GEHA Reviews 149

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.

I cannot express my massive hatred towards GEHA. When I contacted GEHA about my claim that was sent out SIX WEEKS AGO, they stated "we do not see anything about your claim". Actual BS. My orthodontist gave us proof they sent out the claim. Why should I wait any longer for a simple response? Why can't anyone here do their job properly? On your website, it states "give us 30 business days to respond to your claim". LIES. ALL LIES. IT HAS BEEN WAY OVER 30 DAYS!!!!!

I can NOT wait another minute. Every time I check the mail, having some faith GEHA will pull through, nothing. This insurance disappoints me. They do not deserve any of their customers. Honestly, I do not understand why they have customers in the first place.

I do not understand why it takes so long to give a simple response. This company is worth $1.9 BILLION dollars. They earn so much money, yet gives bad customer service. Yes, I understand they have many claims they need to solve, but why should it take so long? I can do a better job than some of these employees.

Furthermore, it's baffling that a company worth $1.9 billion can't manage to provide customer service. With such immense financial resources, one would expect GEHA to invest in efficient claim processing and responsive customer support. Instead, they seem to leave their customers hanging for weeks on end, with no regard for the inconvenience and stress caused by their incompetence. They billion dollar companies only care about themselves, especially the higher-ups.

Moreover, the lack of transparency is alarming. How can they claim to have not received a pre-authorization that my orthodontist has proof of sending? It's either a blatant lie or an indication of their disorganization. Either way, it's completely unacceptable.

I might just need to escalate the issue to the higher-ups at GEHA or seek legal experts, because I believe this is not right. It's unfortunate it has come to this, but I need to make sure my rights are respected and that someone is held responsible for what's happening.

I truly despise GEHA. They deserve absolutely nothing. Insurance is supposed to provide peace of mind, but with GEHA, it's nothing but a source of frustration and anger. The whole system feels like a scam – paying extreme premiums each month for coverage that may never come through when needed.

Just thinking about this awful insurance company makes me upset. Only if I could give them a negative star review, I would. GEHA needs to step up and take responsibility for their failures. They owe their customers better service and accountability. Until then, my disdain for this company will only continue to grow.

The worst--overseas customer--they provide no support lose claims, dont have a standard process to submit claims, and reject things that are covered services. Thier employees all have different answers to the same question or no answers at all and never have accurate timelines on benefit approval. Claims paid out via check 10 weeks after submission, at about 20% of service cost, due to a variety of deductions that are not codified in claim letter. This appears to be a scam and will change next open season. Pretty shocked they are still a federal employee plan provider...

They were disappointing to have as a health insurance provider. It was clear they are not interested in providing good service for their customers or the medical service providers. There are multiple different routing addresses for claims, and often the claim would default to the wrong address. GEHA would send a letter to the medical service provider to resubmit to the correct address rather than rerouting it to the proper department internally. I found them difficult to work with and the medical coverage was minimal. Claims took significantly longer the complete, so we would often be left paying the higher rate and then reimbursed after the claim finally was sent to the MSP. It is also frustrating that they are not the health insurance provider, but an intermediary for a different Health Insurance company that would change on an annual basis. Why not go directly with the Health Insurance company instead of working through an additional layer of management. In all, I was disappointed in GEHA and could not get a new insurance fast enough

We have Geha high option. I broke two teeth. One required a root canal. Both needed crowns. Geha dental refused to pay any toward either required work. Never did I expected they would pay $0. I called and they would not review. This is worthless dental insurance.

My GEHA STANDARD is secondary to aarp UHC advantage plan. The biggest gripe is the GEHA ID CARD does not have the proper group and bin number for secondary payer; consequently, it is a nightmare every time I go to Walgreens pharmacy. They do not run the secondary (GEHA) so there is always a high cost. I have to have them re-run the insurances through again. I had to choose a date when these events took place for this review; however, it happens each time I go to the pharmacy.
Also, the rewards do not apply to me. This is really discrimination. For instance, my doctor advised me to get a Mammogram. She suggested as a woman ages, her chances of breast cancer increases. But it appears I am too old to be rewarded for having a mammogram.

True rating is ZERO. Will drop them asap.

We are extremely dissatisfied with GEHA Dental. We signed up for this plan thru Benefeds three yours ago. So far, we had four minor claims. Out of the four, GEHA managed to lose three claims, requiring extensive follow-up on our part. Our latest claim was submitted in October 2023 and GEHA has yet to pay or process the claim. When you write or call them to ask for the status, you never get details… just canned responses. I’ve asked for a management call-back each time, but never received a response. This will be our final year with this insurance company… worst experience ever!