More about Medicare

Hospital services

If you are hospitalized, Mayo Clinic will file your Part A (hospital inpatient and outpatient services) and Part B (physician services) claims for you. Medicare Part A payments will be sent directly to the hospital. You will receive a Medicare Summary Notice from Medicare when it processes your claim.

Clinic and physician services

Although Mayo Clinic doesn't participate with Medicare Part B, Medicare will help pay for services provided by Mayo Clinic. Claims will be filed to Medicare Part B and supplemental or secondary insurance companies on your behalf. Medicare Part B and supplemental or secondary insurance payments may be sent directly to you. Patients will be responsible for reimbursing Mayo Clinic for any payments they receive and any balances not covered by their insurance.

Medicare assignment

Mayo Clinic is required to accept assignment for Medicare Part B for certain services designated by government regulations (for example, clinical laboratory, drugs and biologicals). For Minnesota residents seeking care within their state, providers are required to accept assignment.

For residents outside of Minnesota, Mayo Clinic does not participate with Medicare and claims will be filed nonassigned.

Medicare supplemental or Medigap insurance crossover

If you expected your claims to cross over from Medicare to your supplemental or Medigap insurance and this did not occur, please contact your Medicare supplemental or Medigap insurance organization to inquire.

Medicare Advance Beneficiary Notice

Before certain items or services are provided, Medicare patients may be asked to read and sign an Advance Beneficiary Notice (ABN) that explains Medicare payment restrictions and estimate of charges. By signing the ABN, you assume financial responsibility in the event Medicare denies payment.

Noncovered services, such as eye refractions, foot care, hearing aids, screening exams, preventive medicine services and elective procedures, do not require prior notification and are not subject to the ABN requirement. Patients are financially responsible for all noncovered services.

Any questions regarding a noncovered item or service should be directed to Medicare at 800-633-4227 (toll-free).

Medicare Advantage plans

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 Account and private fee-for-service plans. If your plan is considered out of network, your out-of-pocket expenses will be higher. As a general rule, Medicare Advantage plans should process the same as Medicare.

The following Mayo Clinic campuses limit access to some of the Medicare Advantage plans:

  • Mayo Clinic's campus in Arizona. Patients covered by any types of Medicare Advantage Plans (exception Cost share/HCPP) that are not contracted may not be seen. Patients cannot be seen on a self-pay basis.
  • Mayo Clinic's campus in Florida. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.
  • Mayo Clinic's campus in Rochester, Minnesota. Patients covered by Medicare Advantage HMO plans without authorization may not be seen. Patients cannot be seen on a self-pay basis.

Medicare Advantage HMO plans require authorization prior to scheduling appointments at the Mayo Clinic site that is contracted or that has accepted your plan; without authorization, the patient will be financially responsible.

Mayo Clinic's campuses in Arizona and Florida do not agree to the terms and conditions of noncontracted Medicare Advantage plans, due to administrative and financial challenges. Please refer to your Medicare Advantage plan for a list of in-network providers.

Medicare reimbursement denials and disagreements

  • If Medicare denies a charge and your Medicare Summary Notice states you are responsible for the charge but you disagree, please call Mayo Clinic's Patient Account Services:
    • 800-660-4582 (toll-free)
    • Arizona: 480-301-7033
    • Florida: 904-953-7058
    • Rochester, Minnesota: 507-266-5670
  • To appeal a denied charge when Medicare states you're responsible for the charge, follow the instructions under "Appeals Information" on the last page of your Medicare Summary Notice. For more information on Medicare and appealing Medicare decisions, please access the link in Related information or call Medicare directly.
  • You must file an appeal within 6 months of the date of the denial notice. Mayo Clinic is not permitted to initiate appeals on your behalf in most instances on Medicare nonassigned services.
  • When Medicare states that you're responsible for a denied charge, please be aware that Mayo Clinic expects payment from you and will continue to send you a monthly statement until your account is paid in full.

In order to apply for financial assistance, patients will be required to apply for their state medical assistance (Medicaid) plan.

Additional Medicare information

More information about Medicare is available at the Medicare website.

Arizona: For questions regarding your Medicare Part B claims for services that you incurred in the state of Arizona, call Medicare at 800-633-4227 (toll-free).

Resources

Medicare.gov: The official U.S. government site for Medicare

Medicare.gov: What Medicare covers

May 21, 2016