ComplaintsforMedical Mutual of Ohio

• Initial Complaint

  12/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Consumer purchase Medical Mutual as supplement to Medicare. She mailed the June payment of $329.83 at the end of May. They claim that they never got it but it cleared consumer bank account, was deposited in ***** ****. Medical Mutual wanted her to send in another check but she did not have the money so they cancelled her insurance. Consumer is on oxygen and the supplemental insurance covered that.

  Business response

  12/18/2023

  December 18, 2023
  
  ******* *****
  Better Business Bureau
  Serving Greater Cleveland
  200 Treeworth Blvd.
  Broadview Heights, OH 44147
  
  RE: ***** *****
  ID#: ********
  
  Dear Ms. *****:
  
  I am writing to respond to the complaint forwarded from your office on December 14, 2023, regarding a payment from Ms. *****.
  
  Medical Mutual never received a check for $329.83 from Ms. ***** for her June payment that she is stating was sent to us at the end of May.
  
  On July 18, 2023, the member supplied us with a copy of check #3813 that states pay to the order of Medical Mutual in the amount of $321.83 which is included. The back of the check indicates it was cashed by ** ****** ***** ****.  Medical Mutual did not endorse this check, does not bank or have an affiliation/relationship with ** ****** ***** ****.  Therefore, Medical Mutual never received the payment/check.  The member should contact their bank to see who received these funds.
  
  Sincerely,
  
  
  Raitoya S*******
  Customer Resolution Specialist
  Appeal and Complaint Department
  
  Attachments

• Initial Complaint

  06/09/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  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.

  Business response

  06/13/2023

  June 13, 2023
  
  Better Business Bureau
  200 Treeworth Blvd.
  Broadview Hts., Oh 44147
  
  Dear Ms. *****:
  
  I am writing to respond to the complaint forwarded from your office on June 9, 2023, from Ms. **** regarding the MRI denial for her husband.
  
  Prior approval is the process of establishing medical necessity of a service in advance of the actual date of service. The result of the prior approval review provides the provider and member with the health plan’s decision regarding medical necessity or explains the failure to meet medical necessity guidelines for the requested service.
  
  If the prior authorization for your husbands MRI was denied and you feel this decision was made in error, you and your doctor have the right to appeal and we encourage you to do so. Directions on how to file an appeal are included in the denial letter or by contacting Customer Service at 800-336-2583.
  
  
  Sincerely,
  
  
  Holly P******
  Operations Business Analyst
  Appeal and Complaint Department
  

• Initial Complaint

  03/27/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My policy for my son with autism was cancelled over a $9.00 dollar payment up charge. Company took payment for two months in advance which possibly disrupted billing or communication leaving 9 dollar balance. The cancellation has caused disruption in services. Company stated they needed to review it to see if they could consider reinstatement.

  Business response

  03/28/2023

  Good afternoon,

   

  With the limited information provided, I am unable to research the issue.  Can you please provide your son's name, birthdate, Identification number or group number along with if the policy was a Medical, Dental or Vision plan? 

   

  I appreciate your assistance. 

   

  Sincerely,

   

  Holly P******

  Customer Resolution Specialist

• Initial Complaint

  01/12/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 3/11/2022 my daughter had a well visit and received a vaccination required for college at her physician's office (Peerless Pediatrics). A claim was submitted Medical Mutual of Ohio and paid at that time. In July Medical Mutual reversed its decision and pulled payment back from the care provider. The care provider notified us of the situation and sent a bill for services in August, knowing this was covered we asked that they resubmit. It was rejected again, we reached out to Med Mutual for explanation at that time. They said they would resubmit and review the claim. No follow up from Med Mutual, the care provider sent another bill the following month. We again called Medical Mutual, this time getting a reference number and a fax number to send supporting documentation for coordination of benefits. My ex-wife and I both have insurance, Med Mutual wanted to establish that they were the primary insurer, which they are as I am required to cover my daughter under my insurance by the divorce decree and I am the older parent. These are the two measures used in determining primary coverage as I have been told by Medical Mutual. Tried to use the fax number and it was wrong. Called again and got a correct fax number and sent the required documentation. Another month passed, no follow up from Med Mutual, care provider still has not been paid. Called again and was told the reference number I had was not correct, no such reference number existed. Spoke to Angie on January 10, 2023 was given ************* as a reference number and was assured that everything looked to be in order and she was sending it for review. Two days later I received a call that they still were waiting on the paperwork. This had already been faxed and had been confirmed on the call. This time I was given an email address to send it to. I have now emailed the documentation as well. I have lost patience and am looking to have this resolved post haste.

