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2.5 8 Reviews

Medical Mutual Of Ohio Complaints Summary

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8:59 pm EDT
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Medical Mutual Of Ohio Prior auth for MRI of lower back denied, even though there is a hx of degenerative disc disease

My husband has a history of degenerative disc disease, and has had two discectomies in the past 14 years. He is now experiencing weakness in his right leg accompanied by major muscles cramps in both legs, keeping him awake at night and unable to sleep. A couple of nights ago, the muscle spasms in his thighs were so intense, it caused him to pass out, and he sustained a head injury/concussion because he hit his head on the bathtub. He went to the ER, and he was discharged with a RX for muscle relaxers. An MRI was not completed, because there was already one that had been scheduled by his PCP. He was scheduled for one on 6/14/23, but Med. Mutual has denied the pre-auth! Med. mutual has authorized an MRI in the past when he had the same symptoms, and the MRI clearly showed he had a herniated disc and required surgery. I spoke with a customer service representative who explained the reason it was denied was because he hasn't tried any physical therapy or alternate medical treatment first. Is Med. mutual actually willing to risk the increased cost for his care not to mention a possible lawsuit if my husband should sustain permanent nerve damage due to physical therapy treatments? Without an MRI, we do not know exactly what nerves are being compressed or the cause for the increased pain and intense muscle spasms and leg weakness. Trial of Physical therapy and other conservative medical measures first may not only prolong his suffering (and possibly cause him to require opiates long term, it's no wonder we have an opioid crisis) but also denies him of the urgently needed treatment that can allow him to return to his normal daily functions. Denying a test that can allow a provider to determine the best course of action is a dangerous risky approach to take. Delays in his diagnosis may cause further irreversible nerve damage, and will further decrease his quality and enjoyment of life as well as possibly remove his ability to maintain his job.

Desired outcome: MRI order from his PCP to be authorized by Medical Mutual, so he may be evaluated by the spine treatment center (who will not see him unless he has had an MRI completed)

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Update by Christel West
Jun 13, 2023 8:30 am EDT

UPDATE: My husband has had to go on multiple meds to help control his pain: Opiates, sedatives NSAIDS and steroids. . is still in alot of pain and is unable to work or sleep at night True to their word, Med. mutual sent him a tablet and instructions for Physical Therapy. A Physical therapist contacted him yesterday, and asked if he was ready to start some PT. My husband shared his symptoms with the PT specialist, telling him his pain radiates from his lower back down his back and down to his knee, he is also c/o numbness/paresthesias to his buttocks and his right heel. The Physical therapist stopped him right there and said, "I don't feel safe having you go through PT unless you have an MRI first! (DUH! WHAT HAVE I BEEN SAYING ALL ALONG?) Obviously, this company doesn't even know how to communicate with each entity involved. Everyone makes their own decisions, and the sad part is they make these decisions that may highly impact a patient's life, yet may never meet even ONE of their clients. Disability may be in my husband's future, and I believe many people have been needlessly placed on disability due to incompetent medical decisions made by insurance companies such as Medical Mutual! If this should happen to my husband, there will also be a BIG lawsuit in Medical Mutual's future!

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7:59 am EDT
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Medical Mutual Of Ohio Super med ppo

I am writing to voice my dissatisfaction with the referral process that you currently have in place. I have a child who needs surgery outside of the tier 1 network. I have had to delay his care for a fracture because I need a referral through Navi Net. My provider faxed the exception form to Med Mutual and I was told by a Med Mutual representative that the form was kicked out because the provider needs to use Navi Net. I was told by the provider's office that they do not have access to Navi Net and they faxed the exception form that was provided by my employer's HR department on their intranet. I find it very frustrating that I am unable to seek the appropriate care for my child in a timely manner. It should not be this difficult to seek approval for services not provided in the tier 1 network

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7:29 am EDT
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Medical Mutual Of Ohio Unethical behavior, attempting to re-charge me, ignorance

Had a total hip replacement 03/28/19. I fulfilled all of my financial responsibilities related to such. Medical Mutual then took back all the money they paid the providers claiming it was a Workers Compensation claim, which it clearly was not. All documentation that this was not WC related was sent to them. They forced my providers to provide bill WC, receive a denial, then reprocessed the claims at a lesser amount and are not claiming I am responsibly for almost $3000. I have spoken with various representatives from Medical Mutual who claim "it is not us, we had an audit". I refuse to pay more than I was responsible for due to their ignorance and unethical standards.

