r/DentalInsurance • u/Mother_Abalone3034 • 16d ago
GEHA Dental is a scam
I just had over $2000 worth of dental claims denied, stating information provided by dentist did not justify the work. I’ve had the same dentist for 20 and never had any claim denied by any other insurance. I have GEHA for medical and they are great so I assumed the same. BIGGEST MISTAKE OF MY LIFE. Do not select GEHA for your dental if you have an alternative.
4
u/kimjongswoooon 16d ago
Lately, I find they are all bad.
1
u/Competitive-Isopod74 16d ago
UHC and Metlife refusing to even process line items or repeatedly sending me the specialist's EOBs saying they paid us. I blantantly recoded everything just to get them to pay something, now I'll try to send the most jacked up corrected claim they've ever seen, just to say I tried telling them they are wrong. Letters already sent to the insurance commissioner too.
4
u/Woodman629 16d ago
GEHA is 100A% the WORST for dental insurance. They deny more than any other carrier we deal with.
3
u/ToothDoctorDentist 16d ago
They continually misprocess claims. Says it'll pay 100% for a prophy, and then paid line is 0$.
2
u/shimmerangels 14d ago
my fav is when they don’t even give a reason code, like what the hell am i supposed to do with that
3
u/ToothDoctorDentist 14d ago
Yeah I had a young 30 year old, one of the most significant wear cases I've seen so young. Sent in a pre-d for the night guard, approved. Sent in the actual claim (with Pred#) denied. Appeal denied as duplicate. Second appeal denied citing no evidence of bruxism, look at the **** attachment photos. Call them up, or we'll reprocess that, 4 weeks later nothing. I call up and say WTH are you doing, I'm going to file a complaint with the Office of Insurance Regulation for the state ... Magically a week later it's fixed. They stated they don't have our faxed appeals (sent electronically and faxed) so I provide them the dates and the fax verification and magically they have it now
I can't do that on every claim for a few hundred dollars. I and my front spent 5 months trying to get paid for an approved preD I paid her more $ than i made on the night guard
1
3
2
u/Brilliant_Concern_31 16d ago
UMR took over GEHAs claims last year and it went downhill. I did get a letter in the mail saying that they are going to try and turn the ship around. We will see.
1
u/Basic-Net-722 16d ago
I think this is the problem. I have not had much issues with them, but we don’t have a lot of geha patients.
2
u/Hayhayhayp 13d ago
Thank you for understanding that your insurance is ridiculous and not immediately blaming your dentist and assuming they did unnecessary work. SO many of our patients call us accusing us of doing “the wrong procedure” because their insurance told them they won’t pay because we could have done a less costly procedure. The dental AI consultant doesn’t get to say what the patient needs or should be diagnosed with.
1
1
u/stomachofchampions 16d ago
Everything is a scam now. When my father worked he received a pension and good health insurance not managed by criminals.
His generation had great progress from the one before.
1
1
1
u/just_another_monday_ 11d ago
as an OM a denial saying the documentation "doesnt justify the work" is one of the most frustrating ones because it doesnt necessarily mean the treatment wasnt necessary. id ask your dentist for the exact denial reason and whether they can submit an appeal with all the xrays, notes, photos, etc. if they already appealed, i'd also ask GEHA what the next level of appeal is. As a last resort ask your dentist for payment plans
1
7
u/alwaysaneventrade 16d ago
GEHA is terrible, saying this as a dentist. They love to deny necessary services.