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Mayo Clinic workers say they have terrible health insurance – Daily Montanan [1]

['Max Nesterak', 'More From Author', '- November']

Date: 2023-11-11  

A Mayo Clinic employee in Florida said he has curtailed mental health treatment for his daughters and avoided seeing a physical therapist for his back pain, yet still pays around $11,000 a year for health care.

An employee in Texas is waiting to get an appointment at a free clinic because there aren’t any in-network doctors with expertise in LGBT-specific care.

Another Mayo Clinic employee in Arizona has filed complaints with state and federal authorities because she says there aren’t any in-network mental health providers for her sons within 150 miles, leaving her with thousands of dollars in bills.

Millions of Americans face the same kind of frustrating bureaucratic morass of limited access and soaring out-of-pocket costs for health care — and workers at one of the nation’s most elite, nonprofit medical organizations are not immune. At Mayo Clinic, workers say it’s just standard operating procedure to wait months to get appointments, plead with insurance representatives on hours-long calls and ultimately pay thousands of dollars for health care.

“I am terrified of having to go into the hospital,” said one remote employee, who said she paid more than $1,200 dollars for a routine physical and bloodwork in January. Her explanation of benefits says her insurance under Mayo’s premier plan should cover half, but she hasn’t been reimbursed even after a half-dozen phone calls with Medica.

The Minnesota Reformer, which originally published this article, spoke with eight current and two former Mayo employees in a half dozen states who said poor insurance coverage has compromised their families’ physical and mental health as well as their finances. All spoke on the condition of anonymity, fearing they would lose their jobs or face professional harm for speaking publicly. The Reformer examined medical bills and worker communications with Mayo and its insurance administrator, Medica, to corroborate their stories.

The difficulty accessing care is so widespread that one Mayo Clinic worker set up a channel on the organization’s Microsoft Teams network called “Medica Sucks,” which includes around 100 workers, according to screenshots reviewed by the Reformer. (The name of the channel was later rebranded to the more diplomatic, “Navigating Medica Issues Together.”)

The purpose of the channel is part crowdsourced HR and part support group, where employees help one another navigate claim denials and vent about medical bills being sent to collections or having to pay for flights to Rochester, Minnesota, the headquarters of the healthcare giant, because they can’t find an in-network surgeon in their home state.

Those who find their way to the group say the experience has spoiled their rosy view of Mayo Clinic as an altruistic organization that heals former presidents and Saudi royalty alongside local farmers and their own employees.

Mayo Clinic is a nonprofit organization, meaning it’s required to provide hospital care for all patients able to pay, including through public programs like Medicaid, and use surplus funds to improve patient care and advance education and research. In exchange, it doesn’t pay taxes on its tens of billions of dollars in assets and revenue.

It’s also Minnesota’s largest private sector employer — with 42,000 staff members at its flagship Rochester campus and another 34,000 workers at its campuses in Florida, Arizona and network of community hospitals in Minnesota, Wisconsin and Iowa.

“They try to make people think they’re so great and they have this wonderful reputation. They’re just another corporation out for what they can get,” a remote worker said.

Reached for comment, a Mayo Clinic spokesperson asked for a list of questions so they could “find the right expertise.” The spokesperson then replied to 15 questions with a statement saying Mayo Clinic is committed to supporting its employees and is continuously evaluating its benefits:

“Mayo Clinic offers a robust benefits program and covers the majority of our employees’ medical plan costs at a rate of approximately 75%. We continue to provide greater access to expanded provider networks, which has translated to increased mental health care offerings in recent years. To ensure our staff understand their benefit options, Mayo Clinic offers educational resources and support to ensure all staff can seamlessly navigate their benefits as part of our unwavering commitment to providing compassionate, world-class care to everyone we serve, including our valued staff.”

Mayo’s health insurance is self-funded, meaning it collects premiums from employees and pays out claims for services directly. The plan is administered by Medica.

In response to a request for an interview, a Medica spokesperson shared a statement saying Mayo Clinic is responsible for the quality of the health insurance it provides.

“As a self-funded plan, Mayo sets the benefits and premiums for its employee health plans. Medica administers the Mayo Medical Plan, including helping employees understand their network care options as well as partnering with Mayo to provide employees with the tools and resources to help them understand their plan,” the statement said.

Employees struggle most with finding an in-network provider. Mayo is in-network for all employees and those who are near one of the major campuses in Minnesota, Florida or Arizona say they receive great care, when they’re able to get appointments.

