How the program works
The Mayo Clinic Complex Care Program is a collaboration between an employer, a trusted payer partner and Mayo Clinic. The employer or payer agrees to provide travel and lodging benefits and waive deductibles, copays and out-of-pocket costs (whenever possible) for individuals referred into the program. In turn, Mayo Clinic provides managed access, including expedited scheduling and condensed appointment itineraries.
Individuals who are eligible for the Mayo Clinic Complex Care Program are generally identified by a health plan, third party administrator or care management team through claims and utilization management data. Other sources for patient identification include: human resources or benefits teams, concierge or navigation services, or patient self-referrals. If a patient meets referral criteria, a case manager or medical director generally makes the referral to the Mayo Clinic Complex Care Program.
If Mayo Clinic experts agree that the individual should travel to a Mayo Clinic campus for evaluation, the required medical records are collected and reviewed in order to create an individualized appointment itinerary for expedited evaluation and treatment.
Once a patient is approved for referral into the Mayo Clinic Complex Care Program, this will serve as authorization for services related to the Mayo Clinic Complex Care Program. Any other services received that are not directly related to the Mayo Clinic Complex Care Program are subject to all of the plan's coverage and prior approval terms.
If needed, Mayo Clinic can help coordinate all travel to and from a Mayo Clinic campus and arrange for accommodations for the patient and a caregiver. Once the patient completes care at Mayo Clinic, the care team will ensure the patient has a smooth transition back to local care.
- Aug. 28, 2020