GEHA Anmeldelser 157

I have had both GEHA standard and High option dental for several years. I have never had them deny a claim. Not everything is covered but that is normal for any insurance company. It is true you can't currently get EOBs online but that is due to the Change health care cyber attack and they have a banner on their website saying that. That is all insurance not just GEHA. I do wish they had expanded customer service call hours. Their hours are pretty much when I work.

GEHA and their in network pharmacy, CVS/Caremark, have been requiring pre-authorizations for basic services and prescriptions. They seem to deny everything by default or total neglect of understanding. I subscribed to the high option, wanting to have the best, but GEHA is now the worst.
My doctor prescribed a medication that worked well for me and they denied it. He appealed, saying that the medication was my best option and had worked well previously for me. GEHA denied the authorization again, saying my doctor told them the medication HAD NOT been successful (why would he have prescribed it then?). Now we are dealing with a longer appeal while I risk my health with a cheaper and less successful and less safe option.
My doctor also sent me for an MRI after a previous test showed what looked like a tumor. GEHA denied the preauthorization because they said I needed an MRI of a different body part instead, or possibly just a different code from my doctor. They didn’t have a firm answer for me, but were happy to keep me waiting for weeks to find out if I might be dying while taking hours of my doctor’s time on appeals.
I have also been told to use CVS to get the in-network price for meds, but CVS pharmacies are as common as unicorns where I live, and the only one doesn’t have a drive through. It’s in a superstore. That CVS tends to be out of my more expensive meds even when other local pharmacies have them, which seems like another excellent scam to save GEHA money. Isn’t that a conflict of interest for GEHA? Their own customer service people even seem frustrated with the company.
Like many others, I was also denied dental coverage for adult braces due to TMJ, misalignment, and other issues. My teeth looked straight, so it wasn’t cosmetic. I paid $3,000 out of pocket and GEHA covered $0. That was a few years ago before things got so much worse with coverage of tests and prescriptions.
Also, they are supposed to notify us before preauthorizations expire, but I have never gotten a notice, just had previously covered meds no longer covered within the same plan year.
I can’t wait for open enrollment! OPM should drop them from our available plans.

I have tried to get reimbursed for a claim submitted months ago. First GEHA miscoded and denied it. I have made three long phone calls, made an additional trip to my dentist for documentation, emailed them multiple times, and still the claim is "in process." I can't see any details of the claim and the rep on the phone could not tell me how long it would take to process, just that I had to continue calling back every couple of weeks. THIS IS THE WORST DENTAL INSURANCE I HAVE EVER HAD IN MY LIFE.

GEHA is terrible about paying claims. I’ve now had at least 3 different providers/procedures where GEHA did not pay per the estimated given to the provider ahead of the procedure. This has become a trend. Every office I speak to tells me that they hate dealing with GEHA, because they never want to pay.

Worst customer service and horrible processing of claims.

I wish I had found this site sooner. We're paying for high option dental and nothing...$zero have been reimbursed. Can't even see the EOBs on line. The site has been perpetually down for ages.

DO NOT USE THIS PLAN FOR INSURANCE. THEY DENY EVERYTHING OR PAY A PARTIAL FROM IN NETWORK PROVIDER. I HAVE THEM FOR MEDICAL AND DENTAL. I CALLED 2X BEFORE SIGNING UP FOR THE DENTAL BECAUSE I NEED BRACES, THEY TOLD ME, OH YES, WE COVER ADULT BRACES AND IT DOESN'T NEED TO BE MEDICALLY NECESSARY. THEY HAVE YET TO PAY A DIME TO MY IN-NETWORK DENTIST. PLEASE, PLEASE DON'T USE THIS COMPANY!!!

I'm going to shop around during new enrollment. There are no quest labs in Hudson County! Today my Quest experience at Trinitas Hosp in Elizabeth NJ, was not stellar. I wasn't able refill my medication and the reason had something to do with being over 21yrs of age. The issue still is not resolved. When I worked at the county and had Horizon I had NO ISSUES! Dental, ugh, another issue. Anything outside of a regular cleaning and xray you are on the hook for and I chose I higher option. Many of my visits with the dermatologist are not covered so even though I have my FSA I cannot use it. Another medication I needed my doctor had to do an appeal because they denied me immediately without looking at my medical history.
I say that because my Dr. Filed an appeal and had to send it 2x because they claim they didn't get it the 1st time and I was approved. Also, they do not provide a debit card for FSA. You pay and submit receipts for reimbursement. So, yes they monitor how your money is spent! I did not experience this working for the county and yes I received a debit card to pay for my otc, copays, and rx.

GEHA's Unacceptable Customer Service is Delaying My Critical Surgery

I am utterly appalled by the abysmal customer service I have experienced with GEHA. For over 6 hours today, I've been tirelessly attempting to resolve a simple issue: obtaining a copy of an OPM appeals decision granting me a necessary surgery. GEHA claims they sent this letter in April, but neither my surgeon nor I received it.

This inexcusable delay has now left me with only two months to schedule and undergo this surgery before the approval expires. GEHA's inaction is not only frustrating but also jeopardizes my health and well-being.

Despite my numerous attempts to escalate the issue, I am repeatedly routed back to the general customer service line, forced to explain my situation over and over again with no resolution in sight. Even after being briefly connected to a supposed leader named Kathy, I have yet to receive a promised call back.

As a GEHA member, I expect a much higher standard of customer care, especially in matters as critical as this. GEHA's negligence and blatant disregard for my urgent medical needs are simply unacceptable. I strongly advise others to reconsider entrusting their health insurance needs to a company with such a callous approach to customer service.