Employees say they have to wait weeks or months to be seen at Mayo because non-employee patients are given priority. Mayo did not respond to a question asking if it was organizational policy to give scheduling priority to non-employees.

Employees far away from a major Mayo campus must find providers that are part of a third-party network to receive the most affordable care: the PHCS Network in Florida, Blue Cross Blue Shield of Arizona for certain pediatric services and First Health Network for all other states.

Workers described what experts call a “phantom network”: the insurer claims to have dozens or even hundreds of in-network doctors and other providers except they aren’t taking new patients or no longer accept the insurance or have retired.

Mayo doctors and executives can be reimbursed up to $10,000 a year to cover the difference between out-of-network and in-network coinsurance costs as well as dental and orthodontic expenses. Other employees — nurses, software developers, researchers — don’t get that benefit.

A former Mayo Clinic employee said she had to pay around $1,000 for going to urgent care after part of her face was suddenly paralyzed from Bell’s palsy. (She said she discarded the bill and could not provide a copy to the Reformer.)

She said she called at least 100 general practitioners in the Bay Area until she found one who would take Mayo insurance. Getting an appointment with a neurologist was further delayed because Medica took weeks to confirm it would cover the appointment with a specialist.

She ended up switching to her husband’s insurance plan even though it came with a $7,000 deductible because it had in-network providers she could access. She quit Mayo shortly after, and is paying off $10,000 of medical debt.

“I was bitter after that experience … You assume the top hospital network in the world, theoretically, would take care of its employees,” she said.

A Texas employee said she had to quit seeing a specialist after taking a job at Mayo and now has to drive nearly an hour to get to the closest in-network provider, even though she lives in a major city.

One employee who’s worked at Mayo’s Rochester campus for about 10 years said she got a taste of what many remote workers face when she was out of town and cut her leg. When she got to an urgent care clinic — one of the largest in a major city — she found out it was out of network and would cost about $800.

After waiting three hours to talk to a Medica representative, she was directed to another urgent care clinic — which she described as “super shady” — to get stitches. A large red circle developed around the wound from an allergic reaction — something she’d never experienced before with stitches.

With Mayo’s premium plan, about half the bill was covered and she was left paying $325.

When she got home to Minnesota, she made an appointment at Mayo to address the allergic reaction. They told her it would take two weeks to get an appointment until she demanded to be seen sooner.

“I showed the nurse and the nurse was like, ‘Oh my God,’” she said.

She also got tested for hepatitis and other communicable diseases because the person who did the stitches double dipped the needle in a large bottle of lidocaine. The wound healed into a gnarly, two-inch-long scar — “exponentially worse” than it should be, she said.

A Mayo human resources specialist acknowledged employees’ complaints about their health care coverage in the “Navigating Medica Issues Together” channel, saying Mayo is evaluating national network options, but the soonest they could implement a change would be in 2025.

She commiserated with her colleagues, saying she personally had trouble with claims being paid correctly, which took a few hours communicating with the provider and Medica.

But the HR specialist defended Mayo’s insurance to the group, blaming providers for being “confused about their network status” and pointing to a “toolkit” they developed to help employees find in-network providers. The benefits manager said she’s heard from “so many new employees” who are grateful for Mayo’s insurance due to its low premiums and “great coverage.”

“I wish we lived in a world where health insurance was easier to understand, less complicated and less burdensome but that kind of change won’t happen overnight,” she wrote.

Because Mayo Clinic is self-insured, it has broad discretion over what proportion of medical bills it will cover and which providers it covers at an in-network rate. For example, the organization pays for some out-of-network mental health services after workers’ deductibles are met.

Like many workers nationwide, long-time Mayo employees say their health care coverage has steadily degraded during the past two decades while their premiums and out-of-pocket costs increased.

One Minnesota-based IT employee said back in the 1990s you could get an appointment at Mayo Clinic within a couple days and never see a bill: “That was the good old days.”

Now, it takes two months to see a Mayo doctor, and he says it costs about $1,500 for a physical with tests to monitor his diabetes and high blood pressure. His prescriptions cost him about $90 a month.

In the past five years, he’s received letters from collections agencies three times for bills that were less than $2,000. More than one employee complained in the Teams channel about being sent to collections.

He didn’t save copies of the notices from collections but said each of the bills was for less than $2,000. He said he paid them each off within a year — although not on a timeline agreed to by Mayo. He said Mayo wanted him to pay more each month than he could afford.

