Based on my doctor's orders, I purchased 4 pairs of support hose to wear every day due to vascular disease. A simple claim, as booklet indicates to submit information if using over normal of 2 pair/year.
I submitted all doctor's information from several years of treatment that I have had the problem and information that vascular disease is getting worse. Doctor's orders were specific: "wear prescribed support hose all the time" to decrease swelling, pain and vein bulging (except when I sleep - 7 hours a night).
I got the run around from all customer service folks at GEHA and had my doctor even submit back years of doctor's notes, and medical claims which GEHA paid to treat my vascular disease. I have been with GEHA for several years.
The denial letter states: "the fact that a covered provider has prescribed equipment does not make it medically necessary." The letter does NOT state that the stockings are NOT medically necessary for my condition!
I wrote to the Vice President/CEO of GEHA and will file an OPM appeal for failure to pay the claims. Not sure what will come of all of it, but advise:
GEHA is NOT a gov't insurance company I will use after my year ends 12/31.
If you want better coverage without the hassle of many hours on the telephone or writing claims appeals letters, DON"T use GEHA!
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