The provider initially began to limit appointments during the winter months due to capacity concerns, but has now turned to “a change in enforcement” that blocks out-of-network patients from making appointments to ensure those in contracted plans have access to Mayo Clinic facilities, a spokesperson told the Tribune.
“The impact is to non-contract Medicare Advantage plans,” the spokesperson told the Tribune. “Mayo does not have contracts with these plans so there should not have been any expectation of access to the Mayo Clinic by these plans.”
The largest player impacted by the change is UnitedHealthcare, who has seen many members tap out-of-network benefits to receive care at Mayo Clinic locations. The provider said that out-of-network Medicare Advantage visits have grown over the past several years, with half of these patients being UnitedHealthcare members.
The clinic told the Tribune that these out-of-network Medicare Advantage patients often result in reimbursements lower than those covered by contracted plans.
A spokesperson for the payer told the Tribune that it is actively negotiating with Mayo Clinic to bring Mayo in-network for its members.
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