Geha Health Plan

I agree with many of the reviewers here. GEHA is the WORST insurance I have ever had. I am a Fed employee and chose it knowing it was higher priced that the other dental policies, but thinking that I would have better coverage. They refuse to reimburse for covered services, putting you through a review process that is a joke. The dentists that THEY hire/​pay review your appeal so of course, they refuse to pay. I am shocked that a company that so clearly attempts to abuse their customers is still in business. You have been warned.

Let me start out by saying I am not surprised to see the low ratings of this health insurance company. I have had GEHA since I was married 26 years ago, and a year ago, I would’ve given them at least four stars. But last year, I developed a back injury which caused numbness, weakness, and functional deficiencies in my leg. I had trouble walking and climbing stairs. My neurosurgeon ordered physical therapy, as surgery is always the last resort. GEHA from the get-​go would not approve all of the sessions prescribed. They literally spoon-​fed me PT visits which hampered and delayed my progress. Then, when I had had a certain number of visits, they cut me off against my doctor’s recommendations, claiming that the therapy was not medically necessary. At the time, I was still experiencing weakness in the leg and difficulty climbing stairs. My complaints fell on deaf ears, and my appeals did not produce a satisfactory resolution of the issue. I have spoken to BCBS patients who, for just a bit of back pain, have had 12 visits of PT approved right away. GEHA has shown me that they are all about the money, not about the care.

I have had GEHA dental for a few years now.
I can not wait to get away from them! I gave them the benefit of the doubt and thought I could stay on with them and they would fix claims and adjust accordingly. No such luck!
I signed up for High Dental option thinking it would cover most of my children’s dental care needs.
They find any reason they can to not pay claims and even go as far as to pay a bit then ask the provider for a refund! Basic care claims are hardly paid or are denied. Why pay so much for dental insurance if I am going to end up paying out of pocket more than half the claims?!!
they automatically assume they are my secondary insurance and pay according to their own in network providers because our federal BC/​BS HEALTH insurance is billed first since they are «sister» companies.
Stay clear of GEHA if you can… its ridiculous!

We have had this insurance for just 2 years, but this year we had major claims. There were some challenges but with some phone calls, they seem to be paying as the plan brochure says they will. The customer service is very friendly and helpful, they do return calls when I leave a message. I had BC/​BS before this, but this company pays the same things with the same maximum out of pocket cost for $ 2400 per year less in premiums. Why pay more for the same coverage?

Don’t get this insurance — RIP OFF!!! They don’t pay crap — my daughter had surgery and because the deductible was not paid — this goes to the full deductible amount — no help at all! Their customer support sucks too! Those people don’t know crap either — can’t wait to get away from GEHA — RIP OFFS!!!

As a Federal Employee, I switched to BCBS Basic. Great insurance.
Paid $ 175 for my wife’s entire pregnancy and billing is now a breeze. No one ever declines to see me, in fact, they love my insurance.
It feels like I can anywhere. I’ve even gone to the San Diego Chargers head Orthopedic Doctor (Tal David), and only cost me $ 40 co-​payment.
So glad I made the change. If you’re a FED, and had the option of going with BCBS or GEHA… its a no-​brainer, go with BCBS.
I even recommend Killer Kaiser HMO over GEHA.

Customer service is extremely rude, ignorant, and ghetto. I simply called to see why my routine physical wasn’t being covered in a calm and polite manner. The girl that answered my call was defensive, kept interrupting me and wouldn’t let me talk as she was talking over me repeatedly! I have never in my life experienced such horrible customer service! The girl was acting of a character on a Maury pooch show or something. Ghetto and defensive. Wow. Good luck trying to get them to cover anything, even a simple routine physical!!!

