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This site is not a substitute to report an emergency. This site must not be used to report an emergency matter involving an imminent threat to life or property. Reports submitted through this site may not receive an immediate response. If your issue involved an immediate threat, contact the appropriate local authorities.
I understand this is not an emergency service.
 
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We are so glad you called.  Can you please tell us where you got this hotline number from?

  
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Please provide the policy number (personal identification number, Member ID) of the patient (subscriber) or the NPI, Tax Identification Number of the provider.  Your Identification number/ID is located on your Medical Mutual of Ohio identification card or located in the upper right hand portion of your Medical Mutual of Ohio explanation of benefits. 

Medicare Advantage = 7 digit number (NO LETTERS)

All other products = 12 digit number (NO LETTERS)

Click Here To View Sample Explanation of Benefits
Click Here To View Sample Identification Card



  

 
CIC Note:  If caller doesn't give you a policy number, please explain why not here.     *    
 
If this was related to a claim file, what was the claim number? Please note, claim numbers are 10 or 13 numeric digits. If not related to a claim for benefits, please enter ten (10) 9's.

  

 
CIC Note:  If caller doesn't give you a claim or identification number, please explain why not here.
 
What is your relationship to Medical Mutual or its family of companies?

  
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If Other, please explain:
 
Do you want to leave your name and/or contact information? Please remember that this is completely optional. However, if you wish to remain anonymous, the investigation may be limited by the information you have provided here.

  
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Name (First Name, MI, Last Name):
 
Telephone Number:
 
Home / Work Address:
 
Email Address:
 
Preferred Contact Time:
 
Are you filing this report on your own behalf or for someone else?

  
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If reporting for someone else, please explain why this individual is not filing the report.
 
Are you reporting a single or multiple incidents?

  


 
What was the date of service or when did the incident(s) occur?

  
Service Date

   
 
First Incident

   
 
Last Incident

   
 
How did you become aware of the Incident(s)?

  

 
If Other, please explain:
 
Please explain the details of your concern.

  
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Have you reported this to another party?

  
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If Yes, to whom?
 
Is there anything else you would like to add? (If you began this report anonymously and would like to provide your name, please enter it here.)

  
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Thank you for taking the time to report this situation.

Enter a one sentence summary to serve as an executive summary on this case.

  
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Please attach here any documents, videos, etc.