Beware! Dental is a scam. I paid the high option for two years and had some dental work. But now will only pay less than 1/3. Though the claim submitted in late Jan, they claimed it was never received; so I sent it again on March. Now, they say that the check was mailed over a month ago, but ‘the check is on the mail,’ that never came. First mail lost ever.
Other insurance companies do direct deposit but not them. I think OPM should have a hard look into GEHA. They should be dropped as insurers.

Worse Dental especially for Invisalign. This is still an ongoing issue. I have been receiving rendered service regarding invisalign. The provider is in network and have submitted claims multiple time. One claim has been received since 05/28/2024 yet it's still in process. When I questioned how long will it take to process because I am paying out of pocket right, I was told basically told it will get process in due time. They are slow and you cannot access your EOBs! As a Federal Employee I will definitely be changing because this is not it. Even prior I asked if a pre Auth is needed and was told no!. Their policy claim to cover 70% with $3500 lifetime maximum. Since February and they cannot respond to the provider with their coverage amount.

I will not be renewing next open enrollment. I was on a medication for my diabetes for a year. My A1C had never been lower and I lost 60 pounds. Put in for a refill and pharmacy said insurance won't cover. I called the insurance company and they said I need to try 5 other medicines first before they consider approving the meds. I tried one and it really didn't work well. I tried it for about 5 months. My doctor prescribed another one. I was on it for three months before they stopped approving it saying it needs pre authorization and statement from my doctor. I've been off of meds for 2 months while my doctor has been fighting for me. Geha is wrong. Doctor sent stuff over and they keep saying they never receive anything. Now I have gained 40 pounds back in the last year and my A1C is up. Wouldn't they want me to be on the best medicine that works for me?

GEHA is terrible. All of my claims that I verified on the website in network went to out of network deductible. Additionally, some expenses I paid to in network deductible reflected for about a week before they were removed again. My prescription was denied because they would rather have me use older and cheaper medicine rather than more advanced treatment. What’s the point of paying for insurance if they don’t process your claims properly and cover you for newer safer treatment recommended by your doctor. I’ve have to delay seeking care for another month because of GEHA to find a company who can actually help me. GEHA is awful.

I went on o a GEHA approved lab for covered standard lab tests 02/22/24. GEHA processes the claim with $0 to the provider, saying services were not covered (They are!). On 07/02/22 I had an emergency room claim that by contract should have been covered. GEHA put that claim in an “In Process” status and NEVER PAID! I was stuck with a $15,000 bill from the hospital. GEHA must be sued and not allowed to do business for breach of contract

I have been unable to get a dental claim processed for over 100 days. It’s ridiculous. There is no access to EOB’s. Do not use this company for dental. They used to process claims, but not anymore. It’s horrible.

For almost two months now, GEHA has not been able to provide EOBs. They keep showing this error on their website: "GEHA members may be unable to access certain self-service documents, including EOBs, due to an ongoing service outage at one of our vendors. GEHA Customer Care team members are also unable to view EOBs at this time. We are monitoring the situation with our vendor, and we appreciate your patience. We will update this message as more information becomes available." What a joke.

A significantly reduced and new staff lacks appropriate knowledge and training before being placed on customer service calls to its members. Then comes the lack of access to records. It's been over 90 days, and they still haven't fixed the issue of where you can access all your claims. GEHA used to be good, but leadership decisions have degraded this once-fine company. Even their website is stripped of what it once was. Disappointed member of 19 years - moving to another provider this coming open season.

With the recent open season, I moved from Aetna Dental to GEHA Dental, as I wanted to try something different. My main objection with Aetna was they still used the antiquated payment method of paper checks vs electronic payment. This I found odd, as the Aetna medical (processed claims for FSBP) did do electronic payments.

Unlike GEHA, Aetna at least processed claims and offered customer service.

GEHA has had a message on its website for over a month that states "GEHA members may be unable to access certain self-service documents, including EOBs, due to an ongoing service outage at one of our vendors. GEHA Customer Care team members are also unable to view EOBs at this time. We are monitoring the situation with our vendor, and we appreciate your patience. We will update this message as more information becomes available."

I have had a dental claim that has not be processed for over a month.

I have written to GEHA three times (2x via the web form, 1x via email address) and still no response after over 2 weeks from my initial contact.

I would give GEHA zero stars, if it were an option, and I am so thankful I did not also switch my medical plan to GEHA.

Go elsewhere next open season!
Very expensive mistake.
If I could get out of this mess, I would. 4 premium payments and no service of any kind. You stuck for a year. Good luck with an appeal which they have a form.
Sad part is they take your premiums and have no obligations to actually provide paid service. They have 3 venders who are sub-contractors that actually pay your dental charges. So, you are just getting another layer of management to complicate the whole process. Go direct for your insurance and most dentists have their own. I always wondered why my dentist was slow to show GEHA payments all these years. Now I know.

Very dissatisfied. I enrolled in the Federal High Dental knowing my kid would eventually need braces. When I eventually put in my claim for $4,926.87 they cover a mere $1306 and when I asked how in the world they came to that number they sent me this from deep in the fine print:
On the initial claims processing, we processed the total billed charges as 3,950 Great Britian
Pound (GBP) with a conversion band date of May 18, 2023. Charges were based on the
total case fee of $4,926.87 U.S. dollars with a maximum allowed amount of $273.71 divided
by nine months of treatment. We paid 70% of the Connection Dental negotiated amount,
$163.33 monthly and applied 30% of the contracted fee schedule towards your monthly
coinsurance amount of $ 70.00. The monthly disallow amount of $40.38 is the difference
between the billed charges and the Plan allowance and is applied towards the patient
liability since in-network providers do not extend outside of the United States. Your total
patient liability amount includes a coinsurance amount of $630.00 plus the disallow amount
of $363.42, which equals to $993.42.