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PUBLIC PAGE
Sep 27, 2017

What will the Medica transition mean to me?

By Robert McGriff, @m039153

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On August 17th, Mayo Clinic announced a new business arrangement with Medica, a Minnesota-based health services company.  The arrangement is part of an overall strategy to help improve access to Mayo Clinic for patients with serious and complex medical conditions.  As part of this arrangement, Medica will acquire MMSI, which does business as Mayo Clinic Health Solutions.

To answer the question of how this change will impact participants in Mayo Clinic employee benefit plans, you first need to understand the services that Mayo Clinic Health Solutions provides.  Mayo Clinic Health Solutions is a benefit plan administrator.  That means that they perform the day-to-day work of a benefit plan.  They manage the provider networks, process claims, and make payments directly to health care providers on behalf of the plan.  However, the benefit plans are designed and funded by the employer who sponsors them.  A change in the plan design (deductible, coinsurance, covered items, etc.) can only come from the employer (Mayo Clinic for our plans).  We do not expect any changes to the Mayo Clinic benefit plans as a result of the change in plan administrator

In the initial phases of the transition, plan participants will see no change at all.  The sale of Mayo Clinic Health Solutions is expected to be completed by the end of 2017.  Current staff of Mayo Clinic Health Solutions will continue using the same technology to manage plan operations for the time being.  This means no immediate change in phone number, website, or forms (like the Explanation of Benefits that you receive when a claim is paid) for plan participants.

Starting in mid-2018, Medica will begin transitioning clients (including Mayo Clinic) to it's technology platform.  Following a communication campaign, you may see changes in the Online Service Center and the Explanation of Benefits may look different than what you are used to.  You may also begin to use a different method of submitting claims to the Mayo Reimbursement Account and the Flexible Spending Accounts.  Each time a change comes, you will receive plenty of information about how and when it will occur.  By the end of 2019, all clients of Mayo Clinic Health Solutions are expected to be moved to the Medica plan administration technology.

And for those of you who are wondering about our colleagues who work for Mayo Clinic Health Solutions, Mayo Clinic leadership has said that they are "committed to helping MMSI staff affected by these changes through this transition over the next two years, and intend to provide these staff with multiple employment options for their consideration."

So, while there is no immediate impact to plan participants, stay tuned for more information over the next 12-18 months.  Be sure to follow this page for updates and feel free to comment below.

Medica grades online are very poor. The service level from online reviews is totally unacceptable. What will be our recourse if indeed the service we receive is as bad as reviewed?

Liked by Dale

COMMENT
@crw03

Medica grades online are very poor. The service level from online reviews is totally unacceptable. What will be our recourse if indeed the service we receive is as bad as reviewed?

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Hi Catherine – the Total Rewards Team will be working closely with Medica to ensure a smooth transition, and will communicate any changes in the way that services (EOBs, claim submissions, etc.) are delivered, well in advance. Keep in mind we don’t expect any changes to the benefits plans as a result of this transition. Mayo Clinic will remain self-insured, with Medica as the plan administrator. Thanks!

COMMENT
@crw03

Medica grades online are very poor. The service level from online reviews is totally unacceptable. What will be our recourse if indeed the service we receive is as bad as reviewed?

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Thank u for your reply. Please google Medica. The concern is the administrative abilities, the wait time on a phone call, loss of medical records, lack of consistency between phone calls, wait fo4 an email response and the list goes on. My main concern is who at Mayo will support our wasted time, energy and money trying to get our insurance to be administered correctly in a timely and respectful manner

Liked by brucew

COMMENT
@crw03

Medica grades online are very poor. The service level from online reviews is totally unacceptable. What will be our recourse if indeed the service we receive is as bad as reviewed?

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Catherine, I understand and share your concern but I don’t want to place too much focus on online reviews. Nowadays, there are negative reviews online for every company, even Mayo Clinic. Mayo Clinic leaders want our plan participants to continue receiveing the high level of customer service that they are used to. Contract negotiations are currently underway and the final contract will include performance guarantees for measurable customer service issues like time to answer the phone, claims processing speed and claims accuracy. If Medica is not able to meet their performance metrics, they will forfeit a portion of the fees that they charge for providing services to the plan. We don’t anticipate there being an issue but we will be monitoring to make sure that they deliver on their commitment of quality customer service for our plan participants.