“They hound me and then they threaten to withhold services. I’ve even had it where they say, ‘You’re not going to be able to fill your prescriptions,’” he said. “It creates a certain bitterness … We’re not talking tons of money and we’re also not talking about somebody who doesn’t pay.”

Mayo Clinic did not respond to a question about its policy for sending medical bills to collections.

Last year, Minnesota Attorney General Keith Ellison’s staff began looking into apparent “aggressive bill-collection conduct” after the Rochester Post-Bulletin published an investigation about the hospital suing low-income patients over bills even though they could have qualified for charity care.

Increasing prices at Mayo and other hospitals is one of the main forces driving up health care costs for Americans, including their own employees.

Mayo Clinic has seen its annual revenue surpass $16 billion while working to evade scrutiny of its prices. As the Reformer reported earlier this year, the organization threatened Gov. Tim Walz and legislative leaders, saying they would move billions of dollars in future investments out of state over two proposed bills, including one aimed at slowing the rise of health care costs.

The bill would have created a health care affordability board with the power to set health care spending targets and fine hospitals and insurance companies for excessive price hikes. In a letter to Walz and legislative leaders, a Mayo Clinic executive called the bill “extremely problematic” and said it must be removed from consideration. Ultimately, lawmakers passed a watered-down version that created a board to analyze health care spending.

One Arizona worker said Mayo was a great employer for the majority of her two decades at the organization, first as a nurse at the Rochester campus and then as an IT worker at the Scottsdale campus.

That was before she needed much health care and before Medica took over administering the health plan.

Then in 2019, one of her sons had a mental health crisis. She pulled up Medica’s website to find an in-network pediatric psychiatrist. There were zero.

Mayo Clinic doesn’t provide pediatric mental health care in Arizona. There were no providers in the “Tier 1” network, which has the highest reimbursement rate or the “Tier 2” network, which requires a higher co-pay.

She tried expanding the geographic range to the maximum 150 miles: Zero.

Then she called her child’s pediatrician and asked for a list of psychiatrists and called every single one. None said they accepted her insurance.

That isn’t entirely surprising given only about half of psychiatrists accept any private insurance, according to a 2014 study, with advocates citing low reimbursement rates as the main factor.

At that point, she just took her son to the psychiatrist with the earliest opening. She was willing to pay anything to help her son. But even after the crisis subsided, she still hasn’t been able to find mental health care covered by insurance.

“I can’t even tell you how many times I’ve looked,” she said. “Many, many, many times I have done that same search and have always gotten the same results of zero options.”

About two years ago, her older son needed help, too. He was struggling with substance use and suffering from depression and anxiety. Again, she couldn’t find anywhere remotely close that was covered by insurance.

She says she submitted a request to Mayo Clinic’s human resources department asking for help, but they quickly closed her case, advising her to consult the “employee assistance program.”

That provides access to counseling — up to six in-person sessions “per problem” under Mayo’s plan — and referrals for other resources, which may not be covered. The employee said her son met with a therapist remotely through the EAP, but the connection was terrible and the therapist couldn’t meet the needs he had.

“If anything, it left him feeling worse,” she said.

In the spring of 2022, she found a behavioral health facility that seemed like a good fit. The psychologist is certified in neuropsychology and has served on multiple professional boards. After he completed an assessment, the bill came to $3,950. Mayo insurance approved her claim but only reimbursed her $161. Only $254 counted toward her deductible.

“That’s approved?” she said. “That really, really pissed me off.”

With weekly counseling, her son is doing well now. He’s in college and continues to see his therapist virtually. And she continues to pay hundreds of dollars a month for it.

Mayo Clinic’s benefits booklet says it covers 80% of mental health services — in or out-of-network — after the deductible is met. But the catch is, only a portion of the bill counts towards the deductible.

At the beginning of the year, the employee paid $210 a visit for her son, but only $156 counted toward her $4,600 deductible. After her deductible is met, insurance doesn’t cover 80% of the entire $210 bill. It covers 80% of about $110, leaving her to pay the lion’s share out-of-pocket, according to the explanation of benefits statements reviewed by the Reformer.

She has complained to Medica, Mayo’s human resources department and even filed complaints about the lack of coverage with the Better Business Bureau, the Arizona attorney general and the U.S. Department of Labor.

“I have told everyone and their brother that I could think of … to get somebody to care,” she said. “Because I just feel like this is so horrific, and I just cannot process how nobody cares.”