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7:27 pm EDT
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Medical Mutual Of Ohio Insurance coverage

We have been with Medical Mutual for 30+ years and never have I been so frustrated with them. They used to be really good and now they just don't care about their members at all. It is all about money and trying not to cover as much as they can get away with. My daughter was struggling to take in a deep breath all night long because her throat hurt so bad. It was a Sunday and we were trying to wait until the Urgent Care opened, but she just couldn't wait any longer. So, we went to the Emergency Room and were told by the hospital staff who checked the insurance that we just needed to pay $600 and the rest would be covered by insurance. Now, they are trying to say it was not a "Valid" Emergency Room visit. Well, how do you know if it's not life threatening unless you go to the Emergency Room to find out?! They are using hind sight to now get out of paying the bill. How can a company give you one price and then make you pay another? This is so wrong on so many levels. People who need serious care are now going to be reluctant to go to the hospital because they are afraid it might not be covered even though we are told it is. I asked them to send me a list of what is considered "Valid" Emergency Room coverage, and they can't even provide that for me. When you are in these scary situations you don't have time to check and double check your coverage especially when the hospital staff does that to begin with. This company is definitely a disappointment. We will be finding different coverage. I filed one appeal which got denied, so I guess I will file a second one, but I am just letting you all know that this company SUCKS and BUYER BEWARE do not use this company for insurance!

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7:39 pm EDT
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Medical Mutual Of Ohio Denied medical claims

Two medical claims have been denied by Medical Mutual due to the fact that I was told they are not "urgent" in nature. Both incidents occurred outside of the time frame of when I could see a primary doctor/urgent care facility. I live in community where same-day appointments are NON-existent and urgent care clinics only stay open until 9pm. Let's not even talk about trying to get into a specialty clinic that usually takes weeks to get into for ANYTHING. I have an extensive history of gastrointestinal, autoimmune & inflammatory diseases.

I have already started calling the news stations in my area because I want this company investigated for screwing with my health. I'm not in a financial position to cover over $2K in medical bills.

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Medical Mutual
, US
Nov 04, 2019 2:46 pm EST
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Hello,

Thank you for reaching out! We apologize for any inconvenience that you may have encountered. Please email us your contact information at facebook@medmutual.com so that a customer service representative can get in contact with you.

Have a good day,
-Social Media Team

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12:47 pm EST

Medical Mutual Of Ohio Paid over $3000.00 dollars for coverage in the last 3 months

Medical Mutual has admitted that it was a "clerical error" that canceled our coverage but keeps saying they are taking care of it. We have continued to pay over $1000.00 dollars a month for coverage. It has been 5 days with no progress. They tell us that we can make an appointment and they will reimburse us. No doctors office will schedule an appointment because it appears that we have no insurance. Beacon orthopedics has canceled an MRI that my husband needs because he is in so much pain. He cannot return to work so what are we supposed to do?

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Nicolet Edwards
, US
Oct 24, 2019 12:50 pm EDT

The flyer for advantage plans says just for calling receive 10.00 card. I called and got the I formation and now they say I have to go to a seminar or let them come to my home and they refuse to send me the card if I dont

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Nicolet Edwards
, US
Oct 24, 2019 12:46 pm EDT

The flyer for advantage plans says just for calling receive 10.00 card. I CALLED GOT THE INFORMATION AND NOW THEY SAY I have to go to a seminar or let them come to my home and refuse to send the card if I dont.

