Received a grievance today…

[DonP]

I wondered this too...was there a POA, power of atty. In that case the POA fam member is all that's needed in Mi as far as I can tell.

One thing more I've wondered about is when the signatures on whatever platform is done, is location easily known on the other end? Like if she's in the client's house doing enrollment with agent on their device, isn't that address easily located upon submission of e-app? In this day and age it sure seems like that'd be plausible. And should be a thing if it's not.

The only carrier i deal with that needs an esig, or finger pad sig, is Humana.

Every other carrier I represent, just needs a typed in name. This is baffling to me...how they could prove who did it? he said, she said? I mean, I'm from old school. Even some carriers needing wet sigs back in the day...I try to get a paper app bc of my old school training most times, but not always feasible. I use Sunfire and all my carriers are in there. This though seems like it would always be wide open for problems.

My case was different but for what it's worth it took about a month....her side and my side in writing, copy of my form with her sig, case was closed. Was a bait and switch allegation.

I have seen though what OP is talking about even though it didn't happen to me, we have 45 agents in our Mi organization, it's happened and nothing come of it. Again, carrier prob makes a dif (heard UHC sticklers). One of the cases we had, was BCBSM switch to Priority during AEP, and back to BCBSM during OEP. Nothing came of it (at least to my knowledge and that agent still writing), no harm done, and client was easily back on what he wanted to be on. Client complaint was he didn't "ok" the switch to Priority in the first place. More to this, but not trying to write a book, I write too much as it is. In my POV, he did probably "ok" the switch, but then had buyers remorse. Glad it wasnt my issue to deal with but it was fine in the end.

You need to show in Good Faith you didn't do anything fraudulent. I get it, hard to do when we can just type in names while on appts. Unfortunately, you have to wait to see what will happen. But worry isn't going to change the outcome.

I imagine the carrier and investigator is what will make the difference in knowing, but it'd be impossible for any of us to know exactly how this will pan out. But worrying isn't going to help...if it were me, I'd go write another carrier until I know whats what. When you do know, plz let us know.

Sunfire allows all typed signatures on scope and enrollment wether face to face or virtual ? There’s no way to sign if Facebook to face ? Connecture a yr ago used to allow you to type name in virtual account n Humana . That’s gone now . With Connecture the client never signs of virtual . You email or text soa and enrollment to their phone. They click some acknowledgments but never sign it . Sure that changes with new cms bs . This is what happens when you have a zero premium item and guaranteed issue . Easy to flip a few times a yr . The incredible profitability of mapd as created a free for all with companies, agents ,Fmo’s and on and on .

 

[sshafran]

Sunfire allows the client to just type when in person. No email needed.

I wouldn't stop using it just because of this one bad experience.

Again, you have phone records where they set the appt. You have your calendar with the appointment. You have a SOA. You (should) have a mileage log.

You were there.
You explained the plan.
He signed.
He seemed cognitively capable.
End of story.

They can't pull your contract over this...

 

[AugustaMi]

Sunfire allows the client to just type when in person. No email needed.

I wouldn't stop using it just because of this one bad experience.

Again, you have phone records where they set the appt. You have your calendar with the appointment. You have a SOA. You (should) have a mileage log.

You were there.
You explained the plan.
He signed.
He seemed cognitively capable.
End of story.

They can't pull your contract over this...

This is what I think too.

Go through the motions and put it in past. Learn and grow.

 

[AugustaMi]

Sunfire allows all typed signatures on scope and enrollment wether face to face or virtual ? There’s no way to sign if Facebook to face ? Connecture a yr ago used to allow you to type name in virtual account n Humana . That’s gone now . With Connecture the client never signs of virtual . You email or text soa and enrollment to their phone. They click some acknowledgments but never sign it . Sure that changes with new cms bs . This is what happens when you have a zero premium item and guaranteed issue . Easy to flip a few times a yr . The incredible profitability of mapd as created a free for all with companies, agents ,Fmo’s and on and on .

Yep and here we all are. ha. Wild wild west. Ride it while it lasts I guess...I've seen way worse go unaccounted for...as if you are in this biz for even under a year and have your eyes open the stuff going on is so very apparent.

This is why that recording thing might actually happen and might actually be a good thing, dare I say. :-O No I won't like it, but I'll know without uncertainty my own ass is covered.