  Business response

  01/17/2023

  01/17/2023
  
  Better Business Bureau
  200 Treeworth Blvd.
  Broadview, Hts., OH 44147
  
  Case: ******* ******
  Assigned ID: ********
  
  Dear Ms. *****:
  
  I am writing to respond to the complaint forwarded from your office on 01/12/2023.  Mr. ****** states his daughter received vaccinations at her physician’s office. The claim was paid, then taken back as there was other insurance from another carrier. He would like his insurance to be listed as primary coverage.
  
  We received claims from the Pediatrics office for services rendered on date of service 03/11/2022. The claim was processed and paid on 03/22/2022.
  
  On 08/02/2022, the claim was adjusted and denied as our records indicated this patient is eligible for coverage under another health insurance plan. To reconsider these charges, we need information regarding the patient's primary carrier determination of benefits for these charges.
  
  On 12/02/2022, Mr. ****** called Medical Mutual regarding the denied claims. He advised that his daughter did not have any other insurance. On 12/06/2022, we sent Mr. ****** a letter advising we were unable to update his daughter’s Coordination of Benefits (COB) without additional information and to please submit a cover letter with your policy number and a copy of his daughter’s previous health insurer's Certificate of Creditable Coverage (also known as a HIPAA Certificate). 
  
  On 12/08/2022, Mr. ****** called Medical Mutual and advised his daughter was covered under other insurance but there was joint custody, and he would fax over the legal documents.
  
  On 12/13/2022, we received those documents and the coordination of benefits was updated. Medical Mutual was primary from 01/01/2022 to 03/09/2022 based on the court order. Once the child reached the age of 18, which was on 3/9/2022, we were then considered secondary coverage by the longer/shorter rule until the policy cancelled on 4/8/2022. These claims have processed correctly.
  
  Mr. ****** should provide the physician’s office with the primary insurance carrier information so they can submit the claims to the correct insurance company for payment.
  
  
  Sincerely,
  
  
  Holly P******
  Customer Resolution Specialist
  Appeal and Complaint Department
  Fax ***** ********
  
  Attachments
  

  Customer response

  01/20/2023

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  From MedMutual's own website Member Right & Responsibilities | Medical Mutual (medmutual.com) it states "You have the right to get a fair, objective and timely review and resolution of an appeal; to be told how the appeal will be handled according to federal and state laws; and to be told any important time limits related to filing your appeal." 

  
  Medical Mutual rejected the claim 5 months after initially paying, never did they reach out to me, each contact I had to initiate, and ultimately, I had to lodge a complaint with the BBB in order to get the actual reason for the denial. Interestingly enough the denial the are currently reporting hinges on information that I had to provide them, which means the original denial was for a different reason. And never have they provided me any information in relation to how the claim was being processed, or what my rights are or what the laws surrounding this matter are. 
  At this point I want this matter transferred to arbitration or an independent insurance review board. I don't trust Medical Mutual to be fair, impartial or objective in this matter. 
  
  Regards,
  
  ******* ******
  
  
  
  
  
  
   

  Business response

  01/25/2023

  01/25/2023
  
  Better Business Bureau
  200 Treeworth Blvd.
  Broadview, Hts., OH 44147
  
  Case: ******* ******
  Assigned ID: ********
  
  Dear Ms. *****:
  
  I am writing to respond to the complaint forwarded from your office on 01/23/2023.  Mr. ****** determined is complaint is not resolved.  
  
  We received claims from the Pediatrics office for services rendered on date of service  03/11/2022. The claim was processed and paid to the provider on 03/22/2022 as we were not made aware of any other insurance for the dependent on the policy.
  
