GEHA Avis 

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 They won't help to find anyone and their list is out of date.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!!!

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