SALUS CLINIC GUAYNABO/BAYAMON

Please let us know if you find anything out .In have driven to hospital in San Juan because i was told only 1.hospital in pr takes my insurance which is champva. ( military insurance). 2 hrs each way. 13 hrs in a waiting room. Not a good experience. Now I am 4 hrs away to that hospital

Mayo Clinic accepts Medicare, but is "Nonparticipating in Medicare" re: Part B. I know that sounds contradictory, but. The legal explanation is equally confusing. Nonparticipating means that Mayo Clinic does not accept the Medicare-approved amount as payment in full. So you will have a co-pay balance.  If you have Medicare "Gap Insurance", some call it  "Supplemental coverage" then that takes care of what Medicare doesn't.

Highly recommended. I pay $140 a month on top of my Medicare for this coverage. I have had 2 hand surgeries ($15k each), two cardio MRA's $3500 each, a Colonoscopy $5,000, an Echogram, a Stress Test, three extensive eye exams, 45 therapy sessions for my hand, too many lab work-ups, too many office visits to 4 different type of specialists, and all of the above in the last 10 months and I have not even seen a bill. Get this coverage, the sooner after 65 the cheaper.

A "formal consulting arrangement" with Mayo only means your clinic has a financial and professional agreement with Mayo to look at your labs or x-rays or whatever that requires an interpretation or diagnosis that your clinic is not capable or qualified to do, or for a 2nd opinion. To me, that is not as impressive as it once sounded. More like an advertising gimmick. Mayo affiliations have popped up around the US like Walmart's.

A clinic or hospital that would not accept Medicare at all would result in them going broke within say 12 months?

Hey Dgdlaw,
I have heard of people with medical insurance ending up with sometimes hundred of thousands of dollar bills, having to sell their home and use all their savings. Is that not the case with Medicare or medicare (a+b+c+d or F)?

I hate to loose it all if I get sick and then there is nothing for my lady or kids.

Medicaid, not Medicare, nightmare most of the time, usually resulting from long term nursing home care (dementia). Medicare only covers very little of that kind of care, like 1 or 3 months? I forget.  I can't post how the smart cookies get around this.

I appreciate the replies even though they have not addressed the question, which is whether or not SALUS accepts Medicare ON ASSIGNMENT.  That's the other term for "contracted with."

For the person who generously offered comments about Mayo's Medicare policy, let's set the record straight. Here is their answer to FAQ:

"Mayo Clinic files claims to Medicare Part A and Part B on your behalf.

When claims are sent to Medicare on a nonassigned basis, the benefits for the services are sent directly to you. The law doesn't require health care providers to accept Medicare's approved amount as payment in full, and providers are entitled to bill you for the difference between their billed amount and Medicare's approved amount. Mayo Clinic limits its charges according to the limits set forth by the Centers for Medicare & Medicaid Services (CMS) for the Medicare program. You're responsible for payment of all billed charges, including those that exceed Medicare's approved amount."

So, when a provider accepts assignment, the provider agrees to accept WHAT MEDICARE PAYS, i.e., the APPROVED AMOUNT at 80% with patient copay of the remaining 20% ---BUT NO ADDITIONAL EXPENSES.  When a provider accepts Medicare on a nonassigned  basis, LOOK OUT. Medicare will pay the approved amount, AND you'll be stuck with ALL OF THE REMAINING CHARGES.  Here Supplemental Plan F might help with the "excess provision" but I wouldn't count on it, and F is the most expensive supp.

So, don't mislead other readers, if you please.

DM

You did not read me correctly. And you have it all figured it so why you asked is beyond me.

So I won't waste my time trying to explain why the quote you posted is what I am saying.

And if your q is you want to know if your clinic accepts Medicare (it does) and in which form, pick up the phone.

As an aside to those that don't know it all about a very confusing topic. I offer the following.

A few months before you turn 65, start calling the Gap or Supplemental carriers (same thing) or visit online. Joining so that it starts when your medicare does will save you money, and of you wait until after you are 65 to get the Gap covearge, there is a penalty after so many months. There are a bunch, you've seen the ads I'm sure. Humana, BC/BS, on and on, all offer a Gap plan. What I learned after hours and hours of studying each is that they are all offering the same coverages, just different names. Each offer about 8. All are governed by Medicare.