  On 08/02/2022, the claim was adjusted and denied as our records indicated this patient is eligible for coverage under another health insurance plan. Notice was sent to Mr. ****** in the form of an explanation of benefits. The explanation of benefits explains what to do if you disagree with a decision and want to appeal. There is no appeal on file for this claim. I have attached the explanation of benefits for your records.
  
  Based on Coordination of Benefits longer/shorter rules, the insurance plan that covered the person the shorter period of time is the Secondary plan.  Medical Mutual is the secondary coverage from 03/09/2022 to 04/08/2022.
  
  These claims have processed correctly. Please provide the physician’s office with the primary insurance carrier information so they can submit the claims to the correct insurance company for payment. Once the claim has been processed by the primary insurance, the provider can send a claim to Medical Mutual with the primary insurance carriers’ explanation of benefits so we can process as secondary.
  
  
  Sincerely,
  
  
  Holly P******
  Customer Resolution Specialist
  Appeal and Complaint Department

• Initial Complaint

  12/01/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  There was a problem with payment to Northern Ohio Surgery Center since they still were not Medical Mutual providers until after a service in Spring 2021. The check MM sent to me for payment of services I signed over to NOSC. Instead of the problem being managed between MM and NOSC, they involved me. NOSC sent me a check for $808.80. On 10-24 I deposited a check for 808.80 from NOSC for reimbursement to MM. On 10-25 I sent MM a check (#****) for $808.80. I am now getting nasty letters that they tried to contact me multiple times and I am not responsive. I contact them every single time they contact me. Today, after waiting for 5 minutes for someone to get back on the phone after they answered, I have given up. They are not kind and not helpful to resolve an issue that is between MM and NOSC.

  Business response

  12/08/2022

  12/08/2022
  
  ******* *****
  Dispute Resolution Specialist
  Better Business Bureau
  
  Complainant: ****** *****
  ID: ********
  
  Dear Ms. *****:
  
  I am writing to respond to the complaint forwarded from your office 12/01/2022. Mr. ***** states he is having a problem with payment made on a claim to Northern Ohio Surgery Center and would like Medical Mutual and the provider to resolve the issue.
  
  Date of Service 05/20/2022, Case # ********
  We received a claim from Northern Ohio Surgery Center for services provided on date of service  5/20/2022 where Mr. ***** was paid $1,108.80 under check number 5844290. Mr. ***** states he signed that check and forwarded payment to the providers office. The check was cashed on 07/01/2022. It was determined that Medical Mutual paid the claim to the member instead of the provider. We attempted to work directly with the provider, but the provider insisted on refunding the member directly. On 10/17/2022 we called Mr. ***** and informed him to contact Shannon at the providers office and request the refund. We received  check # **** in the amount of $1,108.80 from Mr. ***** dated 10/24/2022 for this claim and the case is now closed.
  
  Date of Service 03/01/2022, Case # ********
  We received a claim from Northern Ohio Surgery Center for services provided on date of service 03/01/2022 where Mr. ***** was paid $808.80 under check number 5744853. The check was cashed on 04/12/2022. It was determined that Medical Mutual paid the claim to the member instead of the provider. As of today, we have not received the refund request for this date of service. Notices are still being mailed to Mr. ***** as this is an outstanding amount due.
  
  If Mr. ***** signed this check over to Northern Ohio Surgery Center for services provided on  03/01/2022, he must contact the provider for a refund. If not, please forward payment to Medical Mutual.
  
  Sincerely,
  
  
  Holly P******
  Customer Resolution Specialist
  Appeal and Complaint Department

  Customer response

  12/08/2022

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  Again, they are putting me in the middle.  The check was given to NE Ohio Surgery Center.  I did not cash it.  Medical Mutual needs to call NESC and stop putting me in the middle. I did not take money that didn't belong to me.  I did not cash the check. 
  

  They also need to stop sending nasty form letters and claiming I have not contacted them.  When I call, they leave me on hold for 5 minutes and never get back on the phone. They don't call me back.  They are being rude and nasty; this is unprofessional. 

