GEHA Reviews 149

My dental claim started on 10/10/2024; my dentist incorrectly billed. On 10/17/2024 I called GEHA to make sure they didn't pay; they paid; a corrected claim was submitted by my dentist; GEHA incorrectly processed it as a duplicate claim; I called again on 11/8 to no avail; I called again on 11/13/2024 to no avail. I called again on 11/22/2024 and was told the CSR would send the claim back through as an "expedited correction." She didn't. I called on 12/17/2024 and was told there was a backlog of expedited claims and that mine goes to the back of the pile even further back than original claims! Seems there are 2 separate processing teams and the expedited claims aren't really expedited. What lousy management. It's worse than the government! If I had known it was this bad, I would have chosen another insurance company during Open Season.

Do NOT go with this insurance company, especially if you are on daily meds that you need as they do NOT know how to count calendar days (when I say 'they' i'm speaking in reference to their general first line CSR's, Senior Reps, Case Coordinators, and then Supervisors-and plan to spend hours on the phone with all these multiple people to see the day of light. Over 2 days I spoke with several people (Nathan, Kathy, Michelle, Joanne, Alan-all in the depts I stated above...The ones that do see the day of light DO NOT NOTATE the account NOR fix the INCORRECT dates, which will leave you out of medicine for days close to a week. Do to their lax about the situation will put you in a screaming mood and give you high blood pressure (I'll be lucky if i don't end up in the hospital tonight for high blood pressure due to dealing with these incompetent workers. FYI-over the years, this is what you go through anytime there is an error on their side, this is NOT a one time deal....This is the year I will switch to BCBS where there aren't problems with incompetency and the lack of urgency to fix their errors or notate them.

Our family moved overseas to an impoverished country with extremely limited Dental services. There is really no use for Dental insurance. I figured a move was a QLE and waited until just before we moved to request cancellation. (Despite the fact that my dentist office told me that their cash discount for full payment was about the same as GEHA’s copays). I was told I could not cancel outside of open season because we could submit claims ourself in a country with no authorized providers. I now find we should have been allowed to cancel and the time limit has elapsed. We were not aware of this open season until the last minute and connectivity issues here did not allow us internet access to the site in time. Not happy to have already paid 9 months of service we cant use and now be told we have to pay yet another year! Don't let this poor coverage trap you.

Your review of GEHA is FALSE! My husband and I have had GEHA for decades and not ONE COMPLAINT from us about their company

I have had GEHA since 2009 and haven't had any issues. Maybe I'm just lucky...don't know. Not to fond of the outsourcing and the layoffs. Need to also make sure my physicians are still participating.

GEHA and my medical provider have parted ways. I received no word from GEHA that I should be looking a new provider. The provider sent a letter telling me that GEHA will no linger be paying my treatments and they will be out of pocket billed to me. For my wife that is $16,000 per Oncology treatment. Now I am scrambling to find a new doctor in-plan to continue the treatments.

I would rate this 0 stars if I were able to. I have had nothing but problems with this company from day one. I have had to go through about 5 different diabetic shots. First 3 months would be 25.00, then after that jump up to 300 - 600.00 a month. GEHA/CVS wanted to say it was the pharmacy giving me a discount, and the pharmacy was adamant that they hadn't. This happened EVERY TIME. At one point I had to go without my shots all together which pushed my A1C to over 11. I did some research online about Generic GPL-1's, as CVS stated that a generic form is much cheaper. I found Liraglutide. I talked to my Doctor, he prescribed it. They declined. When I called, they said it was a name brand, Victoza. I said no, the VICTOZA WAS NAME BRAND, Liraglutide was the generic form. It was denied. During this time I was on Xultophy, it did AMAZING with my A1C and it dropped from 11 to 7. But guess what?? It again went up to over 300.00 a month. I was then put on Novolin N, I take over 35 units twice and day and my numbers don't go below 220. So I do more research, cause God forbid, CVS try to help someone figure this out. Again, I looked up Liraglutide in the CVS med search for costs and it gave me the cheaper price. WHAT?!?!?!?! So now, I finally got it approved, so taking 30u of Novolin N 2x a day and .06 of Liraglutide once a day and still can hardly stay under 200. Sure is sad, that someone pays HUNDREDS of dollars a month for insurance and can't take what actually helped them (the Xultophy). NOW, lets jump into the mail order B.S. I live in Alaska, we don't have a CVS. So I would have to do mail order for any 90 day supplies. I finally decided to do that with all the insulin I now have to take. About 10 phone calls to them AND MY DOCTOR, (which Im sure my Doctor's office loved) 10 emails and 4 different deliveries, they have their $#!+ together. Not that I would ever do it, but now I truly understand why people commit suicide because of medication/pharmacy issues. This last 2 years has been rediculous!!! DO NOT USE THIS INSURANCE/COMPANY. YOU WILL REGRET IT!!!

Have had this insurance for several years. They have since switched to using UnitedHealthCare which will not be accepted by WellSpan after October 31, 2024. Called their support to find a new Dr. who will take this insurance. ABSOLUTELY NO HELP! They won't help to find anyone and their list is out of date. They just don't care. Always having issues with Explanation of Benefits and payment to medical facilities. Unacceptable so I will move on. Open enrollment right around the corner. Tired of poor customer service.

We will be opting out this year as the service is terrible and the value, if they ever pay, is not worth the payments we male.

I'm pending a reimbursement check since May 2024. Process date of Check #24067910, process date May 13, 2024.
Reasons and dates:
1. 5/21/24 - pending process, not mailed out
2. 6/27/24 - check not mailed out due to backlog.
3. 7/13/24 - check mailed out on 5/13/24, lost in the
mail.
4. 7/31/24 - stop payment issued and new check.
5. 8/08/24 - pending reissuing.
6. 8/22/24 - stop payment and reissuing was done
incorrectly. Was corrected and
resubmitted for payment.
7. 9/09/24 - Per Supervisor, paperwork is pending
process. Due to back log no reissuing
date can be provided.
To anyone reading my compliant might think it's insignificant, but it's the principle of the matter. Monies are taken from my check each month promptly. Quality of service sucks with everyone working from home. It's the wait and see attitude and it's not acceptable. I'm counting the days to Open Seasons.

I like this insurance for the most part but please give us a better gym membership,
We are only offer Fit and Active which only accepts ONE gym for $30 a month

I have a medical need to have my braces re-done due to some damage caused by a permanent retainer. The retainer is causing a recession in the front bottom tooth and could cause me to lose that tooth if not fixed. They received my claim on June 21, 2024, and they have been holding off till yesterday, Sept 3, 2024, to deny it. It has been well documented that I need to have this fixed and they are being horrible. I will be changing my dental ins as soon as the open enrollment window is there. They are so terrible to work with when you call as well. Even my kids orthodontist office said GEHA is horrible to work with.

I have been happy with GEHA dental insurance for several years, but in 2024 that all went out the window. They are denying claims saying there is other primary insurance for my wife but there isn't. My EOB's are not available and they blame a "third party". I think it might be time for a class action suit! I am now going to file a final appeal with OPM because GEHA is so awful.

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!!!