GEHA Avis 146

Have had geha for 15 years and have had very few problems. Today i had a problem with my Doctors billing service and representative Gina from geha talked to the billing service for me and did an outstanding job correcting this problem. She is the best representative from Geha i ever talked with. 👍👍👍👍 Thanks Gina at elevate plan.

The insurance company support the con artist rip off activities of providers with no recourse for members. Select GEHA if you enjoy wasting your money, time and resources. Pitiful. Unhelpful and low quality providers.

That should be ZERO stars because they aren’t much helpful to find PCP doctors. Never updated on lists of doctor. I m planning to go back to BCBS. Nothing honestly for those GEHA employees doing their jobs. Very disappointing.

If I could give them a negative score vs. 1 star I would.. Never and I repeat Never take their word that they will reimburse you on a claim when you have to pay an establishment up front for rental of medical equipment. I had to pay $150 out of pocket for a turning knee walker. Given the run around about missing codes and comments on how do we know you didn't get this for a family member : /
How about the surgery you paid for me to have!!! Every time you call another rep says something different and they claim no notes are there from previous calls.

Straight trash dental
Insurance!! Avoid! Too late for me unfortunately

Terrible! I dropped them after a year. We paid for the highest plan and they found a way to deny a claim that should have been paid ( two different dental offices agreed) . Unless your teeth are absolutely rotting they will not approve a claim. They treat Veterans poorly . Don't use them ! Switched back to BCBS dental. They always pay as expected. NOW I find they have an F with the BBB! No surprise.

If I could choose negative 3 stars.
I have GEHA in which Invisalign or braces could be covered in adults if needed for other reasons than cosmetic. I had Invisalign done due to bite alignment causing issues such as jaw clenching which actually led to crowning issues. They are refusing to pay. In process of fighting it still.
As a federal employee, I have other options and will certainly be changing my insurance when open season arrives again.

As I understand, the idea behind Trustpilot is for me to describe MY experience so you, the reader, can form your own opinion.

I pay for HIGH option dental insurance through GEHA.

In January 2023, I had to have two teeth extracted; they were located UNDER a fixed bridge. One of the two teeth requiring extraction was the ANCHOR for the bridge. In order to extract the two bad teeth, the dentist had to either send me for expensive, messy and dangerous dental surgery to remove the teeth through my gums OR remove the fixed bridge.

In order to preserve at least the crowned tooth that is the other anchor of the bridge, the dentist spent a lot of time and exertion CUTTING the bridge at that crown. This prevented injury to the anchor tooth! This procedure was done at the same time and as part of the extraction procedure. BTW, doing this saved GEHA the cost of another crown IF the tooth even survived complete bridge removal.

This procedure is called "Partial Denture Sectioning" and is covered by Dental insurance code D9120.

My dentist billed GEHA $250 for THIS sectioning as part of the overall bill for the extraction work. GEHA DENIED payment for this procedure with NO EXPLANATION.

I filed an appeal using their process and following all their arcane rules. In addition to reconsideration of payment, I requested an EXPLANATION for non-coverage.

I received a second denial for payment. The letter offers the following "explanation":

"Fixed partial denture sectioning is not a covered procedure under your plan."

IN SHORT, it is not on our list. I called and requested a reasonable explanation of WHY D9120 is NOT on the list. The very kind person who answered my call did NOT know, NOR does she know WHO in GEHA makes these determinations. They are completely insulated from the public who buy their insurance.

Readers of this should know that there are probably tens of thousands of insurance codes for Dental procedures. I very much doubt that ANYONE in GEHA has ever noticed D9120, let alone made an intelligent, rational, decision to exclude it, per se.

There is NO rational medical/dental reason that I can even IMAGINE for denying coverage when this procedure is NECESSARY as part of another, covered, procedure. Although I am not an attorney, I KNOW that this type of decision is deemed to be "arbitrary and capricious."

Since I’ve had NO experience with any other dental insurance companies in many, many years, I cannot say that GEHA is any better or any worse. What I can say is that ALL insurance companies are wonderful UNTIL the customer files a claim.

THIS is one reason why insurance companies are universally hated!

Followup - On September 6, 2023 - after marinating for a while, I received the EXPECTED response to my request for an "independent third party review" of the denied claim for the D9120 procedure.

