Medical Mutual Customer Care: A Practical, Expert Guide

How to reach the right team the first time

Medical Mutual serves members primarily in Ohio and neighboring regions, with customer care handled through multiple channels. The fastest route for most members is the number printed on your Member ID card; it routes your call based on plan type (commercial group, ACA individual, Medicare Advantage, etc.). If your card is not handy, start at medmutual.com and select Member Login to access secure messaging and live chat. The corporate headquarters address is 2060 E 9th St, Cleveland, OH 44115, and the general website is https://www.medmutual.com.

Members on Medicare Advantage plans can also get help through 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), especially for issues involving enrollment or appeals beyond the plan level. For Ohio-specific consumer assistance or external review information, the Ohio Department of Insurance Consumer Services can be reached at 1-800-686-1526 or via insurance.ohio.gov. If you use a TTY device, dial 711 to reach Telecommunications Relay Service and ask to be connected to the number on your ID card.

Prepare before you call: what to have ready

Customer Care representatives can resolve most issues in a single interaction when you provide specific details up front. Gather your Member ID, the patient’s full name and date of birth, and any relevant dates of service. For claims and preauthorizations, exact codes and dollar amounts save time and reduce call transfers.

If a provider is involved, ask their office for the billing details before you call. A few minutes of prep commonly saves 10–15 minutes of back-and-forth, and can shorten claim resolution by several days if documents are submitted correctly on the first try.

• Claims: Claim number (if available), date(s) of service, provider name, billed amount, CPT/HCPCS codes, diagnosis codes (ICD-10), and provider NPI/TIN.
• Bills: Statement number, service dates, and a copy/photo of the bill showing insurance adjustments and patient balance.
• Authorizations: Authorization/reference number, procedure codes, and clinical notes summary (e.g., MRI lumbar spine, CPT 72148).
• Coverage: Plan year, deductible met-to-date, out-of-pocket met-to-date, and network tier of the provider/facility.
• Privacy: If calling for a spouse/dependent, have a HIPAA authorization on file; otherwise, representatives may be limited to general information.

Claims, EOBs, and billing—what to expect

Most providers submit claims electronically (per the 2023 CAQH Index, about 96% of medical claims are submitted via EDI). After processing, Medical Mutual posts an Explanation of Benefits (EOB) to your secure member portal (member.medmutual.com). An EOB is not a bill; it shows the allowed amount, the plan’s payment, and what you may owe the provider (copay, coinsurance, or deductible). If a provider bills you more than the EOB patient responsibility, call Customer Care with both documents handy to reconcile differences.

Under federal rules for group health plans (29 CFR 2560.503-1), initial benefit determinations for post-service claims must be made within 30 days (with a single 15-day extension allowed if necessary). If you receive an adverse determination (a denial or partial denial), you have a right to appeal; keep the denial letter, as it lists the reason, the evidence used, and how to submit additional documentation.

If you received care from an out-of-network provider in an emergency or at an in-network facility without a choice of an in-network clinician (for example, anesthesiology), the federal No Surprises Act (effective 2022) generally protects you from balance billing. In such cases, contact Customer Care and reference the No Surprises Act when disputing out-of-network charges you did not knowingly consent to.

Prior authorization and medical necessity

Some services—advanced imaging (MRI/CT), certain infusions, elective inpatient admissions, and selected surgeries—require prior authorization (PA). Your provider typically initiates PA and should receive a decision letter. You can verify PA status in the member portal or by calling Customer Care with the authorization/reference number. Submitting comprehensive clinical notes on the first request is the single best way to avoid delays.

Timelines you can rely on (federal baselines)

For commercial group plans: urgent pre-service requests must be decided as soon as possible, but no later than 72 hours; standard pre-service requests within 15 days; and concurrent care decisions promptly to avoid interruption of ongoing treatment. For Medicare Advantage plans: standard pre-service organization determinations are due within 14 calendar days and expedited determinations within 72 hours. If your clinical situation changes, ask your provider to request an expedited review.

Appeals, grievances, and external review

If you disagree with a denial, you generally have up to 180 days from the date on the denial letter to file an internal appeal. For commercial plans, the plan must issue a decision within 30 days for pre-service appeals and 60 days for post-service appeals. For Medicare Advantage, you typically have 60 days to appeal a denial; plans must decide standard appeals within 30 days (pre-service) or 60 days (payment), and expedited appeals within 72 hours. Keep copies of everything you submit.

