Many of my health care providers have stopped offering insurance filing services, so after a doctor visit, I must file the claim with the insurance company myself. I have filed numerous claims for direct member reimbursement and GEHA has refused to pay many of them. This is insurance fraud.
The most recent example is when I filed a claim for a dental visit. I mailed the claim to the address listed on the recently issued ID cards. After a month of not hearing from GEHA, I telephoned. GEHA told me they did not have the claim. After questioning them for several minutes, I determined that they had changed the address where claims are mailed to, without notifying me or anyone else.
My HPPA confidential information contained in the claim was not returned to me, was not forwarded to the new address, and I have no idea where my personal identifying information is.
I resubmitted the claim, waited a week, and called to determine the status. They said it was pending. A week later I called and was told they had never heard of the claim. I next e-mailed the claim to the address they gave me. A few days later I received an e-mail stating the claim was received. A week later, I called to determine the status. I was told the check was in the mail. I called again today and now they state they have never heard of the claim.
Additionally, I have claims pending from 8 months ago that they have refused to even acknowledge receiving. Then they play the game of sending my doctor a letter requesting information that has already been submitted to them.
They delay, then lie, then delay some more. This company should not be allowed to sell insurance and should be prosecuted for fraud, as they do not pay valid claims.
Beware GEHA today! My 2015 experience shows there have been serious bad changes in claims processing, both in time and substance. I filed a claim in April 2015 following a periodic physical exam by my internist. I had been filing claims for this exam for many years and GEHA had always processed them promptly, honoring all the coded items in the claims. My April 2015 claim had only a small number of items added from the last such exam. GEHA lost the April filing, requiring me to refile in June. Then GEHA asked for a copy of my doctor's chart notes and the lab test results, something GEHA had never done before. I sent those items to GEHA in August. I heard nothing for four months during which time I made multiple telephone inquiries. Finally in December I threatened to file a complaint with OPM, whereupon GEHA processed the claim. In that processing they disallowed over two-thirds of the claim, stating that my doctor was testing for things that didn't need to be tested, including a 24 hr blood pressure monitor after the doctor got high systolic numbers during the office exam. The 24 hr readings showed that I didn't need to go on blood pressure meds, but evidently GEHA would rather put me on those meds than pay for the 24 hr test. They also disallowed the $30 occult stool blood test after my gastroenterologist had told me it was a wise test. ALL THIS HORROR WAS DESPITE GEHA BEING MY SECONDARY INSURER. My 2015 experience, so radically different from prior years, shows that GEHA is now nit-picking periodic physical exam claims and disallowing major portions of them, while holding up the processing for many months, in their role of secondary insurer. In my phone calls I was told about their large "backlog" of claims. If this happens to me with GEHA as secondary insurer, what must their primary clients be about to endure?
Geha Health Plan Reviews
Many of my health care providers have stopped offering insurance filing services, so after a doctor visit, I must file the claim with the insurance company myself. I have filed numerous claims for direct member reimbursement and GEHA has refused to pay many of them. This is insurance fraud.
The most recent example is when I filed a claim for a dental visit. I mailed the claim to the address listed on the recently issued ID cards. After a month of not hearing from GEHA, I telephoned. GEHA told me they did not have the claim. After questioning them for several minutes, I determined that they had changed the address where claims are mailed to, without notifying me or anyone else.
My HPPA confidential information contained in the claim was not returned to me, was not forwarded to the new address, and I have no idea where my personal identifying information is.
I resubmitted the claim, waited a week, and called to determine the status. They said it was pending. A week later I called and was told they had never heard of the claim. I next e-mailed the claim to the address they gave me. A few days later I received an e-mail stating the claim was received. A week later, I called to determine the status. I was told the check was in the mail. I called again today and now they state they have never heard of the claim.
Additionally, I have claims pending from 8 months ago that they have refused to even acknowledge receiving. Then they play the game of sending my doctor a letter requesting information that has already been submitted to them.
They delay, then lie, then delay some more. This company should not be allowed to sell insurance and should be prosecuted for fraud, as they do not pay valid claims.
Beware GEHA today! My 2015 experience shows there have been serious bad changes in claims processing, both in time and substance. I filed a claim in April 2015 following a periodic physical exam by my internist. I had been filing claims for this exam for many years and GEHA had always processed them promptly, honoring all the coded items in the claims. My April 2015 claim had only a small number of items added from the last such exam. GEHA lost the April filing, requiring me to refile in June. Then GEHA asked for a copy of my doctor's chart notes and the lab test results, something GEHA had never done before. I sent those items to GEHA in August. I heard nothing for four months during which time I made multiple telephone inquiries. Finally in December I threatened to file a complaint with OPM, whereupon GEHA processed the claim. In that processing they disallowed over two-thirds of the claim, stating that my doctor was testing for things that didn't need to be tested, including a 24 hr blood pressure monitor after the doctor got high systolic numbers during the office exam. The 24 hr readings showed that I didn't need to go on blood pressure meds, but evidently GEHA would rather put me on those meds than pay for the 24 hr test. They also disallowed the $30 occult stool blood test after my gastroenterologist had told me it was a wise test. ALL THIS HORROR WAS DESPITE GEHA BEING MY SECONDARY INSURER. My 2015 experience, so radically different from prior years, shows that GEHA is now nit-picking periodic physical exam claims and disallowing major portions of them, while holding up the processing for many months, in their role of secondary insurer. In my phone calls I was told about their large "backlog" of claims. If this happens to me with GEHA as secondary insurer, what must their primary clients be about to endure?