Back in 2004 I got Geha for health. It was horrible. They paid almost nothing and there was always some «reason» that wasn’t made very clear. I went to BC/​BS and they are great. Now I got their GEHA dental plan. Before picking it, I did the research. I called and asked what would be paid out of network. I looked at what they said they paid out. 80% for routine procedures including fillings. I would prefer to read stereo instructions than this but I did it. I was assured the pay out would be 80% and I was also assured that they would pay basically the same in or out of network but they did tell me it might be more out of network. So, my very first, trip to the dentist I got 1 filling. A composite filling. They paid about 45%. Now, what kind of a dental insurance only pays 45% of the cost of a filling? Later I went to an in network dentist. That dentist is signed up on their site as «Richard Smith» but his tax id is Smith dental. They would not pay the bill. When I called them they told me they wouldn’t accept it unless it said Richard Smith… but that is impossible because of the way things are billed. Do you get it? They will do anything and everything to close their eyes and pretend you aren’t covered. I sent my lovely dentists billing employees to them to attempt to figure out if I would be covered for a procedure. Despite a day of working at it… everyone told them different stories and they couldn’t even determine if doctors were IN the network or NOT in network.
I signed up for another plan and I am writing to the work group that selects health insurers. I am also considering reporting them for health care fraud. I shouldn’t have to fight this hard to get the benefits I am owed.

The worst insurance company I’ve ever dealt with in my life. Getting claims through is worse than a root canal itself. Customer service reps are terrible and provide little useful info. Had one get an attitude with me saying the dentist didn’t send required xrays (even though my dentist did multiple times, but GEHA didn’t file them with the correct claim). Be prepared for numerous phone calls and horrible customer service every time you have a claim. This company is just plain pathetic.

This is additional data to a prior review after receiving the specific numbers in GEHA’s handling of my claim for a periodic physical examination. It was an ordinary every two years physical exam for a 79 y.o. male by a highly-​respected internist who had been tracking my health for many years. The exam included a range of tests appropriate to my age, background, and current health status. GEHA disallowed 70.25 percent of the claim, including disallowing many tests that GEHA had allowed two years prior. The message is loud and clear: forget other than minimal token benefit for ordinary periodic physical exams.

I’ve had GEHA w/​GEHA Connection Dental Federal for the last couple of years. Even though the coverage claims implant coverage and my provide checked with them before performing the procedure, now they claim the will pay the «lowest cost alternative benefit» which is only a fraction of the 50% stated in the policy for implants. My appeal included letters of support from the oral surgeon and statements from numerous dental academies other professional dental organizations stating implants are the best practice. They provide no evidence of good practice for their decision, so obviously they base it on what’s cheapest for them; not for coverage paid for.

I’ve been with GEHA for several years and it has been good. There are some hiccups occasionally which can be bothersome, but I’ve been able to work through them. I suppose all insurance is going through change under Obamacare/​ACA — turbulent times. I’ve had more problems in the past 12 months. However, it seems hard to pick a better insurance company as their reviews are pretty iffy also. They have been tight approving physical therapy appointments, but I’ve gotten the appointments that I needed. Doctors where I live are not familiar with GEHA but tend to accept it. Scheduling an MRI in early 2015 was delayed by GEHA’s MRI intermediary which I didn’t like. But a second MRI later in 2015 was not delayed and I did not have to use their intermediary. Not perfection but not awful either. And it’s cheaper than many other plans.

GEHA is great. I’ve had geha since 1979 continuously. Almost never had any problem myself with Geha itself. Their mail order pharmacy CVS Caremark is another story, had some problems there. It’s a huge bureaucracy though and sometimes you have to be creative in getting through to the right people to get a problem solved. And you’d better be aware of and understand your benefits ahead of when you need that information, because when you are sick or injured it’s the wrong time to be trying to read the brochure.

If you are a healthy person this may be ok insurance. However, because my husband is having prostate cancer issues I am looking at the 15% copay of maybe $ 15,000 for his treatment plan.
I regret not sticking with BCBS/​Basic which in the past was great. I was trying to save money with the cheaper premium. I rolled the dice and lost. At least there is a $ 6,000 out of pocket cap. The trouble is that GEHA gets to decide what’s included in the cap and the deductible.
They give you the Quest card and Quest lab stickers but you feel kind of foolish bringing those into the office to stick on the docs requested labwork. However, we have made good use of the Quest lab.
They also denied a $ 2500 pet scan that my husband needed to stage his prostate cancer. This scan was covered before by BCBS but GEHA is saying it’s experimental. Now I have to go through the cumbersome process of appealing when I am busy with caregiving.
After reading the other reviews here, I am also not looking forward to using the specialty drug program administered through CVS.
Learn from my mistake, you get what you pay for.

