I can't even.
Today we received an Explanation Of Benefits from our former #healthInsurance company, #GEHA. It's for a supposed appointment 364 days ago.
It says the claim was "reprocessed".
It doesn't say what the old EOB said, or if payment was previously sent to the provider.
I can't find any record of the appointment or paying for it, despite being obsessive about hanging onto paperwork.
So I have no idea whether we're owed a refund from the provider or what.
🤦

Over 30,000 feds facing possible FEHB premium spike next year

More than 30,000 federal insurance enrollees may be in for some sticker shock next year, if they choose…
#NewsBeep #News #Topstories #consumers'checkbook #federalemployeeshealthbenefitsprogram #geha #Headlines #johnhatton #kevinmoss #nationalactiveandretiredfederalemployeesassociation #nationalassociationoflettercarriers #officeofpersonnelmanagement #postalservicehealthbenefitsprogram #TopStories
https://www.newsbeep.com/251454/

Remember how my insurance company was trying to cheat me out of some money they should have covered?
Well, now they're trying to cheat me out of even more money. At this point I have to concede that it's not worth continuing the fight, because I can't file a complaint about federal employee insurance with a state insurance board, and it's pointless to file a complaint with the current federal government.
Details: https://blog.kamens.us/2025/06/11/todays-example-of-why-luigi-mangione-had-a-point/#update3
#HealthInsurance #GEHA #FEHB

Remember how my health insurance company bogusly refused to pay part of one of my claims and then made it intentionally difficult for me to appeal their decision?
Well, guess what, they're still at it!
They intentionally delayed their most recent response to my appeal by three weeks, and when they responded they told me to call the people who already told me they couldn't help me.
Read the details and my fiery response here:
https://blog.kamens.us/2025/06/11/todays-example-of-why-luigi-mangione-had-a-point/#update2
#healthInsurance #GEHA #UnitedHealthcare

Today’s example of why Luigi Mangione had a point

United Healthcare is doing everything they can to avoid paying me $158.70 they owe me, because they are scumbags. Five hurdles and still counting!
#GEHA #UnitedHealthcare #LuigiMangione #healthInsurance
https://blog.kamens.us/2025/06/11/todays-example-of-why-luigi-mangione-had-a-point/

Today’s example of why Luigi Mangione had a point

Up until DOGE fired me in February, I had federal government health insurance through GEHA, which unfortunately uses United Healthcare as its network and claims processor. (For the record, when I first enrolled with GEHA they used Aetna, but then they bait-and-switched to United at the start of the next plan year, and it was too much hassle for us to switch our insurance.)

A few months ago I filed a claim with GEHA for one of my kids’ therapy appointments. When I received the Explanation Of Benefits (EOB) for the claim, it said that I had received a “discount” of $26.45 for each appointment. Next to the $158.70 total of the “discount” for all of the appointments, the EOB said, “Your plan negotiates discounts with providers and facilities to help save you money.”

Except my kid’s therapist isn’t in the United Healthcare network, has not signed any sort of contract with United Healthcare, and has not negotiated any sort of discount with United Healthcare.

And this supposed “discount” that I was getting because of the nonexistent negotiation? Well, I had already paid that money to the therapist; since they’re out of network I pay up-front and then get reimbursed by the insurance company.

Looking more closely at the EOB, there’s some illuminating fine print. There’s a “reason code” associated with each of the therapy appointments with a “discount”. At the bottom of the EOB in small type the same reason code is printed with this explanation next to it: “The amount billed by your provider exceeds the reasonable allowable amount. If the provider bills you more than the total you may owe, please contact ClearHealth at 888-550-8910. Please refer to Claims and Appeal Procedures in your Benefit Booklet.”

So, United Healthcare has unilaterally decided what the “reasonable” rate is for my kid’s therapy and decided they’re not going to reimburse for anything above that “reasonable” rate. For the record, the amount they were charged is completely in line with what is typically charged for that type of therapy in the Boston area, but it shouldn’t matter; United Healthcare doesn’t get to decide what providers they don’t have contracts with charge.

The “discount” the EOB is bragging about is actually just United Healthcare using bullshit to get out of paying me what they owe me.

Hurdle score: this is hurdle #1 United Healthcare has erected between me and the money they owe me.

But wait, it says right there I can call ClearHealth to get this resolved! So I call them, leave a message, and wait a week for them to call me back. When they finally do, they’re like, “Duh, we don’t know what’s going on here, you’ll have to call your insurance company.” Hurdle #2, they told me to call people who, it turns out, can’t actually help me!

So I send the insurance company a message and wait several days for them to respond, and when they finally do, they tell me I have to fill out an appeal form. Hurdle #3, an appeal form, when they already have all the information they need to handle my appeal.

So I fill out the appeal form and send it back. A few days later they respond: nope, you can’t submit appeals online, you have to print them out and mail them on paper at your expense to this post office box in Minnesota. Hurdle #4: any insurance company which is still refusing to accept appeals online in the year 2025 is doing that for only one reason, to deter people from submitting appeals.

