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Medicare and Health Care


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Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age person with End-Stage Renal Disease (ESRD). There are many different parts to Medicare; with all of these options, it can be confusing.

This forum will allow members to share their experience with medicare and seek advice* on certain medicare-related situations.

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Istvan  
#1 Posted : Saturday, September 03, 2011 9:43:03 AM(UTC)
Istvan

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I have been a GEHA subscriber for many years.  While the service has never been really good, they have always managed to eventually pay the claims.

That is, until about 10 months ago.  They suddenly stopped paying my ordinary, routine claims--nothing where questions of coverage might be an issue.  They have offered numerous excuses, any one of which would be believable, but taken as a whole suggest they just cannot pay.  It's kind of like the old Popeye cartoon caracter Whimpy who used to say "I will gladly repay you next Tuesday."  And it has gone on for many Tuesdays.

Has anyone else had this problem?

Does anyone know what would happen if a FEHB carrier were to become insolvent?  Would the subscriber have to pay the whole thing or would OPM pay it given that carriers are contractors to OPM?

Has an FEHB carrier like GEHA ever gone bankrupt before?  If so what happened?

Given that open season is coming, how would one evaluate the financial strenght of FEHB carriers like GEHA so as to avoid a bankruptcy?

I would never have questioned the ability of a FEHB carrier like GEHA to pay claime, but we live in an era of downgraded Federal debt, the failure of Congressionally chartered Fanne Mae and Freddie Mack, and the whole debt ceiling thing.

Any information would be appreciated..........

golfer  
#2 Posted : Saturday, September 03, 2011 10:21:04 AM(UTC)
golfer

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ABSOLUTELY AGREE.  There's something wrong ............ GEHA is just not responsive.  Isn't paying our legitimate bills and won't tell us why.  Seems to put our claims in the netherworld.  Are you having problems too?
getting close  
#3 Posted : Saturday, September 03, 2011 6:52:10 PM(UTC)
getting close

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I haven't had that problem; just the opposite. I've had a number of routine claims and they've been paid just as before. Since GEHA was acquired by United Healthcare, a huge operation, I'd be surprised if they are bankrupt. There must be some other explanation.
Istvan  
#4 Posted : Saturday, September 03, 2011 8:24:41 PM(UTC)
Istvan

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Has United Health Care acquired control, defacto or otherwise, of GEHA?
 
That's a potentially huge problem for subscribers.   UHC is a very large operation with the potential to become a  private sector single payer monopolist bully--it not owns doctors practices but the insurance operation too. 
getting close  
#5 Posted : Saturday, September 03, 2011 9:08:26 PM(UTC)
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That's what I had been told but, looking at the GEHA brochure and web site, I now don't think that is correct. I think what happened is that GEHA uses the UnitedHealthcare PPO network in the Washington, D.C. area. So when I show folks my card, they record me as having United Healthcare but the underlying insurance is really still with GEHA. I think they are still separate but just contractually related companies.

getting close2011-09-04 05:22:49
freeageless  
#6 Posted : Sunday, September 04, 2011 12:34:28 AM(UTC)
freeageless

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This may shed some light on what may happen to those who have GEHA. Fifteen or twenty or so years ago, I had Federal Employees CIGNA HMO health plan. Many of the doctor's complained that they were either late getting paid by CIGNA or not getting paid. A number of us called OPM. OPM allowed those of us who had CIGNA to change to any other plan we wanted to, even though is was NOT time for open season. I suspect that is what may happen to those of you who have GEHA, if the doctors complain that they are not getting paid, or not getting paid in a timely manner. I do not have GEHA, so I do not know what is going on with them.
upandup  
#7 Posted : Sunday, September 04, 2011 4:56:27 AM(UTC)
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No, GEHA is not insolvent.
Since GEHA is a non-profit member organization (you are a member!), the financial records are public. Here's the most recent annual IRS filing:
http://www.guidestar.org/FinDocuments/2009/440/545/2009-440545275-069622b0-9O.pdf

Also, OPM does monitor the FEHB plans to ensure solvency. Further, premiums are not released directly to the insurers--they are held in Letter of Credit accounts with the US Treasury and funds are only released to the extent needed to pay claims, cover allowed administrative expenses, and maintain an approved level of working capital. These systems provide protections to health plan members.

