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galileegirl Find out more about galileegirl
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  • Health Insurance

    We are trying to figure out health insurance coverage for our possible trip to Mayo for a myectomy.

    For those of you who traveled out of state for your procedures/appointments, was the doctor/facility covered as in-network? Did you need to get a special referral or special authorization?

  • #2
    Re: Health Insurance

    It depends on the insurance company, the type of insurance you have, plus I am sure other factors. As with everything else I am sure no two are the same. If you have the policy read it you may get some answers there but if possible call or email the company and try to get the information, preferably in writing and from someone with more authority than the person who answers the phone, ask for a supervisor. You can also contact Mayo as they may have the answers or at least try to help you find them.

    Comment


    • #3
      Re: Health Insurance

      You guys are in Israel but if I remember right you are US ex-pats. Do you have a health insurance policy in the US?

      If you do have US insurance and you have an HMO, then you may be limited to providers in your "home" state, unless you are granted an exception based on circumstances (such as no HCM experts in your home state). Not every carrier is the same of course so you have to ask.

      If you have a PPO plan, then you can likely get treatment in any state so long as your provider is "In network", meaning they cooperate with your insurer. For example I live in Georgia and at the time of my surgery I was with Blue Cross/ Blue Shield of GA but Blue Cross is in every state and Cleveland Clinic was in their network, so I was covered. I needed pre-authorization, but the hospital knew how to take care of that.

      The best thing to do in your case is call Mayo and ask. They, along with any major medical systems in the US, have legions of experts in insurance and financial matters. When they see you knocking on the door for what is likely to be over $130,000 in procedures and treatment, they will do everything they can to get you in the door. At Cleavland Clinic they have patients come to them from all over the world and they know how to coordinate it. Mayo has the same or better capacity I am sure. I'm not saying the surgery and treatment is free, but they will know best how to navigate the financial matters and advise you.
      Last edited by angusjcampbell; 05-29-2014, 10:39 AM.
      Angus Campbell
      Golden Isles Region, Southeast Georgia, USA

      Dx'd HOCM at St Luke's Roosevelt, New York City, 2005
      Myectomy Jan 9th 2014 at Cleveland Clinic
      Drs Lever and Smedira

      Comment


      • #4
        Re: Health Insurance

        I echo what others have offered, but urge you to document any "approvals" in writing. Insurance Companies love to change their minds.
        Marc
        Diagnosed @ 48
        Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
        Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
        AICD - Valentines Day '08, Spark Plug replaced 11/14
        After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
        Quietly going insane . . .

        Comment


        • #5
          Re: Health Insurance

          Thanks for the advice! We are US ex-pats and are looking into every option for health insurance.

          It is good to know that others have been able to use their PPO in another state.
          Last edited by galileegirl; 06-02-2014, 04:00 AM.

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          • #6
            Re: Health Insurance

            If not already covered, look at plans under the affordable care act ("ObamaCare") at healthcare.gov. There is no penalty for pre-existing conditions, and we found the process easy to navigate. We used it to change from Blue Cross to Humana and save $500 a month for two of us for pretty much the same PPO plan.

            Remember too to tap the financial expertise at Mayo as well.
            Angus Campbell
            Golden Isles Region, Southeast Georgia, USA

            Dx'd HOCM at St Luke's Roosevelt, New York City, 2005
            Myectomy Jan 9th 2014 at Cleveland Clinic
            Drs Lever and Smedira

            Comment


            • #7
              Re: Health Insurance

              My PPO (in Florida) treats Cleveland Clinic as in-network.

              Gordon
              Myectomy on Feb. 5, 2007.

              Comment


              • #8
                Re: Health Insurance

                Including the doctors etc, Gordon?
                My insurance (in Mew York) said Tufts was in network also. I was told not to worry about it by docs at tufts when I asked to make sure.
                Well Ive received a few thousand dollars in bills from everyone who may have looked in on me it seems.
                Turns out, just because I was told the hospital was in network, the DOCTORS and others , themselves weren't!? I don't understand all that, and I don't want to sound like I'm whining but that, to me, is not right.

                I guess my point is, check then double check. Maybe get it in writing?


