Is it illegal for licensed insurance agents to process cancer screening test?

[AmberBurd]

He is an attorney?

Aetna also covers the genetic testing, see the link. BTW if you are NOT licensed and do NOT have AHIP or FWA, HIPPA and AML then you should NOT be doing this, that is why the other 2 companies (non compliant, won't mention names ) are NOT doing it, they had agents offering gift cards at health fairs swabbing everyone!!! and making up a cancer history on the forms!! They got busted. They ruin it for the rest of us do it legit! Just like MAPD and all of the rules that came about because of the bad apples!
Genetic Testing - Medical Clinical Policy Bulletins | Aetna

 

[Northeast Agent]

Aetna also covers the genetic testing, see the link. BTW if you are NOT licensed and do NOT have AHIP or FWA, HIPPA and AML then you should NOT be doing this, that is why the other 2 companies (non compliant, won't mention names ) are NOT doing it, they had agents offering gift cards at health fairs swabbing everyone!!! and making up a cancer history on the forms!!

Where does it say it's OK for AGENTS to perform the tests and be compensated is what the real questions are.

Is there any proof that agents are being paid?

I'm going to a DNSP training this Wednesday and am sure Aetna will be there, along with a bunch of other carriers. Rest assured, I'll ask the reps about this nonsense and put this damn silly thing to bed then. Just like I did with Humana.

 

[myinsurebiz]

He is an attorney?

no - anything but an Insurance Agent.

 

[Todd King]

Aetna also covers the genetic testing, see the link. BTW if you are NOT licensed and do NOT have AHIP or FWA, HIPPA and AML then you should NOT be doing this, that is why the other 2 companies (non compliant, won't mention names ) are NOT doing it, they had agents offering gift cards at health fairs swabbing everyone!!! and making up a cancer history on the forms!! They got busted. They ruin it for the rest of us do it legit! Just like MAPD and all of the rules that came about because of the bad apples!
Genetic Testing - Medical Clinical Policy Bulletins | Aetna

Did you actually read that article from Aetna? Did you see the criteria they have before they pay for it? They do say they will pay for it if it is "necessary". I'm just not sure how you, as an agent, can determine if someone is actually in need of this.

 

[AmberBurd]

Did you actually read that article from Aetna? Did you see the criteria they have before they pay for it? They do say they will pay for it if it is "necessary". I'm just not sure how you, as an agent, can determine if someone is actually in need of this.

I don't determine, the Doctor does, & YES I did read it and the point is that it must be medically necessary, I never said otherwise.

 

[Todd King]

I don't determine, the Doctor does, & YES I did read it and the point is that it must be medically necessary, I never said otherwise.

So, help me understand. In what order are things done? I though this was about swabbing just about everyone you come across that is on Medicare? If this is not so, then how do you determine who to swab?

 

[AmberBurd]

So, help me understand. In what order are things done? I though this was about swabbing just about everyone you come across that is on Medicare? If this is not so, then how do you determine who to swab?

Family history intake form or personal history, 3 generations of different types make the test a medical necessity. No targeting to just medicare folks

 

[AmberBurd]

Family history intake form or personal history, 3 generations of different types make the test a medical necessity. No targeting to just medicare folks

It is a a lot of detail that I wish not to discuss on this site.

 

[myinsurebiz]

So, help me understand. In what order are things done? I though this was about swabbing just about everyone you come across that is on Medicare? If this is not so, then how do you determine who to swab?

That is exactly what most are doing . . .

These tests are paid for only once in a lifetime - such a crock . . .

Won't be around by Thanksgiving.

 

[myinsurebiz]

It is a a lot of detail that I wish not to discuss on this site.

It ain't rocket science nor a secret . . . I researched many of the companies popping up. If carelumina exited the stage - won't be long before this pyramid crumbles.

I got $5 says CMS nixes this concept before Thanksgiving - maybe before Labor Day.