After exhausting internal appeals, you may qualify for an external review by an Independent Review Organization (IRO). Under the Affordable Care Act framework and Ohio Revised Code Chapter 3922, standard external reviews are generally decided within 45 days, and expedited reviews within 72 hours. For help initiating an external review in Ohio, contact the Ohio Department of Insurance at 1-800-686-1526 or visit insurance.ohio.gov.

• Step 1: Internal appeal—submit within 180 days of denial; include medical notes, letters of medical necessity, and any supporting guidelines or literature.
• Step 2: Second-level appeal or grievance (if available in your plan)—follow the plan’s letter; response times usually mirror Step 1 timelines.
• Step 3: External review—file promptly after final internal denial; decisions due in 45 days (standard) or 72 hours (expedited for urgent cases).
• Medicare Advantage path: Plan appeal; if upheld, your case can go to the Independent Review Entity (IRE); 1-800-MEDICARE (1-800-633-4227) can explain steps and deadlines.

Costs, networks, and getting an accurate estimate

Always verify network status before scheduling non-urgent care. Use the Find a Provider tool at medmutual.com/FindADoctor or by logging into your member portal for personalized network filters. Confirm the facility and all clinicians (surgeon, anesthesiologist, radiologist) are in-network. A five-minute check can avert out-of-network bills that are often 2–4 times in-network allowed amounts.

For price transparency, Medical Mutual provides cost-estimator tools in the portal to compare common services. As a working baseline for many PPO plans in 2025, you might see copays around $25–$40 for primary care, $50–$75 for specialist visits, $75–$100 for urgent care, and $300–$500 for emergency department visits, with imaging and labs subject to coinsurance after deductible. Your exact costs depend on your plan’s deductible, coinsurance, and out-of-pocket maximum—use the estimator with CPT codes from your provider for the most precise figure.

Accessibility, language, and special situations

Language assistance and auxiliary aids are available at no cost under Section 1557 of the Affordable Care Act. If you need an interpreter, tell Customer Care at the start of the call which language you prefer. For hearing or speech disabilities, dial 711 (TRS) to connect through an operator. If you appoint a caregiver or advocate, ask Customer Care for a HIPAA authorization form so they can discuss protected health information on your behalf.

For COBRA, coordination of benefits, or transition-of-care coverage (e.g., ongoing chemotherapy during a plan change), contact Customer Care as soon as you know about a change in coverage. Plans commonly offer transition-of-care provisions that temporarily cover an out-of-network provider at in-network levels to avoid disrupting active treatment. Document calls with dates, names, and reference numbers; if you need written confirmation, request it via secure message in member.medmutual.com.

Digital tools and when to use them instead of calling

Use the secure member portal (member.medmutual.com) to download ID cards, track deductibles, view EOBs, submit documents for claims or appeals, and check authorization status. Uploading documentation through the portal ensures immediate receipt and typically shortens processing by 2–4 business days compared to mail. For quick coverage questions outside business hours, check the plan documents in your portal; most include benefit summaries with exact copays, coinsurance percentages, and prior authorization requirements.

If you must mail documents, use trackable delivery and include your Member ID on every page. However, electronic submission is strongly recommended. Keep copies of everything you send and note confirmation numbers provided by the portal or the representative. Accurate documentation is your best leverage if you need to escalate later.

What is the phone number for Mutual Medical?

Who do I contact? Telephone inquiries should be directed to Mutual Medical Plans at 309-674-0888.

Why was Steve Glass fired from Medical Mutual?

No reason was given for Glass’s departure or its suddenness. Crain’s has reached out to Medical Mutual for further comment. Steven Glass has stepped down as CEO of Medical Mutual. For his part, Glass said, “I am very proud of the role I played in helping steer Medical Mutual in an exciting new direction.

Are Medical Mutual and Cigna the same thing?

Cigna Healthcare is an independent company and not affiliated with Medical Mutual of Ohio. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with Medical Mutual of Ohio.

Is Medical Mutual of Ohio the same as Aetna?

What is the relationship between Medical Mutual and Aetna? Medical Mutual is the company that provides your healthcare coverage. Your Medical Mutual coverage includes access to the Aetna® Open Choice® PPO network if you live outside of the Medical Mutual SuperMed® PPO service area.