- Report: #1275826
Complaint Review: GEHA Health Plan - Nationwide
-
Author Confirmed
Why?
GEHA Health Plan
Nationwide, USA
Web:
www.geha.com
Categories:
Business Rating:
(0)
Tell us has your experience with this business or person been good?
GEHA Health Plan serious negative changes happening Independence, Missouri Nationwide
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?
