Doctors taking Medicare but not Medigap?
- Thread starter crs6633
- Start date
sunny1ib
Expert
- 57
Somarco,
Sometimes I feel like I am some sort of newbie when I'm on here, maybe I should have been contributing more as I have been on this site since 2015...this my friend, is from my notes circa 2014, after reviewing Mayo Clinic Jax website for a client of mine down in Punta Gorda:
The Mayo Clinic is a non participating provider with Medicare Part B. We are a participating provider with Medicare Part A.
What this means is that Mayo will obtain an authorization for all procedures to perform that is both inpatient and outpatient.
* * * * *
An ABN waiver will need to be signed. If Medicare does not pay for any portion of the procedure codes submitted, the patient is required to pay for all charges not paid for by Medicare. They will, as a courtesy, submit their bill to Part B contractor but they expect payment from the patient regardless if Medicare pays (or not).
In 2020, it is my understanding that they do accept Original Medicare but do not accept assignment, so they would be one of the facilities that would charge the excess fees.
There was a recent article where the CEO of Mayo told his employees that their revenues had been down. For scheduled services, individuals who had commercial plans were to receive first scheduling priority, then Medicare, Medicaid and the Uninsured were to follow as they lose money on those patients. They would continue to accept any person thru their Emergency Department.
I also checked Aetna Medicare Premier PPO Plus plan because in the past, Mayo was listed as a contracted provider, as was Humana Regional PPO. I do not see them listed any longer. Mayo (for whatever reason was previously listed under Aetna's short term facility, but I did not find Aetna listed either. Mayo Clinic used to have a list of both their Commercial insurance accepted plans and their Medicare accepted plans. That list is no longer on their site. They have a one paragraph blurb basically stating they do accept Original Medicare but the patient should call to be certain what all services Medicare will cover, and how much the patient may pay out of pocket.
EDIT: Mayo does suggest that the patient contact their Billing/Financial Dept and discuss what insurance they do accept PRIOR to having any services there.
Report: Mayo Clinic to cherry-pick patients with commercial insurance over Medicare and Medicaid patients
Mayo Clinic halts scheduling of out-of-network Medicare Advantage patients
Sometimes I feel like I am some sort of newbie when I'm on here, maybe I should have been contributing more as I have been on this site since 2015...this my friend, is from my notes circa 2014, after reviewing Mayo Clinic Jax website for a client of mine down in Punta Gorda:
The Mayo Clinic is a non participating provider with Medicare Part B. We are a participating provider with Medicare Part A.
What this means is that Mayo will obtain an authorization for all procedures to perform that is both inpatient and outpatient.
* * * * *
An ABN waiver will need to be signed. If Medicare does not pay for any portion of the procedure codes submitted, the patient is required to pay for all charges not paid for by Medicare. They will, as a courtesy, submit their bill to Part B contractor but they expect payment from the patient regardless if Medicare pays (or not).
In 2020, it is my understanding that they do accept Original Medicare but do not accept assignment, so they would be one of the facilities that would charge the excess fees.
There was a recent article where the CEO of Mayo told his employees that their revenues had been down. For scheduled services, individuals who had commercial plans were to receive first scheduling priority, then Medicare, Medicaid and the Uninsured were to follow as they lose money on those patients. They would continue to accept any person thru their Emergency Department.
I also checked Aetna Medicare Premier PPO Plus plan because in the past, Mayo was listed as a contracted provider, as was Humana Regional PPO. I do not see them listed any longer. Mayo (for whatever reason was previously listed under Aetna's short term facility, but I did not find Aetna listed either. Mayo Clinic used to have a list of both their Commercial insurance accepted plans and their Medicare accepted plans. That list is no longer on their site. They have a one paragraph blurb basically stating they do accept Original Medicare but the patient should call to be certain what all services Medicare will cover, and how much the patient may pay out of pocket.
EDIT: Mayo does suggest that the patient contact their Billing/Financial Dept and discuss what insurance they do accept PRIOR to having any services there.
Report: Mayo Clinic to cherry-pick patients with commercial insurance over Medicare and Medicaid patients
Mayo Clinic halts scheduling of out-of-network Medicare Advantage patients
Last edited:
sunny1ib
Expert
- 57
Ha! Ha! That may be true, unless that bird drank some Red Bull
Medicare physician finder says this . . .
Mayo Clinic - Florida
Charges the Medicare-approved amount (so you pay less out-of-pocket)
Medicare.gov
Which is correct?
Authorization from who? And for what?
Medicare does not pre-authorize anything except DME
Traditional Medicare, in contrast, does not require prior authorization for the vast majority of services, except under limited circumstances, although some think expanding use of prior authorization could help traditional Medicare reduce inappropriate service use and related costs
https://www.kff.org/medicare/issue-... contrast, does,service use and related costs.
It is my understanding they started accepting assignment in 2020 or 21.
This, from the Medicare physician finder, indicates they do accept assignment. The popup balloon (which I cannot copy & paste) says you (the patient) will not be billed for more than the Medicare deductible and coinsurance
Charges the Medicare-approved amount (so you pay less out-of-pocket)
- Thread starter
- #55
crs6633
Expert
- 44
somarco, just to clarify since you seem to be the most knowledgable on the topic. Medicare notifies the Supplement carrier correct?
You're saying that when my client buys a Plan G from Acme insurance Acme then notifies Medicare and informs them that any and all claims they process will be covered by Acme according to the terms of the Plan G (not covering the Part B deductible of course). So if my client loses their supplement insurance card they can continue going to their doctor and having him bill Medicare and their supplement will cover it? Without the doctors office billing the supplement?
- 6,463
When a Medicare beneficiary looses their Medigap policy card, I suspect they can obtain a new one from the Medigap company. The carriers I have used have allowed policy holders to create online accounts where they allow the policy holders to see claims and do other things like order replacement cards.
MOST Medigap carriers participate in crossover . . . as such, once Medicare adjudicates the claim it "crosses over" electronically to the Medigap carrier.
There is never a time when a provider should bill the Medigap carrier.
They bill Medicare, claim is adjudicated and passed on to the Medigap carrier, then and only then should the patient pay a bill.
FWIW I have had a few providers tell me they need my Medigap card "in case we have to send them a bill". Nonsense.
Agreed, but Medicare has to know what company it is before they can send it. As far as I know, a Med Supp carrier won't tell Medicare that they have a new client. The client has to get that info to Medicare somehow, which is usually done from the doctor or hospital.
Most people have it on file at their doc's office, which is why they don't get asked for it continuously.
- 29,492
Todd, when you sell someone a Med Supp, the carrier notifies Medicare to send the claims associated with their Medicare Claim # to them.
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