To file a Physicians Mutual claim form, download the one that matches your policy from the Customer Center at physiciansmutual.com, complete your section, have your provider complete theirs where required, and mail it with an itemized bill to the address printed on that specific form. Physicians Mutual publishes a separate form for each product line, so the first move is matching your coverage to the right document. The mailing address is not the same for every product, which is where most delays start.
Pick the Form That Matches Your Policy
Physicians Mutual has six claim forms, one per coverage type. Using the wrong one means starting over.
- Dental Insurance Claim Form (PM1000), administered by Ameritas Life Insurance Corp. on behalf of Physicians Mutual
- Hospitalization / Cancer Insurance Claim Form, for hospital stays or cancer treatment under those policies
- Medicare Supplement Insurance Claim Form, for costs not fully covered by Original Medicare when you hold a Physicians Mutual Medigap policy
- Accident Insurance Claim Form, for injuries from a covered accident
- Life Insurance Claim Form, filed by the beneficiary after the insured’s death
- Long-Term Care claim, submitted through the My Account portal rather than as a printable form
Every printable form lives on the forms page inside the Customer Center. Some can also be completed as online forms after you log into My Account, which sends an email confirmation when the submission is received.
What to Have Ready Before You Start
Regardless of which form you file, pull these together first:
- Your policy or certificate number, printed on your Physicians Mutual ID card. A wrong number delays processing immediately.
- Your date of birth, used alongside the policy number to verify your identity.
- An itemized bill from your provider. A summary or balance-due statement is not enough. The bill needs to break down each service, the date performed, and the charge per line.
- Details of any other coverage you carry, including Medicare or a second insurer, so benefits can be coordinated.
Filling Out the Dental Claim Form
The PM1000 is the form most Physicians Mutual customers fill out, and it has two parts: one for you, one for your dentist. Before you print anything, ask the office whether they file electronically. Dentists can submit through the Emdeon Healthcare EDI Network using Ameritas payer ID CX 068, which replaces the paper form entirely.
Your Section (Part 1)
Fill in the patient’s name, relationship to the insured (self, spouse, or child), sex, and date of birth. If the patient is a dependent in full-time school, add the school name and city. Then enter your own name, date of birth, address, and policy or certificate number exactly as printed on your ID card.
Two authorizations sit at the bottom. Field 9 lets Physicians Mutual and Ameritas gather the medical information needed to process the claim. Field 10 is the assignment of benefits: signing it sends payment directly to your dentist. Leave Field 10 blank if you already paid the dentist and want the reimbursement check sent to you.
Your Dentist’s Section (Part 2)
Hand the form to the office. The dentist completes their name, mailing address, Tax Identification Number, license number, and phone number, along with the date of the first visit in the current treatment series and whether the work was done in an office or hospital. They also indicate whether the treatment stems from an occupational injury, auto accident, or other accident.
Field 26 is the treatment plan: tooth, surfaces, service description, date completed, ADA procedure number, and fee for each line. The dentist should also note whether any services are covered by another dental plan and name that plan. Your dentist’s own standard claim form is acceptable in place of the PM1000 as long as it carries the same information.
Health, Hospitalization, Medicare Supplement, and Life
The hospitalization and cancer insurance claim form is structured like a standard health insurance claim form: a patient section you complete and a physician’s statement your doctor fills out. In your section, enter your name, address, policy number, and the details of your condition or hospital stay. Your doctor confirms the diagnosis, describes treatment, and signs. Field 12 authorizes release of medical records; Field 13 assigns payment to the provider if you want it to go directly to them.
If you hold a Physicians Mutual Medicare Supplement policy, you often do not need to file anything yourself. Medicare pays first and in many cases forwards the claim to Physicians Mutual automatically through a crossover process. When crossover does not happen — usually because the provider is not in Medicare’s electronic crossover system — you file the Medicare Supplement Insurance Claim Form and attach the Medicare Summary Notice showing what Medicare paid and what remains.
For a life insurance claim, the beneficiary downloads the Life Insurance Claim Form and submits it with the insured person’s policy number, a certified copy of the death certificate, and the beneficiary’s own identification. Physicians Mutual states that once all required claim information is received, life insurance claims are processed in 7 to 10 business days.
Where to Send the Form
Mailing addresses differ by product. Check the address printed on your specific form rather than assuming a single claims office.
- Dental claims go to the dental administrator: Ameritas Life Insurance Corp., P.O. Box 82520, Lincoln, NE 68501. Dental claim questions: 1-877-667-6187.
- Pet insurance claims go to Physicians Mutual Insurance Company, P.O. Box 2018, Omaha, NE 68103-2018, or upload the paid invoice through My Account.
- For other products, use the address printed on the claim form itself. The general Physicians Mutual correspondence address is P.O. Box 2316, Omaha, NE 68172-4081, but individual forms may route to a different P.O. Box.
Use a tracked mailing service so you have proof of delivery. For products that accept online submission, uploading through My Account produces an email confirmation faster than postal mail.
One practical note on payment: Physicians Mutual does not offer direct deposit. Approved benefits arrive as a mailed check, so add a few days after approval before the money reaches you.
After You File
Life insurance claims take 7 to 10 business days from the point Physicians Mutual has everything it needs. Dental and health claims do not have a publicly listed processing window, but you can see current status in the My Account portal. If something is missing or a charge is adjusted, Physicians Mutual contacts you, usually by mail, explaining what else is needed or why a service was paid at a different amount. Responding promptly keeps the file moving, and the My Account dashboard is the quickest place to catch a status change.
If Your Claim Is Denied
You have 180 calendar days from the date you receive an adverse determination to file a written grievance. Mail it to:
Quality Control
P.O. Box 82657
Lincoln, NE 68501-2657
You can call 877-897-4328 for help with the grievance process. If you request an in-person review, send supporting documents to the company at least five calendar days before the scheduled meeting. Keep copies of the original claim form, itemized bills, your provider’s notes, and any correspondence from Physicians Mutual explaining the denial. A complete paper trail is what makes an appeal stand up.