Billing Questions and Information in Austin for Your Healthcare Needs

Thank you for choosing Mayo Clinic Health System Billing Questions and Information in Austin for your healthcare needs. As a regional We welcome your comments, concerns and ȱǰȱ ȱȱĴȱȱȱȱ questions related to your billing statement. highest quality care for you and your family. We would like to work together with you to make the ȱȱȱȱȱǱ ȱȱ¢ȱǻǼȱȱȱȱȱ Ǳȱȱȱ ȱȱǯȱȱȱȱȱȱȱ Mayo Clinic Health System ȱ ȱȱȱǯȱ ŗŖŖŖȱȱȱǯǯ ȱǰȱȱȱȱ¢ȱȱ Austin, MN 55912 ȱȱ¢ȱǯȱȱȱȱȱȬ ȱȱȱȱȱ ȱȱ¡ȱȱȱ¢ȱȱȱ ȱȱȱ¢ȱȱȱ Ȭǯȱ ȱ¢ȱȦ¢ȱȱǻǼȱǯ ȱśŖŝȬŚřřȬŞŞŚŞȱȱŞŞŞȬŜŖşȬŚŖŜśȱǻȱǼ

Patient Financial Services ȱȱȱȱ¢ȱȱ ȱȱȱǰȱśŖŝȬŚřŝȬŝŚŗŖȱȱ Payment Policy ŞŞŞȬŜŖşȬŚŖŜśȱǻȱǼǯ ȱȱȱȱȱ¢ȱȱȱȱ Insurance Claims ȱȱǯȱȱȱȱȬȱȱ to limit the increasing costs of health care is focused ȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱ ȱ ȱȱȱ¢ȱȱȱȱȱ¢ǯȱȱ ȱȱȱȱǯȱȱȱǰȱ ȱȱȱ ȱ¢ȱȱȱ¢Ǳȱ ȱȱȱȱȱȱ¢ȱȱ ȱ ¢ȱǯȱ Presentin ŗś minutes before each appointment so we have adequate time to obtain the necessary insurance Payments for co-pays, deductibles, non-covered information prior to your visit. procedures, cosmetic procedures and medical devices will be paid at the time of service or prior to the rinin the most current copy of your insurance delivery of services. card to every visit so we can verify your insurance coverae. All balances billed must be paid in full within 30 days of a statement date. espondin to any inquiries from your insurance company in a timely manner. These inquiries may be If a patient is unable to pay the full balance within in the form of coverae questionnaires or requests for 30 days, they MUST contact the Patient Accounts additional information. Insurance companies will not team to mae other ęnancial arranements, ś0ŝ-Ś3ŝ- consider payment of your claims until you have ful- ŝŚŗ0 or ŞŞŞ-Ŝ0ş-Ś0Ŝś ǻtoll freeǼ. ęlled your obliation to provide additional information. If you fail to respond to your insurance The Patient Accounts team will assist patients in company, any outstandin balance will be your applyin for the Payment AssistanceȦharity responsibility. are ǻPAǼ proram or establishin e¡tended payment arranements when appropriate. ein prepared to provide third party details such as car insurance or home owners insurance if your visit ȱȱȱ¢Ǳȱǰȱǰȱcard, is the result of an accident. ǰȱǰȱȱ¡ȱȱȱǯȱ Managed Care Plans ȱȱȱ ȱȱȱȱȱ ȱȱȱ¢ȱȱȱȱǻMedicaidǼ Managed Care Plans, Health Maintenance Organi- ȱ ȱȱȱȱȱȱ ȱřŖŖȱ zations (HMOs) or Preferred Provider Organizations ȱȱȱȱ¢ȱǯȱȱȱ ǻǼȱȱęȱ¢ȱȱȱȱǯȱ ȱ ȱ ȱȱȱ¢ȱȱȱȱȱ ȱ¢ȱ¢ȱ¢ȱȱȱęȱȱ ȱȱ¢ȱȱ¢ȱęȱȱȱǯȱȱ ȱȱȱȱȱȱȱȱ ȱ ȱȱ¢ȱȱȱȱȱ ȱȱȱȱȱȱȂȱȱęǯȱ ȱȱ ȱȱ¢ȱ¢ȱȱǯ ¢ȱȱȱȱȱȱ¢ȱȱ ¢ȱȱȱǰȱȱȱ¢ȱ ȱȱȱȱȱ¢ȱȱ ǰȱȱȱęȱȱ¢ȱȱ ȱ¢ȱ ȱȱȱǯ