This is the worst health insurance I have ever had in my life. The rate is low but what is the good of that if you can not even use it. I called the doctors on their GAHA website which they claim to be in the network, every single doctor office say they do not accept that plan. WTH? Oh, and they do not update the doctors’ information on their websites either. You may call the number and they say that doctor has moved to another city. I regret for switching to this plan, AND I only go to the doctor ONCE a year for check up. This is a sh*** insurance.

Am fairly healthy and have had no problem with GEHA for a couple in-​network doctor visits for minor illnesses. Have had GEHA for most of my 7 years in federal service.
Main cost thing to remember for someone like me is doctor should prescribe generic meds instead of brand name. I haven’t really had to check on that because usually the doctors do prescribe generic.
As for deductibles and copays, they are explained in the brochure, which follows the same format as every FEHB plan. I got a chest X-​ray one time which I had to fully pay for since the annual deductible was not paid yet, but that’s fine, I knew that from the brochure.
GEHA now goes with CVS/​Caremark for their pharmacy, which is different from prior years mentioned in prior reviews.

I’ve been with GEHA since the 80’s when the biweekly premium was less than $ 10.00. I have re switch them over the years because of the great coverage and customer service.
Unfortunately over the last two years I have seen a change in coverage and customer service, and it’s not to the benefit of the subscribers.
This year they have drastically change the RX program where generic meds are covered and a few brands are covered. However, my HBP med Diovan HCT is no longer approved but Benicar HCT is approved even though it causes gastric problems and is being sued. Research this on the web and how patients suffered because doctors were unable to detect the problem or the root of in a timely manner.
I am considering changing to BCBS, which is slightly higher than GEHA but probably worthy is I can get the meds to treat my medical conditions.

I should have Unilocaled this crappy insurance but now I’m stuck. I pay extra for this and they deny MOST of my claims. What’s the point of health insurance if it doesn’t help cover health care bills?

We switched from bcbs federal ppo and regret doing it. They continue to deny claims. We use the lab card and get services through quest and continue to be charged a few dollars for miscellaneous.
For the maternity coverage, they are paying only 100 percent of the office visits, but not the ultrasound. Yet, their plan info claims 100 percent coverage for maternity. Their eobs say maternity.
Had an accidental emergency claim not paid at 100 percent.
They are quick to blame the providers and very rude cust service. Hoping OPM drops them. I know they will not.

I went online to verify that the doctor I wanted to see was on their plan. The person at the doctor’s office said the doctor was under GEHA. Then when I got a bill, the billing person said the doctor wasn’t under GEHA. I called GEHA, spoke to a supervisor, and GEHA told me that the office and the doctor were GEHA providers.
Then I had an MRI at the office. I get an estimate that shows no payment from GEHA. GEHA then tells me that the MRI machine in that office is not covered – that’s a separate application.
I go get the MRI somewhere else and go back to the doctor’s office. I makes sure I only speak to the billing person and the doctor.
I get doctor bills later sans any payment from GEHA. I find out that the doctor, the doctor’s office, nor the machine are covered in any way. The GEHA website is wrong, the person I spoke to at GEHA is wrong. And I am expected to pay. It turns out that the doctor’s office stopped doing business with some intermediate company which made the doctor’s office no longer a GEHA provider —-but GEHA has no responsibility to keep ITS OWN RECORDS updated. NONE
I complained inside and outside of GEHA until I got tired. (Didn’t take long)
Don’t use them ever.
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You cannot get them to cover your prescriptions at your local drug store. You have to wait for mail order. Good luck if you have the flu or something that can’t wait a few days or five.
And when they say they’ll «expedite the medication for you» they mean the company in Florida will charge you $ 32 to FEDEX the medication —-even if the doctor’s office has THE MEDICATION ON HAND IN THEIR OFFICE
Do not use them. Ever.
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That was 1.5 years ago. I kept the dental plan– mistake
Yesterday I found out that DESPITE the fact that their plan says they pay 50% on all the work I had done on implants if I use a preferred provider, they don’t have to EVER PAY FOR IMPLANTS if they don’t want to.
GEHA can just decide they want you to do something else— like get dentures.
That’s false advertising any way you slice it. I am in the process of complaining now.
Do not use them ever.