I just printed out the appeal form and mailed it in. I imagine Hurdle #5, still to come, is going to be either they won’t respond to the appeal within the time-frames required by law and their own policies, or they’ll try to claim they never received it, which is going to be a bit tricky for them since I used certified mail.

Fuck United Healthcare and fuck every person who works for them.

Fuck the entire for-profit healthcare system in the United States, and fuck everyone who perpetuates it.

UPDATE 1: In response to my complaint after being told that I had to submit my complaint via mail, I received the following today:

You are able to submit appeals online through your member portal as well if you’d like. You can do this by clicking the Claims and EOBs tab, then click Medical Claims. Select the name of the patient to navigate their claims, then select the claim you want to appeal. Once you click the claim link, you will go to a page that has an option to “Appeal this claim”. Please click that to begin your online appeal submission process.

Do we chalk it up to ignorance or malice that the previous support representative told me I had to submit it on paper? Either way, it’s a 🤡 show.

UPDATE 2: On July 25, over three weeks after I submitted my appeal, I received a response letter. The response was dated July 21 but the postmark on the envelope indicates it wasn’t mailed until July 21. So that’s Hurdle #6, delaying the handling of my appeal, probably intentionally, again hoping that if they make it arduous and slow enough I’ll give up. Let’s move on to Hurdle #7… The letter told me to call ClearHealth and said nothing else. I’ve already told them that I called ClearHealth and ClearHealth told me to call GEHA! I just sent the following back in response:

I am in receipt of your letter dated July 1, 2025, attached, telling me to call ClearHealth about this matter.

Incidentally, can you explain to me why, although the letter is dated July 1, according to the postmark on the envelope you did not mail it until July 21, nearly three weeks later? Did you delay the letter on purpose because you are trying to slow-walk the handling of my appeal in the hope that I will give up and you will not have to pay me the money you owe me? It sure looks that way!

As I already informed the GEHA representative with whom I spoke before filing this appeal, I did call ClearHealth. They told me they couldn’t help me and I had to call you.

I did not buy insurance from ClearHealth; I bought it from you. ClearHealth has no legal agreement with me; you do. My agreement is with you, and it’s your job, not mine, to get this problem resolved. If you need to deal with ClearHealth to resolve it, fine, you do that, but stop telling me to deal with them, especially when they’ve already told me to deal with you. It’s almost as if you and ClearHealth are giving me the runaround on purpose to make the appeal difficult in the hope that I will give up and you will not have to pay me the money you owe me!

Let me recap my complaint: either GEHA or ClearHealth came up with some arbitrary determination for what is a “reasonable” charge for therapy from a specialist psychiatrist treating a complicated condition. This determination is inconsistent with what these specialists typically charge and especially inconsistent with what they charge in the area I live in. As such, this determination was unreasonable and is what I am appealing.

Once GEHA or ClearHealth came up with their unreasonable determination, then according to the EOB they designated the rest of the charge for each therapy session as a “discount” that I was “not obligated to pay.” They have no authority to do this, since they do not have a contract with the out-of-network therapist in question and she is under no obligation to refund money to me just because the insurance company said a charge was “unreasonable.” That’s not how any of this works.

I want this “determination” reversed and I want to reimbursed for the rest of that money which I paid to the provider.

Furthermore, I want instructions from you for how to file an internal grievance with GEHA over how this has been handled.

Furthermore, I want instructions from you for how to file complaints with whatever government agency/agencies oversee your operations if this appeal is not promptly resolved in my favor.

Just to avoid all confusion, I am once again attaching the form signed by my daughter authorizing you to deal with me about this.

Thank you for your prompt attention to this matter.

UPDATE 3: As of August 25, a month after I sent the letter above, GEHA has not responded. They have not told me how to file an internal grievance, and they have not told me how to file complaints with the government agencies that oversee their operations.

However, today I received an Explanation of Benefits from GEHA indicating that they reprocessed the claim in dispute. Did they increase the covered amount to include the $158.70 they stole from me? No, of course not, don’t be ridiculous. The new EOB says that because the amount charged by the therapist was “greater than usual, reasonable and customary fees,” they’re going to cover none of it. That’s right, they went from covering $1,491.30 out of $1,650 to covering $0 out of $1,650.

Let’s be honest here: this is clearly retaliatory. They have decided to punish me for disputing their handling of the claim by making it even worse than what I complained about.

Since the $1,491 that they originally said was covered just went toward our out-of-network deductible, which we failed to meet before we switched insurance companies at the beginning of April, I don’t believe this revenge they took on me is going to cost me any money out of pocket. If it were actually going to cost me $1,491, I’d keep fighting. But without that financial incentive, it just isn’t worth it.

I would also keep fighting if they were still my insurance company, since in that case this claim would satisfy a large chunk of our deductible for the year and therefore it would be likely to make a financial difference.