Liked by Bobbie Jo

COMMENT
@m039153

Catherine, I understand and share your concern but I don’t want to place too much focus on online reviews. Nowadays, there are negative reviews online for every company, even Mayo Clinic. Mayo Clinic leaders want our plan participants to continue receiveing the high level of customer service that they are used to. Contract negotiations are currently underway and the final contract will include performance guarantees for measurable customer service issues like time to answer the phone, claims processing speed and claims accuracy. If Medica is not able to meet their performance metrics, they will forfeit a portion of the fees that they charge for providing services to the plan. We don’t anticipate there being an issue but we will be monitoring to make sure that they deliver on their commitment of quality customer service for our plan participants.

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My experience so far is that Medica has been given total control of administering employee insurancce with very little oversight, including decisions on benefits that differ from what the medical plan says. Mayo HR does not seem to be able to answer benefit questions. In addition, the EOB forms have information that is less than correct, such as "Medica negotiates discounts with doctors" I doubt if that's the case. They are a Third Party Administrator of the benefits authorized by Mayo Clinic. It also takes a very long time for providers to get paid compared to service previously provided by MMSI.

Liked by sdb

COMMENT
@crw03

Thank u for your reply. Please google Medica. The concern is the administrative abilities, the wait time on a phone call, loss of medical records, lack of consistency between phone calls, wait fo4 an email response and the list goes on. My main concern is who at Mayo will support our wasted time, energy and money trying to get our insurance to be administered correctly in a timely and respectful manner

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I heartily agree with your concerns about Medica. My experience with them is not positive. It appears Mayo has turned over administration of medical.benefits to them as no-one in HR can even answer a question. In fact I was told they were required to direct all benefit questions to Medica.

COMMENT
@m039153

Catherine, I understand and share your concern but I don’t want to place too much focus on online reviews. Nowadays, there are negative reviews online for every company, even Mayo Clinic. Mayo Clinic leaders want our plan participants to continue receiveing the high level of customer service that they are used to. Contract negotiations are currently underway and the final contract will include performance guarantees for measurable customer service issues like time to answer the phone, claims processing speed and claims accuracy. If Medica is not able to meet their performance metrics, they will forfeit a portion of the fees that they charge for providing services to the plan. We don’t anticipate there being an issue but we will be monitoring to make sure that they deliver on their commitment of quality customer service for our plan participants.

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My comments are based on actual experience, not online ratings. I've found Medica very non-tranparent in answering questions about benefits. One CANNOT speak to a claims processor and their "customer service" call center often cannot answer questions. I'm trying to get an answer to how Medica treats hearing-aid & associated cost benefit under the Mayo Medicare Supplement insurance. I need new hearing aids. Mine are 6 years old. The company I have used previously for my hearing aids tells me they are getting reimbursement for less than the $5000 benefit detailed in the plan document, and they have spent hours on the phone with Medica trying to figure out the criteria used to pay claims. The handling of these claims seems to be very subjective and inconsistent. Mayo HR call center personnel said they have been DIRECTED to forward ALL benefit questions to Medica. One cannot get a straight answer from either Mayo or Medica on this topic. I requested a complaint form from Medica so I can address my questions in writing, which will also be directed to HR Director at Mayo. I was told by Medica the complaint would "have to be addressed in writing". Very disappointed in how insurance benefits are being administered by Medica.

COMMENT
@crw03

Thank u for your reply. Please google Medica. The concern is the administrative abilities, the wait time on a phone call, loss of medical records, lack of consistency between phone calls, wait fo4 an email response and the list goes on. My main concern is who at Mayo will support our wasted time, energy and money trying to get our insurance to be administered correctly in a timely and respectful manner

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Great comment. No customer service.

COMMENT
@brucew

My comments are based on actual experience, not online ratings. I've found Medica very non-tranparent in answering questions about benefits. One CANNOT speak to a claims processor and their "customer service" call center often cannot answer questions. I'm trying to get an answer to how Medica treats hearing-aid & associated cost benefit under the Mayo Medicare Supplement insurance. I need new hearing aids. Mine are 6 years old. The company I have used previously for my hearing aids tells me they are getting reimbursement for less than the $5000 benefit detailed in the plan document, and they have spent hours on the phone with Medica trying to figure out the criteria used to pay claims. The handling of these claims seems to be very subjective and inconsistent. Mayo HR call center personnel said they have been DIRECTED to forward ALL benefit questions to Medica. One cannot get a straight answer from either Mayo or Medica on this topic. I requested a complaint form from Medica so I can address my questions in writing, which will also be directed to HR Director at Mayo. I was told by Medica the complaint would "have to be addressed in writing". Very disappointed in how insurance benefits are being administered by Medica.