The letter advises that the "independent third party" upholds the denial (HUGE SURPRISE). The reason given is identical to the IDIOT response first provided. D9120 is not covered because it is not covered.

That nicely seals the package. I am now seeking another dental insurer and I WILL be reading reviews and asking questions before I sign!

NOTE: The ALLEGED "Independent Third Party" is NEVER identified. Personally, I very much doubt their existence! I just learned that it is a DENIAL RUBBER STAMP company known as P&R Dental Strategies.

UPDATE - 11/3/2023
UNBELIEVABLE! These &*%^$% will not pay for a $250 NECESSARY Dental procedure, D9120, but they are giving away the following for a Baltimore Ravens football game:

Two (2) game tickets
Two (2) Backyard Bash passes
Exclusive pregame tunnel experience
One (1) complimentary parking pass ($45 value)
Two (2) Ravens gift bags

I am OUTRAGED but I am STUCK with this company!

GEHA has denied every claim I have made. This is terrible insurance. They make you jump through all kind of appeal hoops and still deny claims in the face of incontrovertible evidence, including X-rays and dental professional opinions. It is not worth the premiums paid.

DO NOT CHOOSE GEHA DENTAL

I forgot to read BBB reviews which note the same systemic issues we are experiencing before we chose this policy. Appears discriminatory towards customers who choose out of network providers. Appears to ignore correct resubmitted documentation.

Incorrect, missing and misleading answers from phone support. EOB and pre-determinations documentation provided by GEHA is worse than our 3 prior dental insurance companies.
Flat out denials which lack even minimal explanations. I’m sure if federal employees were not in this network the company would be out of business. A disgrace to claim to support federal employees. Two months of this Dental insurance and I’m counting down till I can choose differently in November of 2023.
I cannot believe OPM, government funded, provides and promotes any product from this company.

Edited 6/15/2023

Received check in mail this date for reimbursement of Invisalign which was denied 3 times and had gone thru all appeals which was declined Called and was told they re-evaluated claim and determined to pay for claim. Not sure why they retracted, but will change from 1 star to 2 stars. Although I am still a bit bitter for the hassle and strife they put me thru. Perhaps if they gave me interest it could have been 3 star.

Original post.
Claims for Invisalign not paid although it was supposed to be covered for malocclusion. Had problems with clenching of jaw daily night and day due to malocclusion. Lost a crown due to pressure. Went thru a year of Invisalign and no longer having problem. Yet they refuse to pay their share. They have not covered retainers either. I fought the issue with them and no longer can refute the issue with them. I pay for the higher price monthly for the better plan, I did not do it for cosmetic issue, it was all functional reasons. I will be changing companies unless they see the light!
Also may I add that I even attempted to get a pre auth but they told my dental provider it wasn’t needed, and to just submit claim.

I have been trying for months to join a GEHA approved fitness center. There is a Y in my area and I was
told before picking GEHA that it would be in the plan. Now no one can tell me how to get the benefit. I have bee calling 10-15 times, told twice I would get a call back from a manager, never have I received the call. I have already lost out on 3 months of the GEHA payment for a fitness center, I am paying it myself. The fitness centers should not be mentioned as a benefit because it is impossible to get signed up.

Customer Service rep was awful, she refused to tell me about plans during open enrollment except for one I'm already enrolled in. THAT'S WHY I'M CALLING! TO SWITCH.

The insurance company abdicated medication decisions to CVS who profits from them. Constantly tell you that your doctor needs to change your prescription to something else. Because they know better than an actual doctor who had actually seen me. Constantly denying claims. Require reauthorization of medication every 6 months including resenting the exact same forms with the exact same info. Patient in pain, who cares let them suffer through the 30 day appeal process to them be denied.

Mixed feelings, their criteria for reviewing claims is inconsistent and can take forever for them to process one (I am overseas).

Idea: They should have a portal to submit the claims directly that alouds you to track your claims by number, with timeline of the process and a more friendly interface in case you need to dispute.

If you are overseas: it doesn't cover the yearly preventive tests for women: like a mammography or worst if you don't have a uterus, in which case you need an ultrasound, they just don't cover it... they just cover the pap smear.
I even call to ask why? since it is a yearly preventive test, they should encourage any test, but they just disagree.
I had a 75$ MasterCard reward card for being a good healthy gurl, it was denied at the CVS Pharmacy when trying to pay for a prescription, so again... I don't understand them. My advice... think it twice.