Welcome Guest! To enable all features please Login or Register.

Notification

Icon
Error

Options
Go to last post Go to first unread
monicaindc  
#1 Posted : Tuesday, December 06, 2011 4:41:31 AM(UTC)
monicaindc

Rank: Newbie

Groups: Registered
Joined: 9/24/2011(UTC)
Posts: 4

I've had GEHA Standard for years.  Have been generally happy until past 2 years when claims have been nitpicked repeatedly.  (According to a claims rep at GEHA, all claims from my family physician are flagged for extra scrutiny....). 
 
I am willing to pay higher premiums in exchange for easier claims processing.  Would like to hear about experiences of those who use SAMBA (standard and high), APWU, and Aetna Open Access.
 
Thanks much.
jagfan  
#2 Posted : Tuesday, December 06, 2011 5:00:36 AM(UTC)
jagfan

Rank: Advisor

Groups: Registered
Joined: 12/6/2007(UTC)
Posts: 179



My husband had Samba for 2 years with zero problems.  He was pleased. 
monicaindc  
#3 Posted : Tuesday, December 06, 2011 5:04:56 AM(UTC)
monicaindc

Rank: Newbie

Groups: Registered
Joined: 9/24/2011(UTC)
Posts: 4

Thank you for your reply.  Do you know if he used it frequently?   My husband and I are at an age where we will have moderate use -- probably 4 specialist visits a year each and several prescription meds.
 
Thanks again.
jagfan  
#4 Posted : Tuesday, December 06, 2011 5:34:34 AM(UTC)
jagfan

Rank: Advisor

Groups: Registered
Joined: 12/6/2007(UTC)
Posts: 179



He used it moderately as well.  Annual physical plus a couple general and specialist appointments.  He has 2 prescriptions.  We are eligible for Compass Rose and switched last year because benefits are slightly better and the premium a bit less.
Kendy  
#5 Posted : Wednesday, December 07, 2011 11:49:17 AM(UTC)
Kendy

Rank: Newbie

Groups: Registered
Joined: 12/7/2011(UTC)
Posts: 3

I got angry with GEHA because they said they don't cover "male" issues. WHAT?!!! My hubby had his prostate exam done and I guess whatever the doc put in the report was rejected by GEHA (United Healthcare) because they said they don't cover "male" issues. I told them he went for his free prostate exam and I still ended up paying $350.00. What insurance out there covers everything? I need to know.

Thank you,


upandup  
#6 Posted : Wednesday, December 07, 2011 1:41:34 PM(UTC)
upandup

Rank: Senior Member

Groups: Registered
Joined: 9/25/2010(UTC)
Posts: 716

Kendy, no insurance covers "everything". 
GEHA does cover "Prostate cancer screening: Annual coverage of one PSA (Prostate Specific 
Antigen) test for men age 40 and older"
MaleMan  
#7 Posted : Wednesday, December 07, 2011 5:52:39 PM(UTC)
MaleMan

Rank: Senior Member

Groups: Registered
Joined: 1/1/2009(UTC)
Posts: 747

                                                             .
 

Since you asked, I currently have GEHA and have had nothing but good things to say about them. All my claims have been paid accurately and fast. By fast, the most recent one was paid in 5-days!

I had SAMBA for a couple years and no problems with them, but didn't really use them much.

Now, I am going to change my general flow when it comes to APWU. When you review their plan brochure the plan is pretty nice, that is the end of nice comments about APWU. Their claim service was much worse than terrible, I can't imagine how it could be any worse.

Just about 90% of the claims that I submitted have been rejected, many times not even a reason indicated. Most of them upon resubmitting are then paid within 6-weeks. Other claims were rejected again and required an hour or more on the phone to get a human that would look it up and say something to the effect: "Uh, I see what you are talking about, I don't see why it was rejected, just submit the same claim again and post attention to me" (Jane Doe).

I truly feel it is a cost savings method. Especially on fairly small billings, would you think that 25% of the folks would just figure the item wasn't covered and pay the balance themselves? That would save the insurance company a lot of money.

Bottom line: APWU makes it way to painful to utilize your insurance coverage.

<font color=RED><em> <center> Just Because You're Paranoid - Doesn't Mean They Aren't Out To Get You. </em> </center></font>
monicaindc  
#8 Posted : Sunday, December 11, 2011 9:11:19 AM(UTC)
monicaindc

Rank: Newbie

Groups: Registered
Joined: 9/24/2011(UTC)
Posts: 4

Thank you all for your replies.  Probably stay with GEHA, knowing they will not pay my GP's claims.  SAMBA is double the price, so while it sounds like a good plan, I think I'll come out ahead with GEHA.

Thanks for warning on APWU!!


upandup  
#9 Posted : Sunday, December 11, 2011 2:43:34 PM(UTC)
upandup

Rank: Senior Member

Groups: Registered
Joined: 9/25/2010(UTC)
Posts: 716

Monica, if you are in DC you might be being affected by some issues GEHA was having with their partner United HealthCare, whom they use for network access and some administrative services in some states. I definitely wouldn't accept claims denials. I'd first talk to someone senior at GEHA about the issue (remember: you are a member-owner of GEHA--they work for YOU!). If all else fails, I'd follow the official appeals process as outlined in the brochure (plan->OPM->court).
Rss Feed  Atom Feed
Users browsing this topic
Guest
Forum Jump  
You cannot post new topics in this forum.
You cannot reply to topics in this forum.
You cannot delete your posts in this forum.
You cannot edit your posts in this forum.
You cannot create polls in this forum.
You cannot vote in polls in this forum.


This page was generated in 0.650 seconds.