Remaining the AOR
- Thread starter rugerred
- Start date
- 8,448
Friday, 2-27-2015
Advice: Before assuming Agent of Record status for an insured that you did not assist in enrollment, interview thoroughly.
In December 2014, I was by a non-IL-licensed broker to a lady who accidentally enrolled on at this broker's Sherpa site. I called, introduced myself and sent her my contact info just in case she had questions, or needed assistance.
Today her husband calls me. He's almost in tears because the wife is suffering from what he believes to be food-poisoning, and the BCBSIL HMO plan she enrolled in is not accepted by any doctor or hospital within 100 miles of their rural Illinois home.
I advised him to call HealthCare.gov, explain the problem, her immediate need for care, and ask for a BCBSIL PPO. He called today, and they moved her to one, effective 3/1/2015. Cost is $240 a month more, but they're OK with that of course. She's going to try and get through tomorrow, then visit the Hospital on Sunday 3/1.
But here's what we need to watch out for. The Marketplace assumed that because my name is on her file as AOR, that I gave her bad advice. Jerry (the husband) had to tell them twice that his wife purchased the policy on her own while surfing the net. Finally, the Marketplace Call Center guy accepted this, and processed a SEP enrollment based on customer error. (It's too bad we can't do SEP's for this reason, isn't it?)
In summary, before assuming the Agent of Record status for anyone that you did not personally help enroll, be certain to ensure that this person/family has the appropriate health plan.
-Allen
p.s. HC.gov probably removed my AOR status, but that's OK. This referral will be 65 in May and going on Medicare/MedSupp. I'll follow-up on Monday to see if she's OK. Nice couple.
Advice: Before assuming Agent of Record status for an insured that you did not assist in enrollment, interview thoroughly.
In December 2014, I was by a non-IL-licensed broker to a lady who accidentally enrolled on at this broker's Sherpa site. I called, introduced myself and sent her my contact info just in case she had questions, or needed assistance.
Today her husband calls me. He's almost in tears because the wife is suffering from what he believes to be food-poisoning, and the BCBSIL HMO plan she enrolled in is not accepted by any doctor or hospital within 100 miles of their rural Illinois home.
I advised him to call HealthCare.gov, explain the problem, her immediate need for care, and ask for a BCBSIL PPO. He called today, and they moved her to one, effective 3/1/2015. Cost is $240 a month more, but they're OK with that of course. She's going to try and get through tomorrow, then visit the Hospital on Sunday 3/1.
But here's what we need to watch out for. The Marketplace assumed that because my name is on her file as AOR, that I gave her bad advice. Jerry (the husband) had to tell them twice that his wife purchased the policy on her own while surfing the net. Finally, the Marketplace Call Center guy accepted this, and processed a SEP enrollment based on customer error. (It's too bad we can't do SEP's for this reason, isn't it?)
In summary, before assuming the Agent of Record status for anyone that you did not personally help enroll, be certain to ensure that this person/family has the appropriate health plan.
-Allen
p.s. HC.gov probably removed my AOR status, but that's OK. This referral will be 65 in May and going on Medicare/MedSupp. I'll follow-up on Monday to see if she's OK. Nice couple.
- 8,448
I experienced HMO trouble with a couple of clients in 2014, Ann. During the enrollment assessment, I was only looking to see if their Primary Physician and local Hospitals were in the HMO network. Due to my short sightedness, they were not able to obtain referrals to Specialist physicians within a reasonable driving distance. Never have been a fan of HMOs, but Now I try even harder to dissuade applicants from choosing them. So far this year, 100% success.
- 1,227
There is an Agent of Record form you can get from the new insurance carrier with the provision you are appointed with them, of course. It is all the same information you got from the client to initially enroll that person. And yes, you want to make sure you want this client and they want you as previously recommended. You either email or fax it to the insurance company right away. (I know this information is a little late; for future reference, though.)
Here's my question...
Isn't there something in place for the zip code? How did sherpa/hc.gov/bcbsil allow a zip code to be used that doesn't have HMO coverage? Are the coverage rules a "Texas Thing"? I've got a county 10 miles east of me that didn't have enough docs, so you can't get the UHC HMO. So where is the disconnect? Did I miss something?
Isn't there something in place for the zip code? How did sherpa/hc.gov/bcbsil allow a zip code to be used that doesn't have HMO coverage? Are the coverage rules a "Texas Thing"? I've got a county 10 miles east of me that didn't have enough docs, so you can't get the UHC HMO. So where is the disconnect? Did I miss something?
- 8,448
Just now, I entered the zip code where this client lives into Health Sherpa. It doesn't show any HMO, or Narrow Network BCBSIL plan choices. How she was able to buy it on her own from Health Sherpa in early December is a mystery to me, KGMom.
Most likely, something was programmed incorrectly at that time, which is why this client was able to call in the HC.gov on 2/27/15 and change plans, with no resistance from the call center representative.
- 1,745
Yes, just a week or so ago. I have a referral who is divorcing a bad actor, can't afford insurance without a subsidy, and hasn't filed a joint return in a while. Rep at HC.gov, unlike some I encountered last year who in talking about a similar situation were saying if the person would be divorced for sure before the end of the year, go ahead and say single.
Won't be finalized for 3 more months.
- 335
When you refer to "the new fast application", what are your pointing to?
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