Provider Network Overview
GEHA's network of providers is one of the largest in the nation and includes more than 6,500 hospitals and nearly 2 million in-network physician locations throughout the United States.
In-network cost savings
If you do not have Medicare A&B primary, choosing an in-network provider will save you money. You'll pay a single, low copay for in-network office visits. After you meet your deductible, you'll pay a small percentage of most medical expenses, after the in-network discount has been applied. If you see a provider outside the network, you'll pay a higher percentage of medical expenses.
If you have Medicare A&B primary, using an in-network provider will not change your benefits. Your GEHA benefits are the same whether you see a provider inside or outside the GEHA provider network.
- For complete information on benefits, see the GEHA Plan Brochure.
- For information on services and procedures that require precertification, click Authorizations/Precertifications.
- In-network benefits apply only when you use an in-network provider. If no in-network provider is available or if you do not choose an in-network provider, standard out-of-network benefits apply.
- GEHA does not guarantee the availability of every specialty in all areas, the continued participation of a provider in the GEHA network or the quality of any services provided by an in-network provider. In a few situations, a provider's practice may not accept new patients.
- GEHA benefits are provided only for services and supplies that are medically necessary. Some services from in-network providers may not be considered medically necessary and may not, therefore, be covered under your plan. For details, see the GEHA Plan Brochure.
- Professionals who provide services at in-network hospitals, such as radiologists, emergency room physicians, anesthesiologists and pathologists, may not be preferred providers. However, the plan allowable for services of emergency room physicians who are not preferred providers will be paid at the in-network rate if services are rendered at an in-network hospital.
- For claim forms or questions about a claim, please call GEHA at (800) 821-6136. To view your claims online, register for and use your member web account.
- If you do not find your provider in the network, you can nominate your provider for participation by completing a nomination form.
- Durable medical equipment (DME) providers listed on the website may not be eligible for in-network benefits. Services or equipment provided by a DME provider may not be covered. For information on DME providers in the network, call GEHA Customer Service at (800) 821-6136.
- It's always a good idea to check with your provider at the time of service to determine whether he or she is a participating provider.