Aetna will not verify my Dual Complete QMB applicants

[wehotex]

Usually these go through without issue since they’ve always verified them. Now, the local agent manager told me that I need to get a valid Eligibility letter from the prospect to put it through!
When I mentioned that other carriers are accepting them, she brought up that CMS informed the MA carriers that Marx is inaccurate and that Aetna is “very conservative”. Has anyone had this same issue with Dual verification?

 

[straightnochaser]

Usually these go through without issue since they’ve always verified them. Now, the local agent manager told me that I need to get a valid Eligibility letter from the prospect to put it through!
When I mentioned that other carriers are accepting them, she brought up that CMS informed the MA carriers that Marx is inaccurate and that Aetna is “very conservative”. Has anyone had this same issue with Dual verification?

Aetna is the only carrier requiring that letter, once medicaid checks go back online I would just resubmit the deal. For some reason they don't want to do the backend work the other carriers are doing, but get this... they are still sending out materials, our agency signed someone up last month and she got her cards, her food card etc and it all works but the plan isn't visible in CMS... Overall its a shitshow

 

[wehotex]

One agent manager blamed it on CMS declaring that Marx is not a reliable verification system and that Aetna had to use another one.
Another one told me that their contracted verification partner had been hacked and that they had to put another one online. She told me that it affects 3-1-24 effectives mostly and that a 4-1-24 effective would be good-to-go unless I receive an email requesting more information. It has been 5 working days since I submitted 2 DSNP apps, neither of which is showing up in Marx. I was told to call her this coming Tuesday if they are not appearing.

 

[DonP]

Bs . I did 4 United dsnps last week . All issues in 48 hrs . I did 2 Aetna dsnps March 3rd . For 10 days it wasn’t showing under pending . I called fmo to check on it . 4 days later it appeared and a few days later approved. Get your fmo to call and apply pressure. I called myself several times and nothing happened. Anthem is the only carrier that can verify Medicaid level AND give you Medicaid #. But ti be fair I moved Aetna hmo dsnps to ppo dsnps so that could be why they went through . Humana regional told me Friday they heard could be another month before verification back online

 

[wehotex]

Bs . I did 4 United dsnps last week . All issues in 48 hrs . I did 2 Aetna dsnps March 3rd . For 10 days it wasn’t showing under pending . I called fmo to check on it . 4 days later it appeared and a few days later approved. Get your fmo to call and apply pressure. I called myself several times and nothing happened. Anthem is the only carrier that can verify Medicaid level AND give you Medicaid #. But ti be fair I moved Aetna hmo dsnps to ppo dsnps so that could be why they went through . Humana regional told me Friday they heard could be another month before verification back online

What was the explanation that they gave you? Is Humana also having the same issue? I will contact the FMO contact for Aetna on Monday.

 

[DonP]

What was the explanation that they gave you? Is Humana also having the same issue? I will contact the FMO contact for Aetna on Monday.

No explanation. Humana’s take 5-7 days . United is incredible. Getting approvals on dsnps in 48 hrs

 

[GoPokes]

I too have had several issues with Aetna this year. Several PDP's denied, saying no valid SEP, when there clearly is one. Making it more frustrating, if I send those same PDP directly through medicare dot gov, with the same SEP, they approve it.

I have a DSNP pending with aetna now. We'll see where it goes.

I would also like to know why UHC can get just about any application approved in less than 24 hours, whereas the other big carriers take days, or more than a week

 

[wehotex]

I too have had several issues with Aetna this year. Several PDP's denied, saying no valid SEP, when there clearly is one. Making it more frustrating, if I send those same PDP directly through medicare dot gov, with the same SEP, they approve it.

I have a DSNP pending with aetna now. We'll see where it goes.

I would also like to know why UHC can get just about any application approved in less than 24 hours, whereas the other big carriers take days, or more than a week

I called my upline’s product specialist today to verify how Aetna will fix these? She said that she is currently working on a 3-1-24 effective who actually has the QMB award letter and is still waiting.
A few years ago, a UHC Director cockily told our group of different MA carriers that his company made no apologies for investing so much into their computer systems.
In a lot of ways, UHC is way ahead of the others in making things simpler for the agent including enrollment materials, easy Voice Signature app, member Service’s rapid response for members and ability to look up BOB in Jarvis and even order an ID card on member’s behalf. I think that UHC likes to spend its money on all of those things.

 

[DonP]

United’s speed to approve mapd is off the hook . Many approvals i see in 12-24 hrs usually 48 hrs max . Humana min approval time window 3 days and mostly 4 and sometimes 5-6 . Aetna 2-4 days .

 

[straightnochaser]

Aetna just sent an email saying all functionality is back, thinkagent should be good to go in a day or two and they will be verify eligibility for all plans submitted this month.