In March, a Medica representative sent the employee a letter saying they had received letters from the Better Business Bureau and the Arizona Office of the Attorney General about her complaints. The Medica representative said a review of the Mayo Arizona provider network found multiple mental health providers within 25 miles of her zip code and included a link to Medica’s search tool.

She pulled up the Medica’s search tool again, and for the first time, saw it had more than three dozen providers listed. She might have thought she was crazy if not for the screenshots she took earlier showing the same search terms yielded zero results.

Yet, none of the providers would have been able to help her sons at the time she sought help.

The Reformer used Medica’s tool and turned up 42 mental health care providers, but all were Mayo Clinic practitioners. Mayo Clinic doesn’t provide mental health care to individuals younger than 16 years old at any of its Arizona facilities.

“That is very much a phantom network because they’re saying that they’re covered, but they’re not,” said Sue Aberholden, executive director of NAMI Minnesota, a mental health advocacy group. “And that’s just wrong.”

Finding affordable mental health care is a challenge faced by workers at many companies across the country. About 60% of employees say their insurance plans have enough providers for mental health and substance abuse issues to provide timely access, according to the 2023 benchmark KFF Employer Health Benefits Survey. That’s compared to 88% of employees who say their plans have enough primary care doctors.

This employee believes that not having an in-network provider for mental health services could be a violation of federal law under the 2008 Mental Health Parity and Addiction Equity Act, named for late Minnesota Sen. Paul Wellstone. The law requires insurance plans that cover mental health care to do so to the same extent it covers other medical care.

Federal law also requires insurance companies to process claims within 30 days, while the employee says it would normally take months to hear back from Medica. In Medica’s letter to the employee, the company said the 30-day time frame did not apply because they didn’t receive all the information they requested from the employee.

In July, Medica was fined $300,000 by the Minnesota Department of Commerce for allegedly violating state mental health parity laws by paying providers less for mental health services than medical or surgical procedures. Medica also allegedly scrutinized mental health claims more closely than other medical claims. As part of the consent order, Medica agreed to make systemic improvements in its processes for mental health coverage.

The Commerce Department order does not impact Mayo Clinic, however, since Medica is the third-party administrator, a human resources official told employees in the internal Teams channel. The consent order applies just to Medica-owned plans.

The Arizona worker is hardly alone. A Mayo Clinic employee thousands of miles away in Florida has been fighting a similar battle with Mayo and Medica.

He said he paid about $1,500 to get a psychiatric evaluation for his daughter. He might have taken her to Mayo Clinic’s campus in Jacksonville — it would be covered by insurance and offers mental health care for children — but he was told the waiting list is so long they’re not even putting more people on it.

Two of his daughters are in counseling, which costs him $200 per session. Ideally, they would go every week, but he can’t afford it. So they go every other week until he hits his deductible, after which it costs him $20 a session.

“I can’t even tell you the stress this represents in my life,” he said.

It’s not just mental health care that’s hard to find.

The Florida worker said he spent hours on the phone with Medica and various physical therapists trying to find someone who would accept his insurance. In the end, none of the 15 or so physical therapists in his area would accept his insurance, so he went to a chiropractor for his back pain instead, some of which insurance covered.

It doesn’t help that the website for the provider network — called PHCS — is never accurate. Often, the providers listed no longer accept the insurance. Or their practices have closed. Or they’re not aware of what his insurance is.

He said he’s been on the phone with Medica representatives who have pulled up the PHCS website to show him the list of providers he could use. Then he explained that he already called everyone on that list.

“The same thing happens with just about anything that you’re trying to find,” he said.

When he first started at Mayo Clinic, he signed up for the best plan offered, believing that the higher monthly premiums would pay off with lower deductibles. But it turned out to be a terrible financial decision because there weren’t any providers in-network.

Prescription drugs is another problem. He takes a prescription that would cost him $500 per month if he used his insurance and purchased the drugs through Mayo Clinic’s pharmacy. Instead, the Mayo pharmacy suggested he look for an online coupon code, which he did and ended up finding it online for a third of the price.

The employee said he’s never had such terrible health insurance at any of his jobs. He said he feels conflicted in trying to recruit people to come work at the world’s top health care organization. The organization boasts of great benefits, but he knows they’ll have the same insurance that has him wondering if he can afford to stay at Mayo.

“It’s just this constant, nagging question in my mind of like, can I maintain a career here?”

This story was originally published by the Minnesota Reformer which is part of States Newsroom, a network of news bureaus, including the Daily Montanan, supported by grants and a coalition of donors as a 501c(3) public charity.

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