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Medical Mutual Complaints - Refusal to pay fpr a product they said was covered

Review all Medical Mutual complaints

Medical Mutual

Posted: 2008-08-11 by Jen [send email]
Refusal to pay fpr a product they said was covered
Complaint Rating:  0 % with 0 votes
Never in my life have I been so frustrated with a company as I am right now. My gynecologist's office recently called Medical Mutual to check the availability of coverage for Mirena, the insertable birth control device. The device itself is $700 and the insertion is $200. Tanya, a MedMut rep, was given my policy # and the device code, both required by MedMut to check coverage. After looking up my coverage info, Tanya told my doctor's secretery that the device and insertion were both covered, all but $6 and some change plus my $20 co pay. Two months later, I get an explanation of benefits from MedMut stating that they in fact do not cover this device at all (even though, due to my calculations, it would be $400 cheaper to pay for this device compared to paying for birth control pills for me for the next 5 years) and even though they LOOKED AT MY POLICY and said it was covered, they now refuse to pay for it. I have filed multiple appeals to no avail, have had repeat phone calls go unanswered/unreturned, and now am being hit with late charges from my doctor's office due to the outstanding balance. NEVER DEAL WITH MEDICAL MUTUAL IF YOU CAN AVOID IT AT ALL!!!
Comments United States Health & Life Insurance
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Comments

62 days ago by Kristen [send email]
If your doctor's office has a record of the name and phone number of the representative from Med Mutual who told them the service was covered, you should file a complaint to the state insurance board for promissory estoppal. They reviewed your policy, gave information which you then relied on to receive services you believed were covered. They cannot then deny the coverage for the service. If you have went through the levels of appeal with Med Mutual, I would get your employer's benefits representative involved, and if that doesn't work, then file a complain with your states insurance commission. You should be able to file the complaint online at the state website.
59 days ago by Amy [send email]
Based on the fact someone at Medical Mutual told you it was covered, you CAN get this covered. As a past employee, if you were told it was covered by an employee they will pick up the charges based on your benefits. You must be able to give MMO some sort of date you were told it was covered. They will then retrieve the recorded coversation and investigate. If the CSR Department verbally advised you it would be covered, it will then be honored.

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