What will the Medica transition mean to me?

Sep 27, 2017 | Robert McGriff | @m039153 | Comments (25)

claim_Button

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.

Interested in more newsfeed posts like this? Go to the Benefits Connect page.

@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?
________________________________

Jump to this post

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

REPLY

i don’t have your email address.

REPLY

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.

REPLY

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.

REPLY
@wmahmoud

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.

Jump to this post

I am curious to learn more about what is happening. It is indeed necessary to file a claim each time you receive services, but that claim is typically filed by the provider so the patient is often not involved. Feel free to e-mail me with details if there is a situation that we need to examine more closely. mcgriff.robert@mayo.edu

REPLY
@sdb

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.

Jump to this post

The Mayo Medicare Supplement is a plan for Mayo retirees who have Medicare. The plan is administered by Medica. Claims should go to Medicare first and then to Medica.

REPLY
@sdb

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.

Jump to this post

mcgriff.robert@mayo.edu can probably confirm how the claim process should work. I think the claim is filed with both Medicare and Medica at the same time. When Medicare has processed the claim, they send the information to Medica, which then processes the payment for your Mayo benefit.

REPLY
@m039153

The Mayo Medicare Supplement is a plan for Mayo retirees who have Medicare. The plan is administered by Medica. Claims should go to Medicare first and then to Medica.

Jump to this post

It was doing that and then all of a sudden in July 2019 it stopped working that way. I would get something from Medicare and at the end of the EOB it stated that these charges are being sent to your secondary Medica MMSI, but in July that stopped. Here is a copy of a statement from my PCP clinic and, to me at least, it looks like they only sent a claim in to Medica. I tried to send you a picture of my statement but it doesn't work.

REPLY

Hopefully this is the copy of my statement.

REPLY
Please sign in or register to post a reply.