Health maintenance organizations (HMOs)
Mayo Clinic may not participate with your HMO. An HMO usually requires prior authorization. Your doctor's referral isn't the same as an authorization for payment. Managed care plans such as an HMO may deny payment or reduce benefits if medical care is obtained outside of the established network or authorization of the plan. To avoid denial or reduction of benefits, it's to your advantage to contact your insurance carrier prior to services to determine plan requirements or limitations to receiving care outside of the network.
Mayo Clinic requests a pre-service deposit for all services that haven't been authorized by your insurer. Deposits are based on an estimate of the cost of services you or your doctor request, and deposits aren't necessarily payment in full. Your actual charges may be greater or lesser than the deposit. For example, charges for colonoscopy services vary depending on the number of polyps discovered and the pathology tests performed. If further testing or doctor consultations are necessary, additional deposits may be required. If the actual charges are less than your deposit, Mayo Clinic will refund the balance of your deposit.
If authorization for your services at Mayo Clinic can be verified with your HMO before you receive care, you won't be required to make a deposit for the authorized services. However, if additional services are necessary, Mayo Clinic will require further authorization or deposits. Further authorizations may take up to a week or more depending on the HMO or insurer's review process.
In the event additional charges are posted beyond the date of your visit, Mayo Clinic will send you an adjusted itemized statement of charges. You should pay for these additional services when you receive your monthly statement of account.