Minnesota Crime Victims Fund ȱȱ¢ȱȱȱȱȱȱ ȱȱȱȱȱȱȱǯȱȱ

ȱȱȱȱȱ ȱȱǱȱȱ ĴǱȦȦ ǯǯǯǯȦ

Minnesota Health Care Programs ȱ ȱȱȱȱȱ What we can do to help you with your bills ȱȱǯȱȱȱȱ ȱ ȱȱȱ ȱȱȱȱȬ ȱȱȱȱȱȱȱȱ ȱ ȱȱȱȱȱ¢ȱȱ¢ȱ ǯȱȱȱȱȱȱśŖŝȬŚřŚȬŗşşśȱ ȱȱȱǯȱ ȱȱȱȱǯ epresentatives will treat all patients with dinity Payment Assistance/Charity Care (PACC) and respect reardless of ability to pay.

¢ȱȱ ȱ¢ȱ£ȱȱęȱ epresentatives will consider all patient information ȱȱȱȱ¡ȱȱȱ conędential in accordance with privacy laws. ȱȱǯȱ Assistance requires your cooperation If you feel your income is not suĜcient to pay for ȱȱȱȱȱȱǰȱȱ your services, you may qualify for our PA proram, ȱȱǯȱȱ¢ȱȱ ȱ¢ȱ which is based on your income, assets and family si£e. ȱȱȱǯȱȱȱȱ Prior to applyin for the PA proram, patients ęȱĜȱǱ must ęrst apply for and fully utili£e any overnmental assistance available. The purpose of this re- Spea with a representative by callin ś0ŝ-Ś3ŝ-ŝŚŗ0 quirement is to conserve these funds for individuals or ŞŞŞ-Ŝ0ş-Ś0Ŝś ǻtoll freeǼ. who have no other source of payment. ¡plain the ęnancial situation. As for information about any ęnancial aid prorams Q. What if I have already made payments on available. my account? A. PA discounts will be made only on any remainin As for an application. balance. efunds for prior payments will not be made.

ead the application and promptly complete the ne- Q. What services qualify for PACC discount? cessary paperwor ǻinclude requested documentsǱ such A. All non-elective services received at any Mayo linic as -Ř forms, pay stubs and current ederal ta¡ returnsǼ ealth System in Austin and all aĜliated sites ǻAdams, loomin Prairie, rand Meadow, eoyǼ would Provide all requested information to enable a fair qualify for PA discount. determination of the request for assistance to be made. The discount is not the same at other Mayo linic Mae an appointment with ustomer Service to ealth System sites, includin Mayo linic in review the application and ensure all required docu- ochester, however, we can forward your application ments are included so ustomer Service can forward to verify qualięcation under their proram criteria. your application for ęnal determination. ustomer Service can be reached at ǻś0ŝǼ Ś33-ŞŞŚŞ. Q. How often do I need to apply for PACC program? Payment Assistance/Charity Care A. or account balances less than Ǟś,000, you will need Program Frequently Asked Questions to apply annually. or any visit in which the balance e¡ceeds Ǟś,000, you must re-apply for PA assistance. Q. How do I qualify for the program? Q. If I have some type of governmental assistance A. A representative will review your completed inancial PA application to determine if you such as Medical Assistance and Mayo Clinic Health qualify for a discount under the proram. This System in Austin is not my primary care provider, determination is based on your income, family can I qualify for PACC if I receive out of network si£e and assets. services from Mayo Clinic Health System in Austin? A. o. Patients must fully utili£e any overnmental Q. How does the program work? beneęts available to them prior to qualifyin for PA. A. AĞer you have applied and been approved for a ou must ęrst chane your primary care provider to PA discount, the appropriate adustment will be Mayo linic ealth System in Austin in order to made to your account. ou will then be billed for your qualify for PA. remainin balance. This balance must be paid in a timely manner or your discount will be forfeited. For more information If you would like more information about the Q. Whose income must be included on the Payment Assistance/Charity Care program available application? in Austin, or if you have any questions or concerns A. If you are married, both spousesȂ incomes must be ȱȱęȱǰȱȱǱ included. If you are over the ae of ŗŞ and can be counted as a dependent on your parentsȂ income ta¡ returns, then both parentsȂ incomes must be included. Mayo Clinic Health System Patient Account Representatives Q. Can I apply for PACC if I have insurance? ¢ȱȮȱ¢ǰȱŞȱǯǯȱȱŚǱřŖȱǯǯ A. es. Any discount you qualify for under the PA śŖŝȬŚřŝȬŝŚŗŖȱȱŞŞŞȬŜŖşȬŚŖŜśȱǻȱǼ proram will be made aĞer all of your insurances have been processed.