About five years ago, a health plan (Postmasters Benefit Plan) was kicked out of FEHB and members were moved to other FEHB plans without a break in coverage.

Lastly, the OPM IG regularly audits FEHB plans:


Istvan wrote:
Has United Health Care acquired control, defacto or otherwise, of GEHA?

That's a potentially huge problem for subscribers.   UHC is a very large operation with the potential to become a  private sector single payer monopolist bully--it not owns doctors practices but the insurance operation too. 
The issue you are experiencing is probably related to UHC, but it is not because of they control GEHA or becasue GEHA is insolvent. Some recent chats with GEHA's president address these issues. GEHA is a complicated health plan in the sense that they use different third party networks in different regions. They do operate their own network (PPO USA), but it's not nationwide. GEHA has indicated they are having technical problems with the processing of UHC-network claims. I'm sure this is frustrating to members, providers, and GEHA, but it is not indicative of insolvency.

Here are some quotes from chats as recent as August 2011:
 
http://www.geha.com/contact_geha/gehachat/online_chat.asp?cid=15
Palmyra, Virginia (GEHA Standard Option): How will the sale of GEHA to UnitedHealthcare impact our coverage?
Richard Miles: GEHA was not sold to UnitedHealthcare. GEHA entered into a shared administration arrangement with UnitedHealthcare on October 1 that includes access to UnitedHealthcare Options PPO physicians and hospitals in several states (Delaware, D.C., Maryland and Virginia). 
Your benefits for using a participating provider will stay the same

Oklahoma City , Oklahoma (GEHA Standard Option): Why does our insurance card say United Healthcare Options PPO Network?

Richard Miles: GEHA entered into a shared administration arrangement with UnitedHealthcare on January 1 that includes access to UnitedHealthcare Options PPO physicians and hospitals in several states (Utah, Oklahoma and Colorado). 
GEHA is still your insurance company, and the doctors and hospitals participating in the United Healthcare Options PPO Network have agreed to provide services to GEHA members. It’s possible that your doctor might be more familiar with the name of this local network than with GEHA.

Fairfax, Virginia (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): Since Washington, DC, is covered by the United Healthcare Options PPO Network, does it take longer than the normal GEHA claims-processing time?

Richard Miles: Yes, due to some technical problems it has taken a bit longer with United HealthCare Network claims but we are working to reduce the processing time. You should see some improvement soon

Istvan  
#8 Posted : Sunday, September 04, 2011 6:21:54 AM(UTC)
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If this is "just" an administrative problem, it must be huge. 
 
I have over $5000 in bills that they simply ignore.  One was incurred last October.  My doctors bill United Health Care and UHC says I have no coverage--yet I have been insured by GEHA for almost 30 years.  So I call GEHA and they say to send the claims direrctly to them in Independence MO.  I do this only to get a form letter back stating they won't pay because all bills need to be sent to UHC.  (I have documented all this in numerous email exchanges with them.)  I doubt that I am the only one affected.  I also know that failure to pay for this length of time is ususally a sign of insolvency, or some type of fraud.
 
I would file an appeal with OPM but I think I need an Expanation of Benefits to do this.  So GEHA ignors me, won't pay, and I can't appeal.
 
My doctors will be patient only so long.  If they enlist bill collectors I'm sure it will affect my credit, and I don't have the resources to front the money and hope that GEHA will evenually pay something.
 
I just don't know what to do..................I'm 64 years old and, effectively, have no health insurance because GEHA has chosen to ignore me, despite my long term membership and monthly payment of premiums!
upandup  
#9 Posted : Sunday, September 04, 2011 6:24:57 AM(UTC)
upandup

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lstvan, I understand your frustration. You have PM.
golfer  
#10 Posted : Sunday, September 04, 2011 6:40:54 AM(UTC)
golfer

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PM?
upandup  
#11 Posted : Sunday, September 04, 2011 6:53:46 AM(UTC)
upandup

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golfer wrote:
PM?
A Private Message (with some contact information).
golfer  
#12 Posted : Sunday, September 04, 2011 7:33:18 AM(UTC)
golfer

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thx
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