 

[DonP]

I’m with an integrity fmo . I was just playing with Sunfire on Medicare center . They allow the client to sign the soa on your iPad if face to face . Connecture doesn’t give you that option . Even in person you have to text or email the scope . Drugs look easier to list on Sunfire than Connecture

 

[AugustaMi]

I still have the yearning desire for the answer to the question: If the typed sig is done on location at the clients address if that would be easily known on the carrier side after the enrollment--the location the enrollment was done electonically at?. I know it's prob mute, but seems like it could/would be a thing and would easily make these issues non-issues.

I mean if I am anywhere I can ask Google my location and it tells me where I am coordinates and address....I tried this yesterday. lol.

 

[AugustaMi]

I’m with an integrity fmo . I was just playing with Sunfire on Medicare center . They allow the client to sign the soa on your iPad if face to face . Connecture doesn’t give you that option . Even in person you have to text or email the scope . Drugs look easier to list on Sunfire than Connecture

Never used Connecture, but definitely like Sunfire. Some things are "off" though (ex: sometimes I can't get the Aetna Eagle up or something when I clearly know it's in that county). or the Docs don't always show up. And I've heard Rx can be off. So sometimes it turns into a Think Agent thing, and for Humana I always use Vantage anyway....but HAP Priority BCBSM Sunfire is best for me.

I check every route available (eg. medicare.gov/The carrier site) to make sure whatever plan is right, including calling to double check docs. I do this simply bc some docs do show up, when the doc decided last week or something not to re-credential.

This is where I find MAPD market to be so different from any other market I've done. Not so much the plans themselves, just all the moving parts AND compliance crap/ certs/ AHIP. Stayed away for these reasons for so very long. It's not as bad as I thought, but the time on homework b4 an appt. I'm OCD on making sure whatever I'm doing is as sound as I can get it. I also do GTL for every client not on medicaid. Takes more time but worth it.

I'm thinking down the road to have office personnel do some of this, its so gd time consuming, it will be impossible with more than 400 clients.

I almost always get wet sig generic SOA now, bc I can and always see F2F new clients first appt. But again, as book grows won't always be feasible. Sunfire is rapid for e scopes...just a code and a text works.

 

[DonP]

Never used Connecture, but definitely like Sunfire. Some things are "off" though (ex: sometimes I can't get the Aetna Eagle up or something when I clearly know it's in that county). or the Docs don't always show up. And I've heard Rx can be off. So sometimes it turns into a Think Agent thing, and for Humana I always use Vantage anyway....but HAP Priority BCBSM Sunfire is best for me.

I check every route available (eg. medicare.gov/The carrier site) to make sure whatever plan is right, including calling to double check docs. I do this simply bc some docs do show up, when the doc decided last week or something not to re-credential.

This is where I find MAPD market to be so different from any other market I've done. Not so much the plans themselves, just all the moving parts AND compliance crap/ certs/ AHIP. Stayed away for these reasons for so very long. It's not as bad as I thought, but the time on homework b4 an appt. I'm OCD on making sure whatever I'm doing is as sound as I can get it. I also do GTL for every client not on medicaid. Takes more time but worth it.

I'm thinking down the road to have office personnel do some of this, its so gd time consuming, it will be impossible with more than 400 clients.

I almost always get wet sig generic SOA now, bc I can and always see F2F new clients first appt. But again, as book grows won't always be feasible. Sunfire is rapid for e scopes...just a code and a text works.

I believe in sunfire like Connecture you can check button” to see all available plans in area” . I’m writing as many as I can until Oct 1 until I see what the final compliance document is . If it’s super cumbersome I’ll spend much more time calling clients for the first few weeks for Retention. I think I can handle 800 mapd clients myself . I’m not far off . Non duals/lis rarely call . So I’m working toward mostly writing those clients during aep .

 

[DonP]

I agree about the dsnp . I got some good dsnp clients to . It’s not all bad . But it was a good place to start and I build my book fast . Good renewals will be there for a few yrs . But I’d like to get into t-65 seminars . Also I’m getting good ideas about partnering with 1000 or employee less hr depts . On some Facebook groups people are sharing their brochures to pass out to hr depts . But I think having a table at many places like festivals etc will attract 90% low income .

 

[axeman462]

ive had something like this happen before. As long as you did everything compliantly, and you have proof you are fine.
I think when it happened to me, the plan took me out to lunch, did some CYA training with it, had me sign something saying I did the training, and that was the end of it.