ComplaintsforGEHA

• Initial Complaint

  12/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  In January 2023, GEHA took back all money paid to my childrens providers because of the "birthday rule" that was unbeknownst to me (and probably 99% of other people). There is no big, bold messages telling people this stupid rule, so how would we know this was a thing? In fact, I was told this rule in 3 different ways, so not even customer care agents know how to explain it correctly 100% of the time. GEHA took back all funds for the previous 2 yrs of doctor visits, but doctors only had 90 days to file a claim (completely ridiculous), so Anthem denied their claims. I filed multiple appeals with Anthem and the last appeal/grievance was accepted and paid to me; however, Anthem says the providers are now not in network with Anthem, so the payments were miniscule compared to the charges. I am told I cannot seek GEHA reimbursement for the 2021 claims (had to do it by Dec 31, 2022 even though money was clawed back from providers in Jan 2023). I have tried to submit claims as a secondary policy for 2022, but GEHA sends secure mail, then says they dont receive my responses. The amount of the provider charges for all claims is $5,261.04. I was reimbursed $1,842.82 so now owe providers $3,419.22. I had 2 supposedly excellent insurance companies but now have to pay this? This should be illegal. How can insurance companies take back paid monies for the previous 3 years, but providers and patients only have 90 days?

• Initial Complaint

  04/26/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I saw a provider on 2/28/2023 who is in-network. I verified this through the provider's office and the GEHA website. The claim was processed as out-of-network and was not counted towards my in-network deductible.I called to have this corrected and spent over an hour on the phone with an employee who told me their "website is often out of date" and that I should not rely on it to find in-network providers. I told him the doctor was in-network, and he said that he would resubmit the claim and it would take no longer than two weeks. Over two weeks later nothing had changed, so I called again. The employee said it would take longer than that (another hour wasted on the phone). Over 1 month had passed and the issue was still unresolved, so I called again. The employee told me she understood what the issue was and promised me it would be fixed by the end of next week. Again, nothing had changed, so I emailed. I got an email response three days later saying "I will resubmit the claim again."This issue along with others I have at GEHA are still unresolved. If you elect GEHA for coverage, prepare to waste hours of your time resolving issues that never should have occurred in the first place.

  Business response

  05/01/2023

  Please see attached.

• Initial Complaint

  03/05/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Hello! I am attempting to get the following dates of service with my therapist ********************* processed by processed by GEHA, which have taken roughly over 180 days: 10/24/22, 11/7/22, 11/14/22, 12/12/22, 1/2/23, 1/9/23, 1/16/23, 1/23/23, 1/30/23, 2/7/23, 2/13/23. My GEHA member is ******** In addition, I have attempting on roughly 6 occasions to get the following claims submitted but no one is able to receive the secure email and input them, despite trying numbers times: 11/28 with *********************, 12/12/22 with *********************, and 11/30/22 with ******************* I am also now needing a secure email to submit out of network claim for 2/27/23 with ********************* and 3/1/23 with *********************. Could someone please assist me? I've probably communicated over 30 emails, multiple phone calls, multiple escalations, and no one has helped me. If I have a bad medical episode and get hospitalized will be due to having to abruptly discontinue care, so if someone could please please please please please please please please reach out and assist me, you would be literally saving my life.

  Business response

  03/14/2023

  March 13, 2023

  BETTER BUSINESS BUREAU

  ***************** CIR

  ********** ** *****

   

  Re: Complaint ID ********

  To Whom It May ******** We are in receipt of your correspondence regarding the above referenced complaint. GEHA is regulated under The Federal Employees Health Benefits Act of **** (FEHBA), 5 U.S.C. **** et. seq., which establishes a comprehensive program of health insurance for federal employees, retirees, and their families. FEHBA authorized the ****** of ******************** (OPM) to contract with private carriers and associations, like GEHA, for federal employees health insurance. FEHBA also includes a preemption provision in Section 8902(m) (1), which reads: The terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to health insurance or plans. Please be assured however, GEHA is working with the member regarding this complaint. Should you have any additional questions, please contact our *************************** at **************.

   

  Sincerely, ********************* ********************* Supervisor - Appeals Fax Number: 1 (816) 257-3256b622 cc: Member 

  Customer response

  03/14/2023

   I am rejecting this response because:
  
  Thank you so much *****!! Whatever you did, it worked!! The big backlog of claims finally got processed and I am RELIEVED that I can continue going to therapy/seeing my out of network doctor. There is just 3 last claims that i'm having a hard time getting in, it is 11/28/2022 with *********************, 11/30/2022 with *******************, and 12/12/2022 with *********************. I know a few times the customer service department has confirmed it has gotten sent to claims, but I have not seen anything populate as being in queue (generic provider then saying their name) for those dates, could you do me a favor and **** regarding those 3? then we can close this out and I am so happy and thankful for your help!!! you really did save me from trouble, i was almost going to have to lapse on medical care :( thank you so much!

  Business response

  03/16/2023

  Re: Complaint ID ********

  To Whom It May ********

  We are in receipt of your correspondence regarding the above referenced complaint. GEHA is regulated under The Federal Employees Health Benefits Act of **** (FEHBA), 5 U.S.C. **** et. seq., which establishes a comprehensive program of health insurance for federal employees, retirees, and their families. FEHBA authorized the ****** of ******************** (OPM) to contract with private carriers and associations, like GEHA, for federal employees health insurance. FEHBA also includes a preemption provision in Section 8902(m) (1), which reads: The terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to health insurance or plans. Please be assured however, GEHA is working with the member regarding this complaint.

  Should you have any additional questions, please contact our *************************** at **************.

  Sincerely, ********************* ********************* Supervisor - Appeals Fax Number: 1 (816) 257-3256b

• Initial Complaint

  08/04/2021

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  My complaint is about GEHA their virtual payments. We can't accept the virtual payments I need a paper check. when I call the number to opt out of the virtual payment, I'm on hold for over an hour no answer when I go on line I have no luck I've called every number I can find and I'm directed back to the same line that no one answers I've tried for almost 3 months to get a paper check The patient called and couldn't understand the person she talked too and they refused to call our office. I have another patient also the same company handling the virtual payments but a different ******************

  Business response

  08/20/2021

  see attached

  Customer response

  08/20/2021

   Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. They have paid all claims but one, but the issue is that they cannot be reached, has not been resolved, as of today I cannot get anyone on the phone. But I am satisfied but hope this company can get the issue resolved that there is no contact available for this company via telephone, or internet web page. Thank you BBB you have helped me tremendously.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