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Bruce: I want to offer a few counterpoints to your arguments.
1. There is nothing unusual about the fact that Medica did not allow you to talk to a "claims processor". That is standard practice. Those folks are busy doing their job and not equipped to respond to requests from plan members. That is the work of the Customer Service group that answers the calls.
2. HR Connect staff are correctly referring you to call Medica with your issue. The staff in HR Connect are not trained and do not have access to the right data to be able to respond to your specific questions about the Mayo Medical Plan.
3. The formal appeals/complaint process is by necessity in writing. This is not new to the plan.
I can certainly understand your frustration. If you would like to e-mail me at my Mayo e-mail address, I would be happy to ask a Manager to look into it further for you.
Robert McGriff
Mayo Clinic Benefits

COMMENT
@m039153

Bruce: I want to offer a few counterpoints to your arguments.
1. There is nothing unusual about the fact that Medica did not allow you to talk to a "claims processor". That is standard practice. Those folks are busy doing their job and not equipped to respond to requests from plan members. That is the work of the Customer Service group that answers the calls.
2. HR Connect staff are correctly referring you to call Medica with your issue. The staff in HR Connect are not trained and do not have access to the right data to be able to respond to your specific questions about the Mayo Medical Plan.
3. The formal appeals/complaint process is by necessity in writing. This is not new to the plan.
I can certainly understand your frustration. If you would like to e-mail me at my Mayo e-mail address, I would be happy to ask a Manager to look into it further for you.
Robert McGriff
Mayo Clinic Benefits

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Thank you for your response. The issue is I cannot find out benefit information from Medica related to hearing aids.
I visited Clear Wave Hearing Center where I purchased the previous pair. They cannot tell me what my out of pocket will be for new ones because when they submit claims to Medica, they are being paid less than the full $5,000 benefit. And no two claims are alike. They had no such problems when MMSI was handling claims.
They have a very difficult time getting answers from Medica about how claims are paid and it takes them roughly 4 MONTHS to get paid. MMSI paid within 2 weeks.
I'm not advocating for Clear Wave or anyone else, but I should able to get straight answers on benefits. Medica "customer service" personnel aren't trained to address these questions either.
I'm not sure putting the issue in writing will be understood or even addressed. Then what do I do?
Medica hasn't exactly bolstered my confidence they are interpreting Mayo benefits correctly. Is anyone at Mayo monitoring that?
________________________________

COMMENT
@brucew

Thank you for your response. The issue is I cannot find out benefit information from Medica related to hearing aids.
I visited Clear Wave Hearing Center where I purchased the previous pair. They cannot tell me what my out of pocket will be for new ones because when they submit claims to Medica, they are being paid less than the full $5,000 benefit. And no two claims are alike. They had no such problems when MMSI was handling claims.
They have a very difficult time getting answers from Medica about how claims are paid and it takes them roughly 4 MONTHS to get paid. MMSI paid within 2 weeks.
I'm not advocating for Clear Wave or anyone else, but I should able to get straight answers on benefits. Medica "customer service" personnel aren't trained to address these questions either.
I'm not sure putting the issue in writing will be understood or even addressed. Then what do I do?
Medica hasn't exactly bolstered my confidence they are interpreting Mayo benefits correctly. Is anyone at Mayo monitoring that?
________________________________

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Bruce, I am sorry that you are having this difficulty. I would be happy to ask an expert to examine this for you but I would need your full name and employee ID. That's why I suggested e-mail contact rather than this public forum.
Robert

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i don’t have your email address.

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What options do we have for filing complaints about Medica? I find this juvenile dispute between Medica and the MCHS – La Crosse coding specialist over things like urgent care visits to be counter to the stated primary mission of "The patient comes first".

We shouldn't have to file a claim with the insurance company every single time you go into urgent care. This could be excused 1 time, not so often the billing reps say "This happens all the time". Both the organization and us, the employees, pay alot of money for this plan.

COMMENT

I am a Mayo Clinic employee on LTD. I am on Medicare and also have the Mayo Medicare supplement. Things were going fine as far as claims getting filed to the correct places, but now either they just go to Medicare or my Medicare supplement. Some think that Medica is the primary and Medicare is secondary. I cannot seem to get them to understand what is what. I live in Missouri. I have talked to the billing department for my PCP and I have talked to a person in the claims department at Medica. If you have any ideas, please let me know. Thank you.
I would appreciate any information you can give me. I am not sure who the Mayo Medicare supplement is. Is it Medica, Mayo Medical Plan, or First Health? It's getting to the point where I am being sent to collections for bills that should have been paid by either Medica or Medicare.

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