  My next step is to complain to the State of Ohio Insurance Board.

  
  
  Regards,
  
  ****** *****
  
  
  
  
   

  Business response

  12/13/2022

  
  12/13/2022
  
  ******* *****
  Dispute Resolution Specialist
  Better Business Bureau
  
  Complainant: ****** *****
  ID: ********
  
  Dear Ms. *****:
  
  I have confirmed with the Northern Ohio Surgery Center that a refund was issued to Mr. ***** in the amount of $808.80 on 12/05/2022. Once received, please forward payment to Medical Mutual.
  
  
  Sincerely,
  
  
  Holly P******
  Customer Resolution Specialist
  Appeal and Complaint Department

  Customer response

  12/17/2022

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  It is December 17.  No check has arrived even after a claim it was mailed December 5 and I am leaving town in a few days.  This is an issue that should be resolved by the vendor who took the check that was signed over  to them and the insurance company.  The insurance company can see the cashed check that was deposited into the vendor's account.   The first time this happened I lost $200 because the vendor decided they should only send me a partial amount of the check signed over to them. This is bad customer service by both the insurance company and Northeast Ohio Surgery Center.  They need to stop putting me in the middle.
  
  Regards,
  
  ****** *****
  
  
  
  
   

  Business response

  12/21/2022

  Good afternoon,

   

  I apologize for the confusion. I misunderstood the process described to me by the facility regarding your refund. The refund request was initiated on December 5, 2022 and the check was processed and mailed to you on December 21, 2022. 

   

  I apologize for any inconvenience this may have caused.

   

  Sincerely,

   

  Holly P****** 

  Customer Resolution Specialist

  Customer response

  12/28/2022

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  
  I go half the amount of the check that I gave them.  I never got a bill from NOSC and I am not going to send you $808 when they keep skimming off money from a check they cashed.  It is irresponsible of Medical Mutual to put me in the middle.  You need to be auditing Northeast Ohio Surgery Center.  I am happy to send you the amount of the check they gave me.  I need an address.
  
  Regards,
  
  ****** *****
  
  
  
  
   

  Business response

  01/10/2023

  Dear Mr. *****,

   

  The address is as follows:

  ******* ******
  **** ******
  Columbus, OH 43260-3951

   

  Please include case # ******** in your correspondence. 

• Initial Complaint

  10/05/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  First red flag I talked to Medical Mut through December 12 about medical insurance I’m running out of time due to *** benefit not an answering the phones I am getting insurance for $947 a month but I get it back in two days because my retirementOPRS will pay me back $947 per medical mutual lady I talk to so I agreed to it no harm no prob I get the money back good they was gonna send me a welcome package but it never happened second red flag they’re a red flag I never got my medical card I had to print it out online I called about it more and I get the money I was getting 705 I was getting a run around for a whole three months kept calling 705 is not 947 like it’s like she said my deductible Dr. is $25 come to find out is $60 so that’s the fourth red flag I had to change hospital doctors from ********* clinic University number five red flag she said I will have the same same hospital and doctors and I have a goal plan on medical mutual, find out I have Change doc at the end I was paying too much money for Medical insurance OPRS it was only Pan at 7:05 per month that’s the top limit number six red flag I try to get the overpayment back they refuse I come up with a plan to pay it in two October November and December until the first of the year and I will stop the medical coverage they refuse refuse to give me my overpayment back we went back-and-forth and I told him I paid enough to medical mutual can pay the medical bill I paid 947 seven month ,, medical bill is $6000 I paid it already and never touch the deductible only went to the doctor three times this year and now I got all these bills but I pay medical mutual the money way way more it’s just me and everything the young lady said was a lie I tried I tried over and over to communicate with them they refuse to listen to the reason I’m Diabetic Insulin Blood sugar on disability I’m on a budget I’ll have that much money this man I need my money back ASAP I need somebody here it is already notify commissioner of

  Business response

  10/12/2022

  10/12/2022
  
  Kristie *****
  Dispute Resolution Specialist
  Better Business Bureau
  
  RE: ***** ***** 
  
  Dear Ms. *****:
  
  I am writing to respond to the complaint forwarded from your office on 10/05/2022 from Mr. ***** ***** regarding his policy with Medical Mutual.
  
