GEHA - Provider Search - PPO Network Overview

Provider Search > PPO Network Overview

GEHA's preferred provider organization (PPO) is one of the largest in the nation and includes more than 4,200 hospitals and 650,000 participating provider locations.

PPO Cost Savings

If you do not have Medicare A&B primary, choosing a PPO provider will save you money. You'll pay a single, low copay for PPO office visits. After you meet your deductible, you'll pay a small percentage of most medical expenses, after the PPO 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 a PPO provider will not change your benefits. Your GEHA benefits are the same whether you see a provider inside or outside the GEHA PPO network.

Important reminders:

For complete information on benefits, see the GEHA Plan Brochure.

Click here for services and procedures that require precertification.

PPO benefits apply only when you use a PPO provider. If no PPO provider is available or if you do not choose a PPO provider, standard non-PPO 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 a PPO 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 PPO providers may not be considered medically necessary and may not, therefore, be covered under your plan. For details, see your Plan Brochure.

Professionals who provide services at PPO 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 PPO rate if services are rendered at a PPO hospital.

For claim forms or questions about a claim, please call GEHA at (800) 821-6136. To view your claims online, register for Member Web Services 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 PPO 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.