Mayo Clinic will file your primary claim to Medicare. If you have Medigap or other supplemental insurance coverage, Mayo Clinic will submit a claim on your behalf. If your plan includes an automatic crossover option, Medicare will submit the claim to your supplemental plan without your interaction. If you don't know whether your policy has this crossover feature, contact the company that issued the policy.
Since Mayo Clinic is nonparticipating with Medicare, payments are made to you. Medicare will pay 80 percent of approved charges. Your supplemental insurance may cover a portion of your remaining balance. Most covered laboratory services will be paid in full by Medicare and do not require supplemental filing.
Medicare has utilization limits and medical necessity criteria for certain items and services. Utilization limits restrict how often Medicare will cover certain items and services. These limits are not disclosed to Mayo Clinic. Medical necessity criteria determine which items and services may or may not be covered by Medicare.
Before these items or services are provided, Medicare patients will be asked to read and sign an Advance Beneficiary Notice (ABN) that explains Medicare payment restrictions. By signing the ABN, you assume financial responsibility in the event Medicare denies payment.
Non-covered services, such as screening exams, preventive medicine services and eye refractions, do not require prior notification and are not subject to ABN requirements.
Jan. 08, 2015