                -----Kev
                Dx'ed 4/11 with "left ventricular hypertrophy"
                Re-dx'ed by a new cardiologist 4/13 at age 51 with possible HCM.
                Went to Tufts 7/13 and verified HCM with obstruction.
                Going in for a Myectomy and a Maze procedure on 11/13/13

                Comment


                • #9
                  Re: Health Insurance

                  I've heard that many who had X insurance (example - Blue Cross) and switched to an Affordable Care Act Plan - thinking they were the same, and find out that not all components are the same (doctors, prescription, etc.) It pays to read the small annoying print.
                  Marc
                  Diagnosed @ 48
                  Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
                  Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
                  AICD - Valentines Day '08, Spark Plug replaced 11/14
                  After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
                  Quietly going insane . . .

                  Comment


                  • #10
                    Re: Health Insurance

                    I've heard a lot of similar stories under the Affordable Health Care Act Plan. Patients being sent bills for services they were sure were covered.

                    I've spoken with BCBS and the Mayo Clinic is in-network for the PPO they recommended. If we choose to go that route I will ask for pre-approval from both ends (BCBS and Mayo) before proceeding.

                    Comment


                    • #11
                      Re: Health Insurance

                      Yes, what Marc said above is absolutely correct. Here in California the Affordable Care Act has wreaked havoc with individual policies.

                      When I travelled to Mayo 8 years ago I was covered by a Blue Shield individual policy and had no problem at all. Mayo got everything preapproved and it was all covered, subject, of course, to my co pays and out of pocket maximum. I did not have to get my visit preapproved, but certain tests, surgery and hospitalization all needed pre-auth, as they would here at home.
                      Daughter of Father with HCM
                      Diagnosed with HCM 1999.
                      Full term pregnancy - Son born 11/01
                      ICD implanted 2/03; generator replaced 2/2005 and 2/2012
                      Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

                      Comment


                      • #12
                        Re: Health Insurance

                        Speaking of Health Insurance and COE coverage.....I have begun the adventure of getting a referral to Mayo from Kaiser Medicare Advantage. My Cardiologist and I agreed it is time to head out to Mayo in Rochester for a reassessment and most likely a revision of my myectomy....I've psyched myself up for the adventure after all the wonderful information I got at the HCMA meeting. So when I get my referral approved and my appointment, (I hope it is soon!) I'll post to see if anyone from HCMA is on their way to Mayo at the same time. I'll let you know how it goes.
                        After years of symptoms:
                        Officially Diagnosed HOCM 2006
                        Myectomy 3/11/13 at non-COE
                        Extended Myectomy 7/23/14
                        At Mayo with Dr. Joseph Dearani

                        Comment


                        • #13
                          Re: Health Insurance

                          Still exploring insurance options...

                          Curious to know if anyone saw the final bill from the hospital for their evaluation and myectomy. I know that health care prices are inflated in the US and I'm wondering how much coverage we'd need.

                          I've also asked the Mayo for an estimate.

                          Comment


                          • #14
                            Re: Health Insurance

                            I can say from experience that my hotel, 2 days of testing, and most transportation is cheaper at Mayo then a simple echo/Dr. visit at Cedars Sinai. My total bill was around $65,000. but I don't remember the details. I can't say how the prices may compare for you. Though you doing the right thing to get advance clearance. Perhaps Research hospitals (like Mayo) have an international agreement with other hospitals (I have no idea, just guessing).
                            Marc
                            Diagnosed @ 48
                            Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
                            Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
                            AICD - Valentines Day '08, Spark Plug replaced 11/14
                            After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
                            Quietly going insane . . .

                            Comment


                            • #15
                              Re: Health Insurance

                              Marc, that sum was just for 2 days of testing? Just to clarify - that that did not include the cost of the myectomy and recovery?

                              From the Mayo Clinic International Services website "Whenever possible, Mayo Clinic tries to remove financial considerations from providing medical care." I'm not quite sure how to interpret this statement.

                              They also have a "Charity Care" program which I don't think we'd qualify for since we aren't residents of the USA. http://www.mayoclinic.org/patient-vi...e/charity-care.

                              Comment

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