Buy the best plan of whatever company you decide to run with.

There will only be around a $10 difference between most of the levels. So-o-o-o-o glad I bought the best one, the level A. I went with Transamerica Life because they had a special thru my state Bar Assn, probably saved $10 a month. But I have never seen one bill since I turned 65 in March and started with all the meds I needed and you saw all the stuff I had done.

And remember, your effective Medicare date after you apply, and do so a few months before your 65th, is the first day of the month of your birthday. So if you were born March 31, your effective Medicare day is Mar 1.

What if you are working at 65 and covered currently with a plan at work, do you still need sign up for medicare and gap even with the other plan?
Will they penalize you when you are ready to quit and retire?

That gets tricky and there are a lot of variables on that and I will be the first to admit I am not qualified to answer yours, Rey.

Do you, should you, apply for Medicare at 65 anyway? Does Medicare become secondary? Or vice versa, does your carrier become secondary to Medicare? Another twist is if your wife is still working and you are on her plan, should you still apply?

That is all very confusing to me, and I know those q's are out there for a lot of guys. But I never had to figure that out because I was self employed and covered under my own BC/BS policy and single, so I was happy as a pig in s to get on Medicare on the first day. My monthly BC premium were $480 with a big deductible and a 20% co-pay and on Medicare went to $175 a month Medicare (plus my gap coverage so now app $325) but no deductible and no co-pay because of the Gap.

I went on March 1, and had all my "needed to get done stuff" lined up 2 months in advance--this doc March 2, this Doc Mar 3, Colonoscopy, March 4, hand surgery #1 , April 4th hand surgery # 2; stress test, echo, which led to the cardio MRA's. etc etc.

Best advice is talk to the guys at work that are in your boat or close to it--they'll know alot, and then start calling Gap Providers. You'll get the answers, but it'll be gobbly gook for awhile until you get the basics and the lingo down.

But time to start Rey, sir.

Let's hope Bernie Sanders gets in office.  We will get better medical coverage and pay a lot less money. Plus he cares about fixing Puerto Rico's issues. We really need to get rid of the Jones act. It's killing us here

Watched the first debate last night, I mean the first debate that I watched this election. You may have read that Bernie is way ahead of Hillary with the 30 and under demo. Interesting. She's still supposedly way ahead by 20 pts nationwide though they are neck and neck in Iowa, but why he's got the "kiddie vote" is a kick.

sandrarduncan wrote:

Please let us know if you find anything out .In have driven to hospital in San Juan because i was told only 1.hospital in pr takes my insurance which is champva. ( military insurance). 2 hrs each way. 13 hrs in a waiting room. Not a good experience. Now I am 4 hrs away to that hospital

Hi Sandra,
I have ChampVA and I go to Salus so you should be able to be seen there. Although it is far for you all the way in Guaynabo. All the Dr.'s at Salus take my primary insurance Champ VA and my supplementary ASI they have a lot of Specialists not all of them. I use the imaging and Lab center as well no problem.
Second I wrote to you before on this post about ChampVa...probably you missed it.  https://www.expat.com/forum/viewtopic.p … 94#2879356
Definitely someone gave you some misinformation. I know for a fact that all the best Hospitals in the Metro Area accept Champ VA. This includes El Presby, Pavia, Auxillio Mutuo, HIMA San Pablo, and Dr.'s Center ER and Clinics. There is a Dr.'s Center ER closer to you in Arecibo. I was going to the Dr.'s center clinics before moving to Salus. Also the small ER centers that they call the CDT around the island take Champ Va.  I'm almost positive you should not have a problem using Champ VA at the ER centers in Aguadilla and Mayaguez.  There is a Military base in Aguadilla and most of the Dr.'s accept Tricare over there. Ask the Dr.'s if they accept Tricare then you can explain Champ VA is similar to Tricare except for Spouses of Veterans...you probably will have better luck then mentioning Medicare. I'm not saying I haven't had problems…I've been turned down by a lot of Dr.'s that accept Medicare and some will accept Champ VA as a supplement to Medicare not a Primary which I still don't understand.  Also there are certain Specialists that I can't find that accept Champ VA so it is a pain I know.  Hope this helps.