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2:31 pm EST
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Medical Mutual Of Ohio Health insurance

If you are looking for health insurance DO NOT Get Medical Mutual! I work in the healthcare field dealing with insurtance companies all day. I work with them all, Anthem, UHC, Aetna...you name it, I deal with them. I have never had such a difficult time trying to get my patients authorized for chemotherapy in all my years of authorizing. They have this company "Care Continium" running the show for chemotherapy auths and I send them the proper forms and 100% guaranteed they will tell me thay dont have it. They send back forms claiming they need info that is clearly written. "Valencia" is the rudest dishonest rep over there. I do not know how thay can get away with this. I have left at least 6 messages on so called "managers" voice mail and I have never received a call back. If you need health insurance and value your health DO NOT USE MEDICAL MUTUAL. I will make sure I use every forum available to me to make sure everyone knows how bad they are so no patient will have to wait 30 days to get chemotherapy.

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12:04 pm EDT

Medical Mutual Of Ohio Refusal to pay fpr a product they said was covered

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!

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Ray Kinghorn
, US
Oct 07, 2020 2:42 pm EDT
Verified customer This comment was posted by a verified customer. Learn more

Medical Mutual of Ohio is a non-responsive entity that causes financial and emotional damage to their clients and service provides and then blames everyone without taking any accountability for their actions. We are a service provider that services one of Medical Mutual covered clients. We do not bill any insurance company directly but we do provide our clients with a detailed invoice that they can submit to their insurance company for reimbursement. Our client submitted an invoice last year for reimbursement and Medical Mutual sent the reimbursement checks to our office written out to one of the owners of our clinic. We called Medical Mutual and asked them why they did that, and they responded that it is their policy to reimburse the service providers and they will not send the checks directly to their client. We had the owner endorse the checks and deposited them into our business account. We then wrote a check for the same amount as the two checks to our client that was seeking reimbursement. 9 months later the owner of our clinic received a collection notice claiming that he owed Medical Mutual that money back. We have tried to explain many times to Medical Mutual that the reimbursement checks they sent were not kept by the clinic or the owner but was passed through to the client. We have copies of the checks that we received as well as the check that we wrote to the client. The owner's credit has been damaged and he is currently unable to refinance his house because of Medical Mutual. Why do insurance companies take something that is simple and straight forward and make it so difficult and Complex. Frustrated service provider

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John Compton II
, US
Jun 25, 2020 7:31 am EDT
Verified customer This comment was posted by a verified customer. Learn more

We have had 3 ER claims denied. My son cut his hand while volunteering at Children's hospital, so the staff walked him to the ER and he received 6 stitches. According to med mutual, the Children's staff should have taken him to an urgent care or doctor's office rather than treat him there, . My cost: 1100.

My wife had a kidney stone and the local urgent care referred us to the ER. An ultra sound was done and medication administered, but Med Mutual said it was an unnecessary visit. My cost: 5400

My son was hit head-on by a drunk driver. The car rolled over and caught on fire, but that was not deemed a medically necessary visit to the ER. He had a hip injury that kept him out of summer baseball for 4 weeks. My cost: 2700.

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Nicolet Edwards
, US
Nov 02, 2019 10:16 am EDT

Flyer says 10.00 card just for calling. I called got info and now they refuse to send card unless I submit to them coming to my home or going to a seminar

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ripped off and bent over
, US
Sep 26, 2019 9:18 am EDT

180, 000, 000 that's the profit this company made last year. They made this much because they don't pay for anything. They have legally figured out how rip you off and not have to pay a full price on any so called covered service. URC's are a scam and always leave me with a chunk of money out of my pocket. I wish I could get the $1485.00 dollars a month that I pay from my employer and put it my pocket then go and deal with the doctors on a cash basis. Over the 33 years I've had this insurance they have received just under a half a million dollars from me. I have had 3 kids and a few major surgeries. They all add up to just under a quarter million dollars so this company has made a quarter million just off of me and my family. If I go to the doctor today I will get a bill from that doctor guaranteed! The whole entire insurance business is nothing more than any other U S company, Greed driven and unethical people lining their pockets with hard working peoples money. And they steal with a smile and a thank you

