ComplaintsforGEHA-Connection Dental Federal
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Complaint Details
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Initial Complaint
09/12/2024
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
GEHA Dental offers false and misleading information. GEHA Dental refuses to pay for plan covered procedures. GEHA Dental in an attempt to delay payment to providers attempt to request information that they already have from the sponsor of the plan. GEHA does this purposely to avoid payment of plan covered procedures.Initial Complaint
07/16/2024
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
GEHA Dental is my employer sponsored dental insurance company. After numerous attempts, they've finally finalized a dental claim for my son from October of 2023 however, they refuse to disburse reimbursement payment or even provide a timeline of when they will. I've contacted them numerous times regarding this matter, and all they will say is that it's either going to be processed or it has been but they cannot provide a timeline of when to anticipate it!Initial Complaint
04/10/2024
- Complaint Type:
- Customer Service Issues
- Status:
- Resolved
My dentist filed a claim for orthodontics (GEHA requires pre authorization for ortho services) in January of 2024. I still haven’t heard any updates on this claim. Every time I call they claim the that the case is being worked but they have no timeframe of when it will be completed. It’s been over 4 months to attempt to get orthodontic services approved by GEHA.Business response
06/12/2024
GEHA is regulated under The Federal Employee Dental and Vision Benefits Enhancement Act of 2004, 5 U.S. . § 89 et. seq., which establishes dental benefits to
federal employees, retirees and the r families. This law includes a preemption provision,
§ 8959, it reads:
The terms of any contract that re/a e to the nature, provision, or extent of coverage or benefits (including payments with r, spect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to dental benefits, insurance, plans, or contracts.
The FEDVIP plan brochure entitles •II participants to a full review of their claims. GEHA has a disputed claims process to address complaints, such as the one your office received from our member. GEHA has forwarded this complaint to be reviewed as a disputed claim. To ensure compl ance with the Health Insurance Portability and Accountability Act (HIPAA) this response does not directly address the member's specific claim.
** *** **** *** ********** ****** ** ** ***** *********
Sincerely,
**** *** ****** * ***** ******** ***** *** ****** * **
Customer response
06/12/2024
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.
Sincerely,
******** ******Initial Complaint
03/13/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
Geha dental states it pays for orthodontic Invisalign work. Including malocclusions. Malocclusion states, class 1 upper teeth slightly over lap bottom teeth. My dentist stated I needed Invisalign as my upper teeth are loose and are continuing to move and sent me to an orthodontist, which she agreed. I went to the dentist again last week. He again stated my upper teeth are loose as the bottom teeth are pushing them forward. So… HOW can you deny what is needed and what should be covered???? I have dental coverage through my husband and myself. My husband’s dental states it is needed and covers a portion. My insurance (GEHA) says it’s not necessary?!?! And does NOT want to cover what is stated in their brochure!!! I have a dentist and an orthodontist that states this is needed. Shouldn’t there schooling and degrees have credibility??!? I would think yes.Business response
04/08/2024
see attachedInitial Complaint
06/13/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
GEHA claims to cover wisdom teeth extraction, per the plan brochure, however they then refuse the charges after the fact. In April 2022 my daughters dentist referred us to an oral surgeon for wisdom teeth extraction. At the consultation the oral surgeon agreeed that the wisdom teeth needed to be extracted and told me we had "great insurance coverage" and would be responsible for approx $900. We had the procedure completed on July 1, 2022. In October of 2022, we found out that GEHA denied the claim because prior authorization was not obtained. I disputed that claim because the plan documents clearly stated that prior authorization was not required. They then denied the claim saying it was no medically necessary. At no time was I told this was optional and not necessary. Two different providers recommended the extraction, however GEHA refuses to pay for it. We have been members of GEHA for 15 years, we rarely ever use this insurance, yet they will not pay for a very common procedure. We will be switching companies in December. I don't care if I have to pay double for another policy, I will never use or recommend GEHA again. They won't even cover a standard procedure. They are crooks! Don't believe it when an office tells you that you have great insurance if you have GEHA!Business response
06/29/2023
To Whom It May Concern:
We are in receipt of your correspondence regarding the above referenced complaint.
GEHA is regulated under The Federal Employees Health Benefits Act of 1959 (FEHBA), 5 U.S.C. § 8901 et. seq., which establishes a comprehensive program of health insurance for federal employees, retirees, and their families. FEHBA authorized the Office of Personnel Management (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.
