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

1 United States Review updated:

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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  • Kr
      30th of Sep, 2008
    +1 Votes

    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.

  • Am
      3rd of Oct, 2008
    0 Votes

    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.

  • Oh
      6th of Jul, 2010
    0 Votes

    I have med mutual, good luck with them, they told me my 10 month old daughters ear problems wernt coverd cause it was a pre exsiting condition. I ask them if they wanted the pic of the ultra they have no morals or ethics. I have sent them probably 50 faxes, and more then 5 hours total on the phone with them. I would drop them but my company I work for says I have to carry their insurance if I work for them so im stuck paying 3 grand a year for nothing. 90% of the time i dont even tell the pharmacy or doctors I have insurance cause its not worth the hassle of dealing with med mutual. Also if you say you dont have insurance sometime they give you a better price then what you could get with insurace, mostly med mutual after they make up reason why they deny your claim... I hate them.

  • Pa
      6th of Oct, 2010
    0 Votes

    I so dislike this company. It is a total headache to get anything done. Every doctor I go to cringes when I say I have medical mutual because they know that nothing is covered and it ends up just as big as headache for them as it is for me. Oh I wish I had anyone but them.

  • In
      19th of Apr, 2012
    0 Votes

    We just got done talking to David Earnest in Raleigh, NC. he admitted that Dr.Steven Gaskin ( his client) made a wrong diagnosis.He also said " he was sorry, but that Dr's are not perfect." ARE YOU KIDDING ME???? He also warned us, which sounded VERY much like a threat...not to sue Dr. Gaskin. Mean while I'm stuck with a huge bill from Northeast Hospital in Concord, NC.( this is where Dr. Gaskin works) We kept trying to tell Earnest to look at the date on the X-rays & get someone to read the X-rays for hm. David Earnest said that he was NOT going to do that...the case is closed.
    He said his job was to protect the Dr...even if he was wrong! Can you believe that? I had two Ortho Dr say Gaskin misdiagnosed, as well as our family Dr. There were at least 12 plus X-rays ( that we paid for) that showed Gaskin made a huge mistake. Knowing all this...Earnest ( Medical Mutual ) said they would stand behind Dr Gaskin, because they are protecting their client! THEN threatened us not to sue Dr Gaskin. This insurance company has NO ETHICS. I'm putting my X-rays & pictures of my misshapen thumb with the torn ligaments on U-Tube...I need a few days to get it together then look for me there & sign a petition to put people like D. Earnest & his insurance business in the spotlight of unethical people & companies that they are!

  • In
      19th of Apr, 2012
    0 Votes

    I am Inna Eddy. I wrote the previous complaint & I'm going to try to send out pictures of my hand. Two Orthopedic Dr said I have torn ligaments, AFTER Dr Steven Gaskin diagnosed it as a dislocated, or broke depending on what day you talk to the insurance company. I will most likely loose the use of my hand so said two Orthopedic Dr even if I have surgery...$2, 000 for the Orthopedic Dr, & $15, 000 for the use of the surgery 2011 prices!!! I CANNOT PAY FOR REPAIRS TO MY HAND But, it doesn't matter because Medical Mutual aka David Earnest said they would stand behind Dr Gaskin even if he was wrong! Take a good look at my hand...good thing it wasn't life threatening!!! Maybe next time he will kill someone I bet David Earnest would still stand behind Gaskin!!!
    I heard a rumour...I DO NOT HAVE PROOF, this is only a rumour I've heard...IF THERE IS NO PAY-OUT, & YOU ARE DECLINED*****THE AGENT GETS A BONUS**** If this doesn't make you mad your not breathing! In a few days I'm going on U-tube let's sign a petition to put these "BOTTOM LINE BOTTOM FEEDERS ON THE HOT SEAT!!!

  • Re
      18th of Apr, 2014
    0 Votes

    Medical Mutual is the worst! They tell the doctor what tests to run in what order and would rather have you radiated instead of doing an MRI which is safe, high resolution and was ordered by my doctor first. They take your money and put people last and bad care and I totally recommend people filing complaints against them or better yet suing them. Get a class action lawsuit going!

  • Me
      21st of Apr, 2014
    -1 Votes

    Hi Reality - can you please email your contact information to so we can help with your issue?

    Medical Mutual

  • Mk
      11th of Sep, 2015
    +1 Votes

    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.

  • Me
      11th of Sep, 2015
    -1 Votes

    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 and we will get you in touch with one of our dedicated Customer Care specialists.

    Thank you!
    The Medical Mutual Social Media Team

  • Ba
      8th of Mar, 2016
    +2 Votes

    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.

  • Li
      17th of Nov, 2016
    0 Votes

    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.

  • To
      25th of Apr, 2017
    0 Votes

    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!

  • Ir
      7th of Jul, 2018
    0 Votes

    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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