  Beginning 01/01/2022, the **** ****** ********* ********** ****** (OPERS) no longer offered its group-sponsored plan to pre-Medicare members or re-employed retires. Members had the option to purchase an individual health insurance plan on the open market. OPERS provided members with a monthly health reimbursement arrangement (HRA) allowance that can be used for healthcare expenses, such as monthly premiums. OPERS members could select health plans from any insurance carrier by purchasing directly from the carrier, through the federal marketplace, brokers or *** Benefits, but were required to opt in to an HRA with *** Benefits to receive their monthly OPERS allowances. OPERS funds the HRA with the determined monthly allowance.
  
  Mr. *****, with assistance from a Medical Mutual insurance broker, selected an off exchange individual Northern Ohio HMO plan which services those living in ******** county.
  
  Mr. *****’s concern is that his monthly Medical Mutual premium was $947.73 and it appears his OPERS allowance is $705.00, which leaves him to pick up the difference. Unfortunately, Medical Mutual has no knowledge of what Mr. *****’s reimbursement rate would have been at time of application.  He should contact OPERS through *** Benefits to discuss his reimbursement amount.
  
  Mr. ***** did contact our Customer Care team to express his concerns. Our leadership team researched his complaint, listened to phone calls and determined there was no misrepresentation of the policy by the agent.
  
  Unfortunately, we are unable to refund Mr. ***** the difference between his premium and the OPERS reimbursement.
  
  Sincerely,
  
  
  Holly *******
  Customer Resolution Specialist
  Appeal and Complaint Department

• Initial Complaint

  10/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My healthcare provider has been trying to appeal a claim since 6/30/22. Myself and my healthcare provider have followed up on the status of this claim a total of 6 times and keep getting the run around. Each time we are told to send records to support claim. Records have been faxed, mailed certified twice and uploaded to portal. Now we are being told to fax again. This is unacceptable. I’d like to know where my medical records are since they are not being handled appropriately. My healthcare provider informed me MedMutual has become increasingly difficult to work with over the last year. I also have another claim open from March with no resolution. Absolutely ridiculous and unprofessional.

  Business response

  10/11/2022

  
  October 11, 2022
  
  
  
  
  Kristie *****
  Dispute Resolution Specialist
  Better Business Bureau
  200 Treeworth Blvd
  Broadview Heights, Ohio 44147
  *************************
  
  Complaint ID ********
  
  Dear Ms. *****:
  
  This letter is written in response to your inquiry received on October 5, 2022. Mutual Health Services (MHS) is a division of Medical Mutual Services and is the third-party administrator of the member’s health plan.  This group has a self-funded plan. 
  
  After investigation of the claims in question, we discovered that most of the claims had been adjusted on August 4, 2022 and September 26, 2022.  A prior authorization previously denied was reviewed and approved on October 10, 2022.  The provider and member have been notified by phone of the approval.  An approval letter will follow in 7-10 days.
  
  I hope this information helps your investigation.  If you have any questions, please don’t hesitate to contact me.   
  
  Sincerely,
  
  
  
  Joyce *****, Paralegal
  Joyce.*****@MedMutual.com
  Phone: ************
  Fax: ************

• Initial Complaint

  07/28/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  The date of Dental service was December 15, 2021. The treatment was covered and paid by Medical Mutual Insurance, however there was a billing error which resulted in a refund being owed to me. Instead of medical mutual issuing the refund check to me, they sent it to the the provider. The provider returned the check to medical mutual but to date medical mutual has failed to issue a refund to me. I have contacted medical mutual four times by telephone call to customer service. These are the dates of contact: 6-15-22, 6-16-22,6-28-22 and 7-27-22. The result of each call was the same, "our Medicare department is handling this and will issue a refund soon". I have asked to speak with someone in the Medicare department but have been denied. I am submitting this complaint because I believe the amount of time taken to resolve this issue is obsessive. I do not haver the resources to compete with a major company like medical mutual, therefore I am seeking whatever assistance your agency can offer. Thank You

  Business response

  08/01/2022

  8/1/2022
  
  Kristie ***** 
  Better Business Bureau
  Serving Greater Cleveland
  200 Treeworth Blvd.
  Broadview Hts., OH 44147
  
  RE: ******* *********
  ID#: ********
  
  Dear Ms. ***** :
  
  I am writing to respond to the complaint forwarded from your office on 7/28/2022 in regard to a payment due to Mr. *********.
  
