Looks like cms getting very serious on aca agent fraud . Those no call leads history

D

DonP

Guru
5000 Post Club
5,962

CMS Statement on Agent and Broker Marketplace Activity | CMS

CMS is committed to protecting consumers in the Marketplace. CMS has received reports of consumers in HealthCare.gov states whose coverage was switched by agents and brokers without their knowledge. In response, CMS is taking swift actions to protect consumers from unauthorized activity by...
www.cms.gov



There going after fraudulent agents and turning some into state ins depts and even law enforcement
 
Wow, 1/3rd of business stolen in the time it took me to make this post


NABIP outlined the following:

  1. This is the only market that agents don't send all applications for enrollment directly to the carrier. The carrier has little control over the process as applications are processed through Health Serpa whose technology holes that allows the use of BOTs. One GA had 7,000 of 20,000 enrollments switched in 3 minutes prior to the enrollment period ending.
  2. Need two stage authentication, first is to ensure consent, second is to ensure there isn't a BOT.
  3. We would endorse the use of a change order that is signed by the consumer substantiating the change request to reduce smaller entities from using access to the enrollment system, from switching consumers. CCIIO might benefit from why a consumer is requesting a switch to another plan, such as network adequacy or physician is no longer in the network. The form would be signed by the consumer and the agent, thus slowing down potential fraud.
 
Yagents said:
Wow, 1/3rd of business stolen in the time it took me to make this post


NABIP outlined the following:

  1. This is the only market that agents don't send all applications for enrollment directly to the carrier. The carrier has little control over the process as applications are processed through Health Serpa whose technology holes that allows the use of BOTs. One GA had 7,000 of 20,000 enrollments switched in 3 minutes prior to the enrollment period ending.
  2. Need two stage authentication, first is to ensure consent, second is to ensure there isn't a BOT.
  3. We would endorse the use of a change order that is signed by the consumer substantiating the change request to reduce smaller entities from using access to the enrollment system, from switching consumers. CCIIO might benefit from why a consumer is requesting a switch to another plan, such as network adequacy or physician is no longer in the network. The form would be signed by the consumer and the agent, thus slowing down potential fraud.
Click to expand...
I'm fighting with Ambetter right now as somebody rewrote one of my clients on march 28th the exact plan i wrote and changed their app from smoker to non smoker to cut their premium in 1/2 . I made no complaint on the agent as the customer could very easily have agreed to it to lower his premium . I do know outside the agent getting a 3 ways call to changed the aor( this could have happened but ambetter in 4 weeks has not told me that ) I'm fighting to get the aor back . But even if i get the aor back the other agents names will stay on the app and if no changes made this coming open enrollment the new agent will be the aor in 2025. It's like mapd . If you change the aor in the first yr of a policy the new aor gets no commission the first yr. But he will get the renewals
 
DonP said:
I'm fighting with Ambetter right now as somebody rewrote one of my clients on march 28th the exact plan i wrote and changed their app from smoker to non smoker to cut their premium in 1/2 . I made no complaint on the agent as the customer could very easily have agreed to it to lower his premium . I do know outside the agent getting a 3 ways call to changed the aor( this could have happened but ambetter in 4 weeks has not told me that ) I'm fighting to get the aor back . But even if i get the aor back the other agents names will stay on the app and if no changes made this coming open enrollment the new agent will be the aor in 2025. It's like mapd . If you change the aor in the first yr of a policy the new aor gets no commission the first yr. But he will get the renewals
Click to expand...
How many times do I have to tell you that Ambetter is the only company that does not charge a higher premium for smoking. The other agent did something else to the app to get AOR changed.
 
Yagents said:
How many times do I have to tell you that Ambetter is the only company that does not charge a higher premium for smoking. The other agent did something else to the app to get AOR changed.
Click to expand...
In Arizona and Fla your correct they don't charge for smoker . In many other states they do charge for smoker like Texas , Ga and Sc . It takes premium up 50- 100% . See Yagents you learned something today
 
Yagents said:
I thought you were talking about AZ client. What happened to the infamous Ambetter "agent lock"?
Click to expand...
It's non existent if agent gets client to do 3 way call to an ambetter customer service . Easy enough to do if you're not doing no call leads . " Mrs Johnson I'm putting you in better plan( He just flips 1 silver to another) But we have to call Ambetter right now and you tell them you want me to be there agent .
 
You must log in or register to reply here.

Similar threads

L
Oregon IMO for ACA
Replies
0
Views
44
Leslie W Stevens
L
marindependent
UnitedHealth under criminal probe for possible Medicare fraud, WSJ reports
Replies
0
Views
82
marindependent
marindependent
CJ Tibbs
Future with ACA ... Do agents have a place?
2 3
Replies
25
Views
2K
DonP
D
STIBROKER
Feds suspend ACA marketplace
Replies
1
Views
1K
Yagents
Y
M
Georgia Access-ACA
Replies
9
Views
2K
goillini52
goillini52

Latest posts

Back
Top