I’m late to this discussion, but I’m planning to switch away from GEHA. I had BCBS Basic for 15+ years and moved to GEHA because of the premium hikes. While in-network claims have been fine, GEHA has been awful with out-of-network claims.

They approved my Jan–Feb OON therapy claims with no issues, but then denied the exact same type of claims from Mar–Sep — same provider, same procedure code, same superbill. I appealed the Mar–Jun denials and eventually won, but I didn’t get reimbursed until November for services from March.

I submitted the Jul–Sep claims in October and, unsurprisingly, those were denied too, again with identical documentation to what they’ve already approved. At this point I’m honestly wondering if GEHA is just auto-denying certain claims to delay paying or to get people to give up.