Insurance process

The Mayo Clinic payment process includes private insurance companies, managed care plans and government payers such as Medicare, Medicare Advantage Plans and Medicaid. Mayo Clinic contracts with some of these insurance companies. It's your responsibility to consult with your insurance company to determine whether Mayo Clinic's bill will be covered in whole or in part, or what portion of your charges will be your personal responsibility. This may include any pre-existing exclusions and limited benefits policies. In these cases Mayo Clinic may ask you to pay a pre-service deposit based on scheduled services.


If you have insurance, Mayo Clinic will file primary insurance claims in all cases, which means that Mayo Clinic will send the bill directly to your insurance company. Because each insurance company has its own benefits plans and requirements, it's vital that you understand exactly what your health care insurance policy provides, including whether the company has a contract with Mayo Clinic. If you would like an estimate for a specific procedure, Mayo Clinic's estimating service can explain the charges to you.

Your insurance company decides how much it pays for a medical service by establishing its own fee schedule, which insurers often refer to as "usual, customary and reasonable" (UCR) fees. Any balance remaining after your insurance pays is your responsibility.

Example of usual, customary and reasonable

Suppose Mayo Clinic charges $3,000 for a treatment and your insurer pays 60 percent of its established fee schedule — the UCR amount. In this instance, you would be responsible for 40 percent of the UCR amount, in addition to any amount not covered by your insurance company.

Example of UCR payment calculation
Mayo Clinic charges $3,000
Insurance UCR This amount will vary from company to company. $2,000
Insurance payment 60% of UCR ($2,000) $1,200
Patient responsibility
Amount exceeding the insurer's UCR $1,000
40% of UCR ($2,000) $800
Total patient responsibility $1,800

If you have secondary or supplemental insurance, you must provide copies of both sides of your secondary insurance card. Coverage by secondary insurance companies generally is based on what is owed after your primary insurance company has paid. Mayo Clinic will file claims directly with your secondary or supplemental insurance company. Most, but not all, secondary insurance companies send checks directly to you.

If Mayo Clinic has a contract with your primary insurance company, Mayo Clinic agrees to accept the contracted fee schedule. Under this agreement, your out-of-pocket costs usually will be lower than if your insurance company wasn't contracted. The contracted insurance company pays its portion of the total amount to Mayo Clinic.

Insurance payments sent directly to you, whether from primary or secondary insurance companies, should be used to pay outstanding charges to Mayo Clinic. Please deposit these checks into your bank account and issue a payment to Mayo Clinic. Include the lower portion of the first page of your billing statement with your payment.

Dec. 25, 2014