Scope of Appointment Insanity

"I forgot"

In other words, I don't think most carriers really care that much.
I would assume they don't until a slight issue comes up,
also we have to remember who cuts the monthly renewals and also has the upper hand. So, with that being said I would not recommend anyone use "I forgot"
It might not work out to well in the end, better to be safe than sorry.
 
ACA_Aetna_CVS_Health_Logo
Brokers,

We are providing notification to all AetnaCVSHealth (“Aetna”) Individual & Family Plans producers/brokers/agents and their agencies (all the “Agents”) of the immediate implementation of a zero-tolerance policy for any behavior or activity that Aetna deems inappropriate or prohibited.

Like many carriers, we have seen the level of unacceptable activity and behavior in the producer pool for Individual & Family Plans increase. Due to these circumstances, we have made the decision to conduct a comprehensive, sweeping review of potentially prohibited agent activities. This includes the implementation of a process that could potentially result in Termination for Cause of any agents that are not able to provide proof of all required documentation.

Effective immediately, Aetna will be closely reviewing agent activity and will send a letter of inquiry to any agent that is affiliated with a member complaint that is filed through CMS, the state DOI or directly with Aetna.

A Termination for Cause will be triggered if either of the following occur:
  • The request is not fulfilled in a timely manner
  • The request is not fulfilled as requested or the documentation is not in compliance with Aetna and CMS requirements
Additionally, throughout this process we will be closely reviewing all forms of provided consent to verify authenticity and compliance. When submitting consents, please ensure that they adhere to the allowed CMS formats for documenting consumer consent. CMS documentation and consent requirements can be viewed at the following link:

https://www.cms.gov/files/document/2024-pn-ab-faq-9823.pdf

Your cooperation and understanding during this review period is appreciated. We understand that most of our broker partners are just that, good partners. However, we will not tolerate violations of our policies, and we will not hesitate to terminate, suspend, and/or cancel agreements and relationships for non-compliance.

Please contact us with any questions.

PLEASE DO NOT REPLY. This email box is not monitored.

FOR AGENT/BROKER USE. DO NOT DISTRIBUTE.

Health plans are offered or underwritten or administered by Aetna Health of California Inc., Coventry Health Plan of Florida, Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna® is part of the CVS Health® family of companies.
This material is for information only and is not an offer to contract. An application must be completed to obtain coverage. Information is believed to be accurate as of the production date; however, it is subject to change.
 
Better not have a complaint...

...Effective immediately, Aetna will be closely reviewing agent activity and will send a letter of inquiry to any agent that is affiliated with a member complaint that is filed through CMS, the state DOI or directly with Aetna.


I wonder what agents have been doing illegally?

EDIT: After rereading I think I know what's going on.
 
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Better not have a complaint...

...Effective immediately, Aetna will be closely reviewing agent activity and will send a letter of inquiry to any agent that is affiliated with a member complaint that is filed through CMS, the state DOI or directly with Aetna.


I wonder what agents have been doing illegally?

EDIT: After rereading I think I know what's going on.
It's all about that ACA crap. Stealing AORs.
 
Yup. I was first thinking Medicare plans but then realized it was ACA.

Probably forging their name on the consent form or just not filling one out.
Maybe that but mainly stealing AORs without the client's knowledge. They trick them into signing something. Not sure exactly how they're doing it but it's led to thousands of complaints and several law suits.

We had several guys on here pimping that crap last year and even earlier this year.

But they've been awful quiet the last few months.
 
Maybe that but mainly stealing AORs without the client's knowledge. They trick them into signing something. Not sure exactly how they're doing it but it's led to thousands of complaints and several law suits.

We had several guys on here pimping that crap last year and even earlier this year.

But they've been awful quiet the last few months.
Your boy Nick Williams is going as strong as ever. I’m getting pop up seminars he’s having left and right for no call leads .
 
ACA_Aetna_CVS_Health_Logo
Brokers,

We are providing notification to all AetnaCVSHealth (“Aetna”) Individual & Family Plans producers/brokers/agents and their agencies (all the “Agents”) of the immediate implementation of a zero-tolerance policy for any behavior or activity that Aetna deems inappropriate or prohibited.

Like many carriers, we have seen the level of unacceptable activity and behavior in the producer pool for Individual & Family Plans increase. Due to these circumstances, we have made the decision to conduct a comprehensive, sweeping review of potentially prohibited agent activities. This includes the implementation of a process that could potentially result in Termination for Cause of any agents that are not able to provide proof of all required documentation.

Effective immediately, Aetna will be closely reviewing agent activity and will send a letter of inquiry to any agent that is affiliated with a member complaint that is filed through CMS, the state DOI or directly with Aetna.

A Termination for Cause will be triggered if either of the following occur:
  • The request is not fulfilled in a timely manner
  • The request is not fulfilled as requested or the documentation is not in compliance with Aetna and CMS requirements
Additionally, throughout this process we will be closely reviewing all forms of provided consent to verify authenticity and compliance. When submitting consents, please ensure that they adhere to the allowed CMS formats for documenting consumer consent. CMS documentation and consent requirements can be viewed at the following link:

https://www.cms.gov/files/document/2024-pn-ab-faq-9823.pdf

Your cooperation and understanding during this review period is appreciated. We understand that most of our broker partners are just that, good partners. However, we will not tolerate violations of our policies, and we will not hesitate to terminate, suspend, and/or cancel agreements and relationships for non-compliance.

Please contact us with any questions.

PLEASE DO NOT REPLY. This email box is not monitored.

FOR AGENT/BROKER USE. DO NOT DISTRIBUTE.

Health plans are offered or underwritten or administered by Aetna Health of California Inc., Coventry Health Plan of Florida, Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna® is part of the CVS Health® family of companies.
This material is for information only and is not an offer to contract. An application must be completed to obtain coverage. Information is believed to be accurate as of the production date; however, it is subject to change.


Ohh Never mind its for information only
This material is for information only and is not an offer to contract. An application must be completed to obtain coverage. Information is believed to be accurate as of the production date; however, it is subject to change.


these disclaimers are crazy anymore
 
Maybe I am the last to find out about this, but...

The '25 UnitedHealthcare recertification training has this language in it, pertaining to home visits, or virtual or telephonic:
  • When during an appointment, a consumer or agent requests to discuss a health-related product not identified on the original SOA, a new SOA that identifies the new product must be obtained and a future appointment scheduled no less than 48 hours from the time when the SOA is obtained. This includes appointments for Medicare Supplement Insurance where the agent determines that an MA Plan and/or a PDP may be beneficial to the consumer, but was not identified in an SOA prior to the start of the appointment.
In the past, if one wanted to comply with the rules, during an appointment, whenever a client requested information on a product not originally indicated, we would write a new SOA and, in full compliance, continue with the appointment.

This new rule clearly says that if I drove 100 miles to meet with a client and his original SOA only specified PDP plans, and then he asks about MAPDs, I would need to execute a new scope, leave, and return two days later to continue the discussion. That's insane.

Is this a new CMS reg that I missed, or is this specific to UnitedHealthcare?

Lastly, is there anyone in his right mind who would do this?
Dude, this is why so many of us stick around for renewals only. I havent added any new clients since 2005. When the renewals dwindle to under 10 clients Im done w AHIP scam BS too. The end is coming with MAPD free Giveaway like OTC cards free dental silver sneakers ect ect. Its a generation stealing from another. The commissions being paid while in house agents have to take all the inquiries will eventually turn commission structure to $200.00. Like it was bf they opened it up to brokers.

Guaranteed 💀
 
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