Insurance Coverage and Programs
Insurance Coverage & Verification
If your insurance plan calls for a co-pay, it’s due when you visit. We accept personal check and credit/debit cards (Visa®, MasterCard®, American Express® and Discover®)
At M Health Fairview, our providers are often in-network with many insurance plans to ensure your access to quality care. However, insurance coverage can change, affecting which services and providers are covered.
Before scheduling an appointment, we strongly recommend contacting your health plan to confirm network coverage and understand any potential out-of-pocket costs. You can normally find the number to call your insurer by referring to the back of your insurance card. Discuss your coverage, including referrals or prior authorizations, with your insurer to avoid surprises.
For cost estimates, you can use MyChart. Stay informed to make informed healthcare decisions.
The primary plan will be that of the family member (subscriber) with the earliest birthday in a calendar year.
If you have any other billing or payment questions, please call our helpline:
Monday - Friday, 8:00 a.m. to 4:30 p.m.
Phone: 612-672-6724
Toll free: 1-888-702-4073
Medicare and Government Programs
The following information will help you understand the Medicare billing rules and how they affect your billing statement.
Medicare rules require hospital-based clinics to bill some services as two separate charges. One charge is for the provider's services (provider fee). The other charge is for the costs of nursing staff, supplies, equipment and building expenses (facility fee).
So what's divided into two charges? Clinic services (including office visits and some treatments given in the office), X-ray, lab, and EKG charges are the most common types.
Don't worry, this doesn't mean you're billed twice for the same service. The total of the two charges is equal to the full charge for the service. Fairview's hospital-based clinics will submit all claims to Medicare.
For people with Medicare supplemental insurance, we file separate charges for the provider and facility fees to your Medicare supplemental insurance.
Here are a few more Medicare terms and definitions:
Medicare crossover
This is a benefit that is offered by Medicare. The patient allows Medicare to process claims and payments to the patient's secondary plan.
Medicare Part D
This is a plan that provides prescription drug coverage through Medicare. Part D co-pays aren’t covered by Medical Assistance because Medicaid and Medicare each require their own co-pay.
If you are at a hospital facility and receive outpatient or observation services, you may be responsible to submit those charges to your Medicare Part D carrier for reimbursement.
"Donut hole"
The term "donut hole" refers to a gap in coverage under Medicare Part D (prescription drug program). Under the standard benefit, there is a gap in coverage between the initial limit and the catastrophic threshold. Within this gap, you would pay 100 percent of the cost of your prescription drugs. The government agencies and insurers prefer the term "coverage gap," but "donut hole" is more widely used.
For patients needing financial assistance, M Health Fairview offers help. Treatment will never be denied because a person is unable to pay.
For further questions, you can call our helpline:
Monday – Friday, 8:00 a.m. to 4:30 p.m.
612-672-6724 or 1-888-702-4073
No matter what Medicare coverage you choose, we recommend you start your health plan search by reviewing the resources at medicare.gov. This is the most comprehensive resource for all things Medicare-related. You’ll learn about the requirements for signing up for Medicare coverage, the different kinds of Medicare plans, and be able to search for all the plans available to you.
To better support our patients, M Health Fairview partnered with Chapter, a team of licensed independent Medicare advisors. They offer personalized, one-on-one counseling at no cost to you. Chapter’s trusted advisors can help answer questions and ensure you get enrolled in the best plan for you. Call (855) 797-3811 to speak with a Chapter advisor today, or schedule an appointment here.
Minnesota Aging Pathways also provides guidance on Medicare options. Call 1-800-333-2433 for free and unbiased information provided by the Minnesota Board on Aging.
Medicare Advantage plans that include our doctors and facilities
Many of our patients say they like Medicare Advantage plans. Medicare Advantage plans generally offer more comprehensive coverage than Original Medicare alone, and can include vision, hearing, dental, prescription drug, and other popular benefits.
Our health system participates in the Medicare Advantage plans for the insurers listed below. This includes the M Health Fairview providers and facilities in the Twin Cities metro area, Fairview Range in Hibbing, and Grand Itasca Clinic and Hospital in Grand Rapids.
Once you find the health plan options available to you, make sure that your M Health Fairview care team is in the health plan network before you enroll. If your doctors and their clinics and hospitals aren’t in the plan’s network, you may pay more for your care.
Our providers or facilities may also be in the network of other Medicare plans you might be considering, such as Original Medicare, Medicare Cost Plans, Medicare Supplemental Plans or Medicare plans offered through an employer. Refer to the resources at the top of this page for more information.
Find the complete list of insurance plans that M Health Fairview accepts here.
To find out if your health insurance is accepted by independent physicians who care for patients at M Health Fairview hospitals and clinics, please check with your insurance provider.
M Health Fairview also provides access to free, one-on-one Medicare and Medicare Advantage counseling through our partnership with Chapter. Chapter advisors can also review your potential plan selections to ensure your doctors and their hospitals and clinics remain in network for you. Call (855) 797-3811 to speak with a Chapter advisor today, or schedule an appointment here.
M Health Fairview participates in many Medicare Advantage health plans. Before you enroll, it’s important to make sure your providers participate in your health plan network.
Contact the health insurers on our Medicare Advantage health plan list for more information.
For more information, please refer to the ACO REACH for Medicare page.