Insurance & Billing
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Billing in Caledonia
All insurance plans have varying requirements. We encourage you to take an active role in understanding the details of your insurance plan. This includes determining in-network options, prior authorization or referral requirements, copays, noncovered services, deductibles, out-of-pocket maximums, and coinsurance amounts. If you don't have insurance, you may be asked to make a preservice payment.
Learn more about billing by selecting an option:
Billing process
Each episode of care you receive will be assigned a visit number which is attached to the end of the Mayo Clinic number, and used to track services and payments. In some cases, there may be multiple visit numbers associated with the same episode of care.
Mayo Clinic will send you an itemized statement of charges. This document is not a bill. It will provide detailed visit billing information that won't appear on the monthly statement of account. Please retain this information for your records.
The itemized statement of charges includes an:
- Itemized list of charges for services at one of Mayo Clinic's facilities
- Identification of and information concerning your insurance company, if applicable
You may see more than one charge for one office visit. This can occur because the routine and preventive portion of the visit must be billed separately from the nonroutine and nonpreventive portion.
In some cases, you may receive multiple itemized statements associated with the same visit. You will receive a separate itemized statement for each facility participating in your care. For example, laboratory and radiology services at the primary care sites may be processed at another facility.
FAQ
When can I expect to receive my billing statement?
We submit claims on a daily basis, and insurance companies usually process claims within 25 to 60 days. If you have a patient-responsible balance, you will receive a monthly billing statement indicating your services, any insurance payments and the remaining balance that now is your financial responsibility.
How do I read my statement?
You can find instructions on the back of the first page of your statement. If you need additional explanation, call Patient Account Services at 1-844-217-9591.
Why are there names of providers on my statement that I didn't see?
There are providers who help with your medical care even though you may not see them. These commonly are supervising physicians or physicians who read your lab results, X-rays, EKGs and other tests. If applicable, you will receive separate bills from ambulance services.
What is an explanation of benefits (EOB)?
An EOB is a detailed document from your insurance company identifying the service, amount paid and the amount that is your responsibility, such as copays, deductibles, coinsurance and any other charges your insurance policy may not cover.
Why didn't my insurance company pay in full?
Charges may be applied to your deductible, copay or coinsurance; charges may not be covered under your benefit plan; coverage was not active at the time of services; or your insurance company may need additional information from you. Review your EOB for information regarding the amount you owe and contact your insurance company or Patient Account Services at 1-844-217-9591 if you have any questions or concerns.
Will Medicare cover my entire bill?
Medicare usually pays 80% of the allowed amount for covered services after the deductible is met. In addition, Medicare may identify a coinsurance or copayment amount for various hospital services. Learn more about Medicare coverage and how Medicare works.
What if my visit is because I was injured at work?
Notify us when you schedule your appointment or check in, and we will bill your employer or workers' compensation for your services. Notify your employer of the injury, or they may deny your workers' compensation claim. Make sure to bring your claim number to your appointment.
Can you bill my auto accident or liability insurance?
There are some instances where we can bill your accident or liability insurance. Call Patient Account Services at 1-844-217-9591 or present the information when you check in for more information.
Provider-based billing
Thank you for choosing to receive your care with us. For our patients who have Medicare, Medicare Advantage and Tricare insurance, we bill services as provider-based billing, sometimes called hospital-based billing.
Provider-based billing FAQ
What is provider-based billing?
Provider-based billing is a type of billing for services provided in a clinic or hospital department. This is common for large health care systems. Clinics located several miles away from the main hospital campus may be considered part of the hospital. Even though you are seeing your regular physician in a clinic setting and not actually hospitalized, your visit is billed under the hospital rather than the physician's office.
Will I pay more for services?
In many cases, you will receive a statement with charges split apart for each visit. One charge will be a professional fee, or clinic charge, and the other will be a technical fee, or hospital charge. The combined total charge is the same, but the components are split.
Depending on your specific insurance coverage, it is possible that some benefits will differ for these services and procedures. Some patients may have to pay a higher cost because a portion of the billed service is being charged as a hospital charge. The increase in cost is a result of the health plan's coinsurance and deductible, not an increase in actual fees. Patients with a supplement plan will not likely see much change.
Are all patients being billed this way?
No. The requirement for breaking out charges for each office visit was set by the Centers of Medicare and Medicaid. Thus, only patients with Medicare, Medicare Advantage and Tricare insurance are billed using provider-based billing. At this time, commercial insurance companies do not require this breakout.
What if I have questions?
Review your insurance benefits or contact your insurance provider to determine any changes to what your policy will cover. You can also call 1-844-217-9591 to speak to our trained staff who can help you and answer questions.
What should I ask my insurance carrier?
Making informed health care purchasing decisions is important. Ask your insurance company these questions:
- Does my benefit plan cover facility charges in a hospital-based outpatient clinic?
- How much of the charge is covered?
- How much of the charge will be applied to my deductible?
- How much of the charge is subject to insurance?