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Irwins
, US
Jul 07, 2018 12:20 pm EDT
Verified customer This comment was posted by a verified customer. Learn more

July 7 th 2018
I don't understand your insurance company that you have the nerve to leave me with out good coverage. I have a brain tumor now for 4 years. I don't understand why you have dropped the Cleveland Clinic from your list of doctors. I had to spend a lot of money just to stay with the best doctors which happened to be from the Cleveland Clinic. What are my insurance payments going to if I can't see the doctors I need to for my brain tumor? If something really bad happens What am I to do? You only cover my meds if they are generic . I didn't find out there was a problem with my insurance until I needed to use it for my last check up which was in May 2018. Someone should have called me with information about how I could still use the insurance policy I have now.

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Tori T.
, US
Apr 25, 2017 9:32 pm EDT

Had Medical Mutual through my dad until I was 26. Desperately needed birth control not only to prevent pregnancy, but because my periods would leave me (literally) sick to my stomach and in gut-wrenching pain every cycle. In all the years I was on various forms and brands of contraceptives, I was always told by my doctors and pharmicists (after going through MedMut to see if anything was covered) that it wasn't. Not a single goddamn thing pertaining to womens' health except my annual exam was covered, not the copay, not anything. I now have United Healthcare and they're amazing. I owe literally nothing for my annuals, owed only a copay for a colposcopy/biopsy, and all forms/brands of contraceptives are free. Does anyone know if I can go after MedMut for charging me for all of my contraceptives since the ACA has been in effect? That was a LOT of money that I couldn't technically afford to pay but needed to in order to not miss a week of school or work every time my period came rearing it's ugly head. Even my generic was $50-something!

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livingsocial29
, US
Nov 17, 2016 8:05 am EST

I am doing research for a Medicare Advantage Plan for my mother and I've noticed on the government's Medicare site, their plans are listed as 2 1/2 stars out of 5. I've also noticed that what they have done this year is "re-branded" 2016's plans under a different plan number so that the plan can't be rated because it is too new...very tricky and a good reason to stay away IMO. Stick with plans which are consistently rated 4 out of 5 or better.

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BaseballAIABT
, US
Mar 08, 2016 1:26 am EST

Medical Mutual goal is to do two things: collect your premiums and avoid paying claims. That is what they are notorious for. They like to breach their certification coverage contracts, while at the same time make them very difficult to read and understand, so their customers will be able to get easily confused.

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Medical Mutual
, US
Sep 11, 2015 12:14 pm EDT
Verified customer This comment was posted by a verified customer. Learn more

MKL531 - we are so sorry about the confusion and frustration your experiencing and would like to help you with this situation. Please send us an email at Facebook@MedMutual.com and we will get you in touch with one of our dedicated Customer Care specialists.

Thank you!
The Medical Mutual Social Media Team

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Medical Mu Sucks
, US
Dec 18, 2019 6:25 pm EST

Dedicated Customer Care Criminals is more like it... whole company of [censored] bags.

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MKL531
, US
Sep 11, 2015 12:08 pm EDT

Medical Mutual is also breaking the law by not providing free birth control. My GENERIC brand of birth control now cost me $51.00 with medical mutual (it is also on their list of preferred drugs). I have been told (several times) that it is NOT considered preventative and I have to meet my deductible before it is free! When I asked for a list of birth controls that are considered preventative they said they could not provide me with one, but they could look up Up To Three medications for me, otherwise I needed to figure it out on my own. My plan is not a grandfathered plan, therefore Medical Mutual is required by law (Affordable Health Care Act) to provide me with at least 1 form of birth control for FREE (they cannot charge a copay or put it towards my deductible). This is illegal activity and I plan on reporting it to several women activist groups and magazine/newspapers.

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