Complaints

This profile includes complaints for Medical Mutual of Ohio's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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• 

  Medical Mutual of Ohio

  100 American Rd Brooklyn, OH 44144-2322

• 

  Medical Mutual Of Ohio

  10 W Broad St Ste 1400 Columbus, OH 43215

• 

  MedMutual Protect

  969 Keystone Way Carmel, IN 46032

• 

  Medical Mutual of Ohio

  9848 Olde US 20 Rossford, OH 43460

• 

  Medical Mutual

  9050 Centre Pointe Drive Suite 225 Liberty Township, OH 45069

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:12/14/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  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

  Date: 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

  Date:06/09/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  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

  Date: 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

  Date:03/27/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  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

  Date: 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

  Date:01/12/2023

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  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

  Date: 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 Answer

  Date: 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

  Date: 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

  Date:12/01/2022

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  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

  Date: 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 Answer

  Date: 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

  Date: 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 Answer

  Date: 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

  Date: 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 Answer

  Date: 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

  Date: 01/10/2023

  Dear Mr. *****,

   

  The address is as follows:

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

   

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

• Initial Complaint

  Date:10/05/2022

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  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

  Date: 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

  Date:10/04/2022

  Type:Billing Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  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

  Date: 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: ************