Provider Network Overview
GEHA's network of providers is one of the largest in the nation and includes more than 2.7 million in-network provider locations and over 9,300 hospitals.
In-network cost savings
Our fee-for-service plan offers services through a PPO. This means that we designate certain hospitals and other health care providers as “preferred providers.” We assign you a “home network” based on the state where you live. Your home network is listed on your GEHA ID card. Please refer to our GEHA Networks by State webpage to determine your home network.
The PPO organ/tissue transplant network for all members is LifeTrac. The PPO dialysis network for all members is the Preferred Outpatient Dialysis Network.
You have access to PPO providers inside and outside your home network. If you do not have Medicare A&B primary, when you use a PPO provider in your home network you are only responsible for the deductible, copayment and coinsurance for covered charges. When you use a PPO provider that is outside your home network (in a GEHA network listed above but not printed on your GEHA ID card), GEHA will pay a PPO benefit based on a contracted rate, negotiated amount or a billed charge. You are still only responsible for the deductible, copayment and coinsurance for covered charges. If you expect that you or a dependent will be residing outside of your home network for a temporary period of time, please contact GEHA for special assistance.
To find PPO providers, use this site's Provider Search or call GEHA at 800.296.0776. When you phone for an appointment, please remember to verify that the physician is still a PPO provider. GEHA providers are required to meet licensure and certification standards established by State and Federal authorities, however, inclusion in the network does not represent a guarantee of professional performance nor does it constitute medical advice.
You always have the right to choose a PPO provider or a non-PPO provider for medical treatment. When you see a provider not in the GEHA PPO network, GEHA will pay at the non-PPO level and you will pay a higher percentage of the cost.
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 Care 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.