GEHAReviews of geha.com

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.