Mayo Clinic out of network

I kind of feel like I got punched in the gut today.   We have been so blessed that we are from So. Minnesota and the Mayo Clinic is only 40 miles from our home.  Best. Care. Anywhere.   So, today, I get our enrollment package for our health insurance.  They want to "discourage expensive behaviors" and have classified Mayo as an out of network provider - so really high deductibles, 60/40s, and really high maximum out of pocket expense ($12,000) if we choose to stay with Mayo.   Our company as well as BCBS want us  to get out of the Mayo System.  As I said, Mayo is all around us - our small local clinics are all Mayo affiliated.   They want us to drive to Minneapolis for my husbands treatments ...but they are giving us $50 gas cards to help defray the additional cost of getting there.   I just can't bring myself to switch health care providers at this point in my husbands journey, so I guess we just have to figure it out financially. Sorry - just needed to let off steam.

I am sorry you are having to go through all of this   My mom was treated at the Mayo Clinic as well and I agree with you they are one of the best! Has your husband already went through treatment? 

many insurance companys have what is called in network for outof network care.  I never new about it until a few years ago when my son lost his left eye to an accident.  you have to get past the morons that answer the phone at the insurance company.  be patient  but stern.  will not get the mayo to be your GP, but should be able to get covered for bt treatmetns

josh

This may all be a shot in the dark, but I wonder if there is any chance Mayo would treat your husband's case as if they are a network provider?  I had to have surgery about 6 years ago, but the surgeon only did surgery at a hospital that was out of our network, so the hospital agreed to accept me as if they were an in network provider. I honestly don't know how they were able to do that, but they did.  Also, I have heard where an insurance company would allow an insured to continue their care with the same provider and pay as if provider is in the network...maybe in extreme cases??? It just seems crazy to expect someone with such a devastating disease, such as GBM, to change midstream. I wonder if making a call to see if they would make any exceptions would be worth the try??

I'm so sorry you have to deal with this ridiculous nonsense....There should be some kind of clause in place for extreme cases where they don't have to change providers when they are in treatment process. 

My gut and my heart ache for you.  I hope that somehow this all works for you and your husband.

Melissa

On Nov 07, 2012 3:17 AM tromda wrote:

I kind of feel like I got punched in the gut today.   We have been so blessed that we are from So. Minnesota and the Mayo Clinic is only 40 miles from our home.  Best. Care. Anywhere.   So, today, I get our enrollment package for our health insurance.  They want to "discourage expensive behaviors" and have classified Mayo as an out of network provider - so really high deductibles, 60/40s, and really high maximum out of pocket expense ($12,000) if we choose to stay with Mayo.   Our company as well as BCBS want us  to get out of the Mayo System.  As I said, Mayo is all around us - our small local clinics are all Mayo affiliated.   They want us to drive to Minneapolis for my husbands treatments ...but they are giving us $50 gas cards to help defray the additional cost of getting there.   I just can't bring myself to switch health care providers at this point in my husbands journey, so I guess we just have to figure it out financially. Sorry - just needed to let off steam.

What in the name of hell do they mean by "discourage expensive behaviors?"

Nice of them to throw you a bone in the way of the gas cards.  I suppose it never occured to them that an 80 mile round trip can really wear out a cancer patient.  Not to mention wear and tear on your vehicles.  I'd have more confidence in whoever makes these . . .  decisions . . .  if they had a stake in them as well.

sounds like you have switched insurance? So if that is the case many insurances just need a referral to a health care provider,even if it's out of network and referred by doc in network, many will cover at in network costs.

I've heard such good things about Mayo clinic, but was surprised at my own insurance companies policy on this.  I am insured by Golden Rule, a subsideary of United Health Care.  I pay for my own insurance, since I do not work.  Anyway, in a very obvious place somewhere on my policy, there is a clause that they will no long pay ANYTHING towards any care at the Mayo Clinic.  I have no idea why.  But I guess I just assumed they wouldn't agree to the price United Health Care offered Mayo Clinic for their services.  Maybe United Health Care feels that Mayo charges more than the average Hospital.  I don't know, just wondering.

I forgot to add that I have the ability to go to out of network places.  United Health Care, however does not count Mayo Clinic as out of network.  They just will not cover any part of any treatment there.  Puzzling.

I was able to get a bit more information today.   Evidently, all other health care providers (Allina, Health Partners, United) discount to Insurance companies.   Mayo does not give the same discounts and absolutely will not negotiate.  The company I work for is self-insured and administered by BCBS.  So, I guess I understand that the difference in cost is a direct hit to our companies bottom line.   Ok, so maybe I can drive 80 miles when I have a minor medical issue.  But Neuro-Oncology is different, and I'm pretty sure the minute clinic at Target isn't going to cut it.

It is kind of concerning, however, that Mayo is so unbending.  Supposedly, many of the large companies in this area are following this path, so I'm wondering why Mayo isn't concerned about losing patients.

We'll figure it out, I guess.   Thanks for the comments!

On Nov 07, 2012 11:32 PM tromda wrote:

I was able to get a bit more information today.   Evidently, all other health care providers (Allina, Health Partners, United) discount to Insurance companies.   Mayo does not give the same discounts and absolutely will not negotiate.  The company I work for is self-insured and administered by BCBS.  So, I guess I understand that the difference in cost is a direct hit to our companies bottom line.   Ok, so maybe I can drive 80 miles when I have a minor medical issue.  But Neuro-Oncology is different, and I'm pretty sure the minute clinic at Target isn't going to cut it.

It is kind of concerning, however, that Mayo is so unbending.  Supposedly, many of the large companies in this area are following this path, so I'm wondering why Mayo isn't concerned about losing patients.

We'll figure it out, I guess.   Thanks for the comments!

Perhaps someone has an overdue boat payment . . . good luck with all of this.