If you have any questions, please feel free to contact our Customer Service Department at ***** ********* ********** ***** ***** ***** *****
********** * ******* *** ****** * ***** ******** *** ******* ******
Initial Complaint
06/08/2023
- Complaint Type:
- Billing Issues
- Status:
- Answered
I have two dental insurances one is called liberty dental through Medicare which is in my own name since I’m a 24 year old disabled person and the other is a dental plan through my step dad called GEHA, he is retired military and has me covered with medical and dental through him. I went to the dentist a number of times called complete dental down midlothian turnpike in midlothian VA for my dental work. When the appointment was first made I explained my Medicare dental benefits through liberty was primary over GEHA since this is what Medicare and my Medicare worker told me. Well complete dental billed it opposite and now a year later not one bill has been paid by either GEHA or livery dental. I’ve filed several grievances and appeals for liberty and heard nothing back. I’ve called both companies numerous times and I’m told neither is primary. This has got to be some sort of insurance fraud! Now complete dental is threatening to send these to collections and I don’t know how to get this paid! I want my bills paid immediately, I should not be getting threats of collections when I have 2 insurance companies who are downright refusing to pay bills!Business response
06/21/2023
*** ********* ** ******** ** **** ** *** ********
GEHA is regulated under The Federal Employee Dental and Vision Benefits Enhancement Act of 2004, 5 U.S.C. S 89 et. seq., which establishes dental benefits to federal employees, retirees, and their families. This law includes a preemption provision, S 8959, it reads:
The terms of any contract that relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supetsede and preempt any State or local law, or any regulation issued thereunder, which relates to dental benefits, insurance, plans, or contracts.
The ****** plan brochure entitles all participants to a full review of their claims. GEHA has a disputed claims process to address complaints, such as the one your office received from our member. GEHA has forwarded this complaint to be reviewed as a disputed claim. To ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) this response does not directly address the member's specific claim.
** *** **** *** ********** ****** **** **** ** ******* *** ******** ******* ********** ** ***** ********* ********** ***** ***** ********** * ******* *** ****** * ***** ******** *** ******* * ********Initial Complaint
03/03/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
I have the higher end dental insurance thru GEHA which allows for Invisalign in case where malocclusion exists. I have lost a crown due to this because the malocclusion was causing me to clench my teeth putting pressure on all my teeth excessively due to bite. I have been trying to get claim thru GEHA but after 3 attempts with submission of claim, trying to get reversal of claim, they continue to say my bite was not that off, and that they would not pay claim. Also they ended up taking over 6-7 months to even deny claim, and when I tried to get it pre approved they told both my dentist and I pre approval was not necessary. I cringed! I knew at that point, most likely it would not be approved. Please BBB help me. At this point they have already denied even my retainers.Initial Complaint
10/28/2022
- Complaint Type:
- Customer Service Issues
- Status:
- Unanswered
GEHA dental insurance company has not responded to the claim submitted for the oral surgery performed on August 8, 2022 for my dependent daughter. Discussions with customer service has only resulted in requiring me to re-submit the claim. I submitted the forms in August, September and October. The initial submission of the forms was via mail, then via secure email and by fax and again by certified mail. The surgical office required me to pay $4800 in advance and they gave me the form with the procedures performed. I submitted the required GEHA forms in addition to surgeon's form. I am requesting that GEHA pay the insurance portion of the claim. No responses from GEHA is unacceptable. I will be looking for another insurance provided after this unacceptable service to a paying customerInitial Complaint
08/31/2022
- Complaint Type:
- Billing Issues
- Status:
- Unanswered
GEHA Dental insurance seems to be taking advantage of people. Last November I got an implant supported denture. My dentist Dr ********* did molds and fabricated the lower denture and that was all they did. I picked up the denture on Nov. 5 2021. On Nov 8 2021 I went to ** ****** **** ******* where I was sedated because of extreme anxiety, I had 9 extractions and I had 2 surgically endosteal posts placed. When I received my EOB from GEHA about my oral surgeon bill, they had given an alternate benefit (complete denture) for my implants, had changed the code for 8 of my surgical extractions to just an extraction. When GEHA received the claim from my dentist for an immediate denture they denied the claim stating they had already paid for this service. Both my oral surgeon and dentist office filed appeals to no avail. I don't have a complete denture I have an immediate denture and they seem to think that is my issue. My issue is that looking at my EOB they paid my oral surgeon for a denture that they don't do and didn't pay any part of my implants. The allowable amount for a denture is 1025 while max allowable for an implant is 2203 and I had 2. They paid zero to my dentist who actually made the denture. Last week I had the final step of the implant supported denture finished by getting abutments attached to my denture and this bill is over $2500. When all is said and done without my last visit my bills have totaled 14960 of which GEHA paid $1482. With so many codes being changed by GEHA, between the 2 offices I have paid $7152 unfortunately I have paid more than $3000 more than I should have and GEHA has gotten out of paying the $3000. The 5 units of anesthesia was declined because they said it wasn't necessary.Initial Complaint
08/02/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
My son recently had to have a large amount of dental work completed. Our dental insurance covers us overseas because we work for the US department of state. At the time of the dental work we were posted in the US mission Mexico in Mexico. They Insurance is asking for information on the claim that Mexican dentist do not provide. I submitted an x-ray of my son‘s teeth, as much as as I could provide on their claim form, and Payment receipts. When I spoke to the insurance they said if I can’t provide the information they are requesting then my claim is denied. How can I provide information that a dentist in another country doesn’t provide to me.
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Customer Complaints Summary
13 total complaints in the last 3 years.
5 complaints closed in the last 12 months.