employer groups
• Individual and Medicare supplement members

Please note that out-of-network BCBS members are typically responsible for 40-60 percent of Mayo Clinic's billed charges.

Filing a Blue Cross Blue Shield Claim

Mayo Clinic is required to electronically file all primary claims with the BCBS-AZ clearinghouse, which then forwards the claims to out-of-state offices in 5 to 7 days.

Mayo Clinic files all primary claims.

What To Do When You Receive Payment For Your Blue Cross Blue Shield Claim

BCBS patients receiving their care at Mayo Clinic on an out-of-network basis will receive Mayo Clinic's payment directly from BCBS. These payments must be sent to Mayo Clinic upon receipt. BCBS patients are asked to pay their entire balance due to Mayo Clinic within 60 days of the date claims are filed. Patients who are unable to meet this payment requirement must make alternative payment arrangements with Mayo Clinic.