  On 3/22/2022, we received a claim for dental services for date of service 12/15/2021. The claim was processed and the problem focused exam was denied as not covered under the plan. The dental provider was paid $465.13 for all other services billed.
  
  On 04/24/2022, we received Mr. ********** appeal for the denied service. The denied service was overturned and an additional $38.59 was paid to the provider on 06/10/2022.
  
  On 06/16/2022, Mr. Chapelle advised us that the dentist voided and returned the check to Medical Mutual and that he would like additional funds sent to him and not the dentist.
  
  On 7/12/2022, we received the returned check from the provider. Since the provider was originally paid, a manual process to send the funds to Mr. ******** was initiated. Unfortunately, this process does take time  to complete. Mr. ********** payment of $38.59 is in process and he should receive a check within the next 7-10 business days. We apologize for the delay.
  
  Sincerely,
  
  Holly *******
  Customer Resolution Specialist
  Appeal and Complaint Department

  Customer response

  08/01/2022

  Dear Ms. *****,

  I am responding to medical mutual's reply to my complaint. My issue is the lack of timeliness on their behalf. If they were serious about resolving this issue they would expedite my refund and not make me wait another "7-10 days" I have had to wait long enough due to their mistake. Keep in mind the date of service dates back to December of 2019. Had they sent the refund directly to me and not the dentist then there would be no issue. They gave me the old "contractual" response to why the refund was sent to the dentist and not me. That is a load of crap. I know this because having been in corporate myself whenever my company was wrong we always used the "contractual" response. It works because who really knows and who is really going to take the time to find out. Most consumers don't even question it.  I would however like to thank you and the BBB of Cleveland for your prompt response. I do understand that you cannot force a company to do anything but at least you tried. I do however feel powerless but I hope that by submitting another complaint against this horrible company it may help someone in the future. I have no other issues at this time. I will just wait for them to send my refund and pray it happens sometime this century. But what should I expect from a company that only rates 1.2 stars from your agency. 
  
  
  Regards,
  
  ******* *********
  
  
  
  
   

• Initial Complaint

  07/19/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  On June 14 2022 i had accidentally sent a payment of $510.30 to medical mutual. When i learn of my mistake I had contacted MEDICAL MUTUAL and explain to them of my problem. on my first call. I was told that the bank sent them a check and that they had to write the bank a check back. and this will take time. So i called the bank back . and was told that they send the money electronically and that this was the first big fat lie by medical mutual. So i called back and spoke with a different agent she told me that she trying to call me on this issue this was the second big fat lie. Called back a third time and and was told that they send me a check and this would take ten days to receive. If they received the money electronically they should be able to return it electronic this is number 1 of big fat lie. this whole problem has been going on for 34 days. If you So today 7/19/22 i get a call from a miss Kimmy who is a supervisor in the billing dept she tell me that they sent a check back citizens on 7/15/22. why would you send a check back to the bank if you already sent one to me. this is number 4 of a big fat lie. would you send out 2 check. also for your information ( medical mutual plays a recording at the beginning of all calls before answering you call . Stating that all call are recorded.

  Business response

  07/21/2022

  7/21/2022
  
  BBB Case # ********
  Complainant: ***** *******
  Dear Ms. Angel:
  
  I am writing to respond to the complaint forwarded from your office on 07/19/2022. Mr. ******* states he contacted us regarding a premium payment he mistakenly made to Medical Mutual and required a refund. He states he still has not received the requested refund.
  
  On 06/23/2022, we received a call from Mr. ******* stating he made an incorrect online bill payment to Medical Mutual on 06/14/2022 in the amount of $510.30. We advised that we would request the refund. 
  
