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Important Information

MedMutual Advantage PPO plans


MedMutual Advantage HMO plans


Important information for MedMutual Advantage PPO plans

This directory provides a list of MedMutual Advantage PPO network providers. To get detailed information about your healthcare coverage, please see your Evidence of Coverage.

You can find a list of pharmacies that offer Part B and Part D drugs in our pharmacy directory. Check with your pharmacy to see if it offers the services you need to fill a prescription.

Use this directory to stay in the MedMutual Advantage provider network. Be sure to check the directory to see if your healthcare provider is in the network. If not, we have many excellent doctors, hospitals and other providers you can choose from.

We strongly encourage you to select a primary care provider (PCP), although it is not required. With a primary care provider, you’ll have a provider who knows your medical history and can coordinate your care. Having a primary care provider means you’ll have a medical expert partnering with you to help you make important health decisions.

Provider information contained in this directory is updated five days per week, excluding Saturdays, Sundays or interruptions due to system maintenance, upgrades or unplanned outages. This information is subject to change at any time. Please check with the provider before scheduling your appointment or receiving services to confirm he or she is participating in the Medical Mutual Medicare Advantage PPO network.

The network providers listed in this directory have agreed to provide you with your healthcare services. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue to go to that same provider. Other physicians/providers are available in our network. Visit MedMutual.com or call us at   (800) 982-3117 for more information.

In PPO plans, staying in network means you’ll pay less out of pocket and get the most value from your health plan. Out-of-network/non-contracted providers are under no obligation to treat Medical Mutual members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

How do I submit a claim?

Most providers will submit a claim for you. However, if the provider will not submit the claim and bills you directly, you can submit the claim to us. Send us a claim form and the itemized bill that includes the diagnosis, procedure, date of service, charge, and provider’s name and address. Submit the completed form to our office within the timeframe stated in your Evidence of Coverage.

Where do I find a claim form?

You can find medical, dental, vision and other claim forms on My Health Plan at MedMutual.com/member under the Resources & Tools tab or by calling Customer Care.

Obtaining care after normal office hours

When you are ill, injured or feeling like you need immediate care, always call your PCP first. Your PCP can assess your symptoms and direct you to the right place to get care. If your PCP’s office is closed and you need prompt but not emergency medical attention, go to a network urgent care facility or other convenience clinic, which may cost less than an emergency room visit.

Symptoms that may require an urgent care or convenience clinic include:

  • Signs of the flu
  • Signs of a sprain
  • Signs of a sinus, ear or bladder infection

What is an emergency?

In an emergency, symptoms are severe and serious enough that a person who has no medical training, with an average knowledge of health and medicine, could reasonably expect that, without immediate medical attention, the result would be any of the following:

  • Placing the health of the individual in serious jeopardy
  • Serious impairment to bodily functions
  • Serious dysfunction of any body part or organ

Examples of emergencies are shock, chest pain, choking, poisoning, unconsciousness, severe pain, uncontrolled bleeding, hallucinations, delusions and attempted harm to oneself or others.

Getting emergency care

During a medical emergency, go to the nearest emergency room or, if necessary, call 911. Contact your provider within 24 hours of the emergency to arrange follow-up care with a network provider if necessary. If you are admitted to a hospital, our Care Management department will work with your provider to review your care. You do not need to contact us for prior approval for emergency care.


Important information for MedMutual Advantage HMO plans

This directory provides a list of MedMutual Advantage HMO network providers. To get detailed information about your healthcare coverage, please see your Evidence of Coverage.

You can find a list of pharmacies that offer Part B and Part D drugs in our pharmacy directory. Check with your pharmacy to see if it offers the services you need to fill a prescription.

Use this directory to stay in the MedMutual Advantage provider network. Be sure to check the directory to see if your healthcare provider is in the network. If not, we have many excellent doctors, hospitals and other providers you can choose from.

We strongly encourage you to select a primary care provider (PCP), although it is not required. With a primary care provider, you’ll have a provider who knows your medical history and can coordinate your care. Having a primary care provider means you’ll have a medical expert partnering with you to help you make important health decisions.

The network providers listed in this directory have agreed to provide you with your healthcare services. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue to go to that same provider. Other physicians/providers are available in our network. Visit MedMutual.com or call us at   (800) 982-3117 for more information.

In HMO plans, you must use plan providers in your network except in emergency or urgent situations or for out-of-area renal dialysis services. If you obtain care from out-of network providers, neither Medicare nor Medical Mutual will be responsible for the costs. You will have to pay the entire cost of medical services.

How do I submit a claim?

Most providers will submit a claim for you. However, if the provider will not submit the claim and bills you directly, you can submit the claim to us. Send us a claim form and the itemized bill that includes the diagnosis, procedure, date of service, charge, and provider’s name and address. Submit the completed form to our office within the timeframe stated in your Evidence of Coverage.

Where do I find a claim form?

You can find medical, dental, vision and other claim forms on My Health Plan at MedMutual.com/member under the Resources & Tools tab or by calling Customer Care.

Obtaining care after normal office hours

When you are ill, injured or feeling like you need immediate care, always call your PCP first. Your PCP can assess your symptoms and direct you to the right place to get care. If your PCP’s office is closed and you need prompt but not emergency medical attention, go to a network urgent care facility or other convenience clinic, which may cost less than an emergency room visit.

Symptoms that may require an urgent care or convenience clinic include:

  • Signs of the flu
  • Signs of a sprain
  • Signs of a sinus, ear or bladder infection

What is an emergency?

In an emergency, symptoms are severe and serious enough that a person who has no medical training, with an average knowledge of health and medicine, could reasonably expect that, without immediate medical attention, the result would be any of the following:

  • Placing the health of the individual in serious jeopardy
  • Serious impairment to bodily functions
  • Serious dysfunction of any body part or organ

Examples of emergencies are shock, chest pain, choking, poisoning, unconsciousness, severe pain, uncontrolled bleeding, hallucinations, delusions and attempted harm to oneself or others.

Getting emergency care

During a medical emergency, go to the nearest emergency room or, if necessary, call 911. Contact your provider within 24 hours of the emergency to arrange follow-up care with a network provider if necessary. If you are admitted to a hospital, our Care Management department will work with your provider to review your care. You do not need to contact us for prior approval for emergency care.


Provider data last updated on: 7/20/2017
Page last updated on: 10/31/2016

The information on this Web site and any links are for your information only and does not take the place of, or is intended to be a substitute for professional medical advice, diagnosis or treatment from your doctor. Any services recommended or provided by your doctor may not be covered under the terms of your benefit plan. Eligibility and coverage are subject to the specific terms of your benefit plan.