Physicians MutualReviews of physiciansmutual.com

I have had Physicians Mutual Dental since 2016. It was an awesome Dental policy until this last year they changed everything. It is a PPO policy and even using an in network provider they have allowed amounts that the provider is supposed to abide by. They cannot bill you over the amount that is allowed by Physicians Mutual Dental allowances. But that has changed Physicians Mutual now is allowing the dentist to balance bill you the difference between the allowed amount and the portion that is supposed to be a write off and cannot be billed. They will not address the issues of the provider balance billing the patient in excess of the contracted amount for an in-network provider. X-rays are paid at 100% and you're supposed to have no out-of-pocket. Now the dentist can bill you what is not covered which made me responsible for $221. This policy is a piece of crap I canceled it immediately after almost 10 years and will never go back. I don't recommend anybody taking their Dental or Vision policies they're a trap to deplete seniors of their money. MY INFORMATION IS ACCURATE. I WORKED IN THE HEALTH AND DENTAL INSURANCE COMPANY FOR BENEFITS FOR 15 YEARS. YOU DO NOT SUPPORT YOUR POLICY HOLDERS AND LET THE DENTISTS SCAM THE SENIOR CITIZENS. XRAYS COVERED AT 100% DOESNT COME WITH A $221 BILL FOR ROUTINE XRAYS. YOUR DONE SCAMMING ME

My dentist told me I should have a crown put in because my tooth had a crack in it. They told me it would be $1800 and my insurance company (Physicians Mutual) would cover half. Even $900 was a big expense for me but I did it. I never thought my insurance company would deny the claim. I even waited more than a year to have this done so that my coverage for this procedure would kick in. I jsut received a letter from PM saying they reviewed my dentist's claim a second time and denied it. They said they're consulting dentists (paid I assume by the company they're consulting for!) said there was enough tooth structure for retention of the crown. I guess my dentist felt it necessary remove more of the tooth to place the crown. Wow! I am paying $100 per month for me and my wife for two years and they can't cover HALF a crown procedure? No wonder insurance companies are under fire these days. If you paid this claim we'd have kept paying our premiums for years probably and you would have made thousands off of us. Now you won't have a customer anymore. Was it really worth it?

I had Physicians Mutual Top tier plan (they say they have 3)... this may help cover expensive procedures like a bridge or a crown but it covers Almost Nothing for routine cleanings. I called them and asked them why they didn't cover more for preventive procedures. I was told they would if I had the Top Tier plan. I told them I did.. but the representative then told me I had the "Old" Top tier plan... and they had New level plans.. I asked why I wasn't on that New Plan? Their response was they couldn't just move me to that plan without my consent because it cost more. They never notified me and they only advertise that they have Three plan levels. I asked if they could upgrade me.. they said Yes.. But if they did that, I would be subject to the one year waiting period for major procedures... this company does it's best to deny paying what they should. You are better off putting the monthly amount they charge into a saving account and paying your dentist in cash as this company pays almost nothing for "covered" procedures!

I applied for dental insurance. 7 days later my bank was drafted 1st month premium. After a couple more weeks i still had not received policy to be reviewed. i sent message to cancel policy (in trial phase) of which i still had not received. Before trial period complete My bank was again drafted for next month premium! several days later i receive policy of which i returned same day with instruction to cancel as previously requested and refund both premiums that was drafted! As to date; even tho i’ve contacted them numerous times. I did everything they said was required to get my refund and i still have not received my refund! This tells me this is not a company I want to do business with ! BBB NOW INVESTIGATING

I and my spouse have had a Qualified LONG-TERM CARE INSURANCE CONTRACT UNDER SECTION 7702B OF THE IRS CODE for over 20 years. My wife is chronic ill individual drawing under this policy. My problem with this company is there claims people. The communication is one sided, they want redundant paper work from you, but ask them a question, don't call us, don't write us, just send us everything that shows the patient is still chronically ill from a Certifed Licenced Health Care Practitioner with a Long Tern Treatment Of Care every 3 months and we may extend this time period to 6 months. Then they send you a 1099 that is 30% higher than the amount received by you, Don't ask where the other money went, that not you business. 3rd party got that. They will send a letter stating you will get a 5% increase this year. Then when you receive 1% over last year, their final answer is oh, it's 5% above your 1999 distribution. But your increase in premium is 12% of your 2022 premium. Do you get my frustration, I will not buy anything from company.

I have had Physicians Mutual as sort of a backup plan, before I even picked a different Medicare provider (who happened to cover dental better than any other). I kept PM as sort of a backup plan. I finally got around to seeing if I could get services covered from 2023, in November. (after paying PM premiums for over a year). First off, they held up processing, waiting on "clarification" of a charge from the dentist: a charge that obviously wasn't reimbursable yet, since I was still in the first year of coverage. It has taken until now to figure out that they dragged their feet....then, what they did pay went to my dentist, not me! Even though the dentist got paid already by my Medicare plan. The claims processing branch of their business didn't help much, when I called last night for an explanation. So I got right on calling PM today to cancel. Not worth the money, unless you have no other insurance.

I had their dental insurance plan for over eight years in North Carolina. It's a mixed bag with pros and cons. Pros-it covers implant-related procedures, has a 38% discount for in-network dentists and does direct reimbursement for out-of-network providers like dental schools. Cons-For NC and VA they never raise the reimbursements. So if you start with them paying $400 per crown then 8 years later you're stuck with the same reimbursement. This is very unfair because they do raise the monthly rate over time. Next they arbitrarily won't cover some procedures on some parts of the mouth. For example a procedure may be covered for the lower arch (jaw) but not the upper. Another con is that they don't offer a deductible-based plan so the costs are high relative to what you are getting. Overall their dental plan is ok if you self pay and have no other insurance and quit the plan to restart every few years otherwise it really is way overpriced. Another problem I had was with them giving lower reimbursements than a procedure should have gotten and I had to appeal to get it fixed. So they are basically money-grubbing.