So, you’re seeking treatment for your health issues and want to visit Mayo Clinic. It’s good that you have insurance, but is it accepted at Mayo Clinic?
Before you book your appointment, it helps to confirm whether Mayo Clinic accepts the type of insurance that you have. Otherwise, you’ll have to pay out of your pocket.
Here’s a quick guide for you.
Does Mayo Clinic have contracted insurance?
Your insurance company determines the benefit coverage for any care you get from Mayo Clinic, depending on your specific medical benefit plan.
Some of the insurance plan contracts that Mayo Clinic are the following:
- Arizona Foundation for Medical Care
- Blue Cross Blue Shield
- Kaiser Permanente
- AXA Assistance USA
Contact the customer support of your insurance company to verify that Mayo Clinic is part of their in-network care providers.
Is Medicare accepted at Mayo Clinic?
Yes, Mayo Clinic honors your Medicare coverage. Medicare Part A covers inpatient hospital care, including lab tests and surgery.
Meanwhile, Medicare Part B covers doctor fees, outpatient care, and clinic services. Regardless of whether you participate in Medicare Part B, Medicare will help pay your bill for any care services you get from Mayo Clinic, usually up to 80% of the allowed amount after the deductibles. Mayo Clinic will file the claims on your behalf.
Note, however, that Medicare may not pay for a test if it’s not medically necessary. It means that the test should be reasonable and necessary for proper diagnosis or treatment of your health issue.
How about Medicare Advantage plans that are offered by private companies?
Mayo Clinic accepts limited Medicare Advantage plan coverage. If you have the following plans, you may not be seen at Mayo Clinic, not even on a self-pay basis:
- Any types of Medicare Advantage Plans, except PPO/Cost share/HCPP, that aren’t contracted aren’t accepted at Mayo Clinic’s campus in Arizona
- Medicare Advantage HMO plans without authorization aren’t accepted at Mayo Clinic’s campuses in Florida and Rochester, Minnesota
Does Mayo Clinic accept Medicaid?
Mayo Clinic accepts limited Medicaid coverage programs.
In Arizona, Mayo Clinic accepts Medicaid for transplant services if you have Arizona Health Care Cost Containment System (AHCCCS) plan. Before you book your appointment, make sure that you have secured authorization from AHCCC.
In Mayo Clinic’s Florida campus, patients can have transplant services if you have Florida Traditional Medicaid.
Its Rochester, Minnesota campus participates with Medicaid programs in the following states:
- North Dakota
- South Dakota
Mayo Clinic doesn’t accept Medicaid out of the states mentioned above. You’ll be considered self-pay then, and you need to pay a deposit of the estimated cost of care.
Can you use your Tricare or CHAMPUS insurance at Mayo Clinic?
If you have a CHAMPUS or Tricare insurance plan, you can use it when you get care services at Mayo Clinic. However, coverage limitations apply depending on your plan, so you may have to pay a deposit before you receive care services at Mayo.
The providers have payment restrictions for some diagnostic services, consultations or checkups, and other procedures that they don’t consider effective. It’s better to contact your provider first before you book an appointment at Mayo Clinic. Otherwise, there’s a chance that your insurance won’t pay your treatment or would reduce your benefits coverage.
Additionally, you must secure a written referral from a physician and pre-authorization, which is needed if you’re going to be admitted or receive certain outpatient procedures. Call the military health-benefit adviser near you to get these.
If you’re an active duty member, you also need to get a referral from your commanding officer and bring your uniformed services ID card.
Note that Tricare and CHAMPUS don’t usually pay in full for the cost of care services you received from Mayo Clinic. So, be prepared to pay your deductibles, cost-share, and noncovered services out of your pocket. These will be itemized in the statement of charges for each visit and the monthly statements.
What HMO does Mayo Clinic accepts?
Mayo Clinic only has a few contracted health maintenance organizations (HMOs), such as Group Health Cooperative, Compcare, and ContinuUs.
To use your HMO at Mayo Clinic, you must secure authorization from your insurance company. Mayo Clinic will verify the authorization with your HMO before providing you any care services. Mayo Clinic will also assist you in filing insurance claims as you receive additional services.
If you need care services that are unauthorized by your insurance company, you’ll have to pay a deposit that is equivalent to the estimated cost of services you need.
Does Mayo Clinic accept any other insurance types?
Mayo Clinic does not accept several commercial and traditional health insurance plans. You need to confirm with your insurance company or employer what your benefits Mayo Clinic services are covered.
Other types of insurance that are accepted at Mayo include disability insurance, motor vehicle insurance, prescription plan cards, and worker’s compensation.
You need to provide all pertinent details to Mayo Clinic to help you process your claims faster. For example, if you need motor vehicle accident-related care, tell Mayo Clinic your motor vehicle insurance information.
Meanwhile, if you’re a new patient and you visit Mayo Clinic for a workers’ compensation visit, Mayo Clinic might not see you unless you have a referral or prior authorization from your employer’s insurance company. Your employer will also need to file a report of your injury with the Industrial Commission.
The Bottom Line
Mayo Clinic sites are contracted with several insurance providers and HMOs, including Medicare and Medicaid. If your insurance provider and Medicare and Medicaid coverage are honored at Mayo Clinic, the benefits typically cover your doctor consultations, laboratory tests, hospitalizations, and medical procedures.
In most cases, you need to secure a prior authorization and referral from your insurance provider before you can book an appointment with Mayo Clinic and receive care services. You may also need to pay a deposit for unauthorized services.
Be sure to contact your insurance company before you receive any treatment to ensure that Mayo Clinic services will be paid. Otherwise, you’ll have to pay out of your pocket.