  On 07/05/2022, we received a call from Mr. ******* inquiring on the refund. We advised that the check would go back to his bank account.
  
  On 07/08/2022, we received a call from Mr. ******* inquiring on the refund. We advised that a check had been sent but 10 business days were needed for the check to reach his account.
  
  On 07/18/2022, we received a call from Mr. ******* inquiring on the refund. The call was escalated and a Medical Mutual representative called him back on 07/19/2022 indicating that the bank received payment and the check was cashed on 07/15/2022 and that he should contact his bank on the refund status.
  
  Before issuing a refund on an account where the original payment was received by check, we require time for that check to clear the bank it was drawn on before issuing a refund. Because we received the initial payment by check, we refunded it in the same manner as it was received.
  
  We have confirmed that the refund check was cashed on 07/15/2022 and Mr. ******* should verify with his bank that the credit has been processed back to his account.
  
  I apologize if this process was not communicated to Mr. *******. We value our members and exceptional service is always our priority.
  
  Sincerely,
  
  Holly P******
  Customer Resolution Specialist
  Appeal and Complaint Department
  

• Initial Complaint

  06/24/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  **** called Medical Mutual of Ohio Dental Insurance & they said he would be covered @ ******* ****** in Johnstown. He called ******* ****** to confirm he was cover at their office with his insurance. they never confirmed with him. He kept his appt @ Premier. He asked again if he was covered under his insurance.when he arrived They said ,"Yes" he asked 2 or 3 times all "Yes' but now after 2 visits & work is done they find out He is not covered. $810.00 This is the 2nd time he first call Medical Mutual of Ohio Dental Insurance & asked if he was covered at 2 different Dentists offices. !st time was ********* ****** Insurance said he was covered by his dental insurance. After he Had work down & was not covered received a billing. ********* ****** was gracious & never billed him. But the 2nd time he confirmed with Medical Mutual of Ohio Dental Insurance to see if covered at ******* ****** of Johnstown was told by insurance again he was covered. After getting work done he received a bill from ******* ****** saying he was not covered for their services. He has paid on 11-16-2021 $123.00 for Premier's first appointment & $ 810.00 for 2nd appointment. He wants Medical Mutual of Ohio Dental Insurance to pay the charges they should pay for these 2 appointments they said he was covered for.

  Business response

  06/28/2022

  06/28/2022
  
  Better Business Bureau
  200 Treeworth Blvd.
  Broadview Hts, OH 44147
  
  Dear Ms. Angel,
  
  I am writing to respond to the complaint forwarded from your office on 06/24/2022. Mr. ****** states that he called Medical Mutual Dental Insurance and was advised that ******* ****** in Johnstown was covered.
  
  On 10/28/2021, Mr. ****** contacted our customer service, inquiring about network status and a claim for date of service 10/15/21 from Dr. Brian Walsh for $315, which was denied because the provider is not in the network. Mr. ****** asked if ******* ****** was in his network. We checked the network website for providers in his area, and two dentists at ******* ****** were in network but in the Sunbury office near Columbus not on the Coshocton Rd, Johnstown office that he requested. Mr. ****** did not want the Sunbury office.   We explained that the Johnstown office is not in network, then supplied other in network providers names and addresses per Mr. Jordan’s request.
  
  We received two claims from Dr. ****** at ******* ****** for dates of service 11/11/2021 in the amount of $288 and 11/16/2021 in the amount of $645. Both claims were denied as not covered as the provider is out of network. 
  
  On 12/6/2021, Mr. ****** contacted customer service regarding the above November claims and we explained the non-network status and provided Mr. ****** additional network providers.
  
  We have no record of where Medical Mutual advised Mr. Jordan that Dr. ****** from ******* ****** was in his network.
  
  As of today, we have not received an appeal for these claims. We encourage you to review the explanation of benefits that provides you the steps if you disagree with a decision and would like to appeal. We have attached them for your convenience.
  
  Sincerely,
  
  
  Holly P******
  Customer Resolution Specialist
  Appeal and Complaint Department
  Fax (216) 687-7990
  
  Attachments

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