I've had GEHA as my dental insurance for a few years now. Overall they had been doing fine until this past year when multiple concerning issues have arisen.First, the more minor one - took 3 of my kids to a dentist in July 2025 that we have used in the past with GEHA insurance without any issues. It was for a routine cleaning. GEHA sent EOBs to me showing I owed $0 on the services, as expected. However, I kept receiving bills from the provider for 2 of the 3 kids. Turns out, even though they had received IDENTICAL services, they had only paid in full for one of my kids and only paid half for the other two. Had to call the dentist and GEHA several times and to get this resolved. Concerning and inconvenient, but not ultimately a dealbreaker worthy of a 1 star review.Which brings me to my next and more concerning issue. Our plans states that GEHA covers 70% of orthodontic services, up to $3500 total lifetime maximum payment per person, for in AND out of network providers. On my last assignment overseas (but still US territory), we had orthodontic services provided for my son. The provider unfortunately did not have a process to submit claims, so I had to do a member-submitted claim. The initial services were done 4/15/25 and 5/8/25. The entire payment was made up front by me out of pocket for $5607. I received the needed paperwork from the provider on 5/15/25 and submitted the claim on GEHA's website through my member portal on 5/19/25 exactly according to the instructions as laid out by GEHA. After a month went by I reached out to them to confirm it had been received and they said it had. After another few months I called again to check the status and was told it would be "escalated." I called several more times, including 11/20/25, 12/4/25, and 12/11/25. During one of the calls the rep told me that it looked like additional documentation might be needed (even though it wasn't being processed yet, she was trying to supposedly preemptively assist me), so I reached out to the provider and got the additional documentation together to meet that requirement (despite it not being listed on GEHA's member-submitted claim instructions). The rep had told me I could call back once I had the documentation and it could be added directly to the existing claim without having to resubmit or negatively impacting the timeline for processing; she also allegedly "escalated" the claim for processing again. However, when I called back, the new rep I dealt with told me that it was not possible to do what the original rep had said; finally, after much back and forth, she directed me to submit it via email following specific instructions. I did so on 12/11/2025 and also asked again for an update on the status and when the claim might be processed; I never received a response either answering my question or even acknowledging receipt of the additional documentation.As of 1/30/2026 the claim still just shows in the system as "submitted." I am sick and tired of waiting for this claim to be processed. There is no reason it should be denied, but even if it were, at least at that point I would have recourse to file and appeal and eventually take it up with OPM if still denied. But right now the status is just indefinitely in limbo and I have no idea what I'm supposed to do to force them to process a claim I submitted nearly 9 months ago. The customer service at this company is absolutely horrendous and their processing times are ludicrous. It should not take this long to reach a decision. It is surprising that in this day and age, with review sites like this and BBB, as well as social media, that companies still try to pull this kind of crap on customers. I mean, just look at their 1.4 star rating. Who would ever choose to do business with them going forward? I for one will be changing companies at the next open season and will not look back.
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The company currently offers traditional fee-for-service medical plan options with a preferred provider organization along with a high deductible health plan that can be paired with a health savings account.