If this were a regular insurance policy for a regular private company, then at this point I’d be able to file a complaint with the state insurance board overseeing the company. Best case that would force them to reverse course, worst case it would take up their time and annoy them which as far as I’m concerned is also a worthwhile outcome.

However, since I worked for the federal government, this insurance was issued within the Federal Employee Health Benefits (FEHB) program, and well, see, one of the interesting thing about FEHB policies is that there’s no state oversight for them; they are overseen by the federal government (OPM or HHS, I honestly can’t remember which).

I don’t know if you’ve noticed by now, but we don’t exactly currently have a functional federal government that’s advocating for its employees.

I am not going to waste my time filing a complaint about what GEHA is doing to me when it’s patently obvious that nothing will result from it. That will be a waste of my time, not GEHA’s, and I just don’t have any more time to waste on this.

This really sucks, but it’s time to face facts: the shitty insurance company won this particularly fight.

#GEHA #healthInsurance #LuigiMangione #UnitedHealthcare

My health insurance company (#GEHA) decided late last year to stop processing emails sent to their customer service mailbox (replaced with the "message center" on their new website).
So they just started ignoring emails.
They didn't notify members to stop using the mailbox, or set up an auto-reply, or turn off the mailbox so messages would bounce.
They just stopped handling the messages.
And they apparently consider this a reasonable, OK thing to have done.
#smdh #healthInsurance #wtf #fail

Still more #MDLive fuckery…
Furthermore, MDLive is supposed to file claims for my appointments with my health insurance company (#GEHA), but despite the fact that my first MDLive appointment was more than a month ago, according to the #GEHA portal they still haven't filed claims for any of the three appointments.
These guys are absolute 🤡s.

When I called #GEHA to ask why their portal wasn't working, they told me to try again at 3:00pm Central time because it would be back up by then.
Imagine my surprise that now, at 3:03pm Central time, the portal is not back up.
However, there is a new warning on the portal: "GEHA is performing system maintenance. During this time you will be unable to access your member portal information."
It wasn't there an hour ago, which implies an unplanned outage. Too soon to predict a security #breach?

I am unable to look up information I need about my health insurance claims in the middle of this work-day because my health insurance company's "system is down." Whether this is because they think it's OK to take down their systems in the middle of the day or because they are incapable of maintaining a high-availability system is immaterial; either is unacceptable. Grr.
#GEHA #healthInsurance #DevOps

Important Fan Information for Sunday's Game at #GEHA Field at #ArrowheadStadium #Chiefs #NFL

https://www.chiefs.com/news/important-fan-information-for-sunday-s-game-at-geha-field-at-arrowhead-stadium-x9246

Important Fan Information for Friday's Game at #GEHA Field at #ArrowheadStadium #Chiefs #NFL

https://www.chiefs.com/news/important-fan-information-for-friday-s-game-at-geha-field-at-arrowhead-stadium

Go, #Geha, go!

@mo Beim #Geha war das mit den Kügelchen nicht so interessant. 🙃
Hab eben gelernt, dass es noch #Heiko gab. #DDR

My #HealthInsurance company, #GEHA, was impacted by the #ChangeHealthcare #Ransomware attack; they were unable to send out EOBs or reimbursement checks for several months and had to implement a replacement process from scratch.
EOBs and checks started flowing again eventually via the new process. Alas, there's a problem: there's a bug in the system, and they're sending out some duplicate EOBs *and duplicate checks*.
How much do you suppose this will cost them?

I have so many questions, including:
1) Why is my #HealthInsurance company, #GEHA, glorifying a violent, exploitive sport with a history of racism that persists to this day, a sport that destroys the minds and bodies of many of the athletes who participate in it?
2) Why are they paying money for their employees and guests to attend the NFL draft? This is not what my insurance premiums are for.
3) What could they possibly gain by this in terms of improving health outcomes for members?
#wtaf

Welp, I'd thought my family wasn't impacted by the #ChangeHealthcare attack, but it turns out it's why my #healthInsurance company isn't mailing out EOBs or displaying them on their website. "#GEHA is actively working on a contingency plan to restore both provider and member payment processing as well as access to impacted member and provider documents," they say. No ETA given for when that contingency plan will take effect. *sigh* #infosec #cybersecurity #ransomware #healthcare

#TFW your #HealthInsurance company (looking at you, #GEHA) accidentally forwards you an email message containing someone else's #PHI (Protected Health Information, for the uninitiated).
I filed a complaint with the GEHA privacy office through their online form; replied to the email and told them they done fucked up; and emailed the person whose PHI was sent to me to give them a heads-up. I don't mess around with this shit.
#privacy #HIPAA #infosec

I recently switched my #HealthInsurance company (#GEHA) from sending Explanation of Benefits (#EOB) forms in the mail to notifying me electronically. I want to save the insurance co. money so they can pass those savings on to me, and I want to save the environmental cost of printing and mailing EOBs.
I quickly encountered 2 problems which forced me to switch back to paper:
1/3

@HasnainKazim Unfassbares #geha-Bashing! Ich fühle mich diskriminiert. 😭