48hr Scope

[Tkruger]

Has anyone else noticed the contradiction between AHIP and the carriers?

AHIP question was client calls you (inbound call) on Dec 4th to change plan. Correct answer was get scope and schedule call for the next day.

Carrier X says inbound calls are not required to have the 48hr scope but out bound are.

Anyone have any further insight on this?

 

[policywunk]

Has anyone else noticed the contradiction between AHIP and the carriers?

AHIP question was client calls you (inbound call) on Dec 4th to change plan. Correct answer was get scope and schedule call for the next day.

Carrier X says inbound calls are not required to have the 48hr scope but out bound are.

Anyone have any further insight on this?

Inbound calls to carriers and call centers are excluded from this rule - not sure if it is because of technology they use or just because they have a lot of influence over CMS

 

[Tkruger]

Inbound calls to carriers and call centers are excluded from this rule - not sure if it is because of technology they use or just because they have a lot of influence over CMS

Nothing mentioned of this much discussed topic in the final rule. What I am saying is that AHIP is saying one thing....carrier training something else...

 

[Fisher]

AHIP question was client calls you (inbound call) on Dec 4th to change plan. Correct answer was get scope and schedule call for the next day.

You're stating that AHIP is saying that there is a 24-hour scope?

 

[Tkruger]

You're stating that AHIP is saying that there is a 24-hour scope?

As noted per the example:
Client calls you (inbound call) on Dec 4th to change plan. Correct answer was get scope and schedule call for the next day.

This I presume is the exception to the 48hr rule per CMS.

 

[Brad G]

The Final Rule was released during Spring and the AHIP training was published based on that. It is customary for CMS to further define their intended interpretations of their Final Rule as we get closer to AEP and the new selling year.

The Final Rule stated exceptions to the 48 hour Scope of Appointment when either a prospect drops by your office, kiosk, etc without a scheduled appointment or when a prospect is within the last 4 days of a valid election period. Hence December 4th would be within the last 4 days of AEP. In these cases, you could just complete the SOA and proceed.

However, two of my local Broker Managers from two major carriers have stated that upon clarification from CMS, a 48 hour SOA is not required for inbound telephone calls. This was NOT once mentioned in the AHIP training nor so far in my carrier certifications including United Healthcare and Scan. Both Agent Managers (one from Anthem and the other from Humana) have put this in writing regarding 48 hours not being required for inbound calls.

Ultimately, wre as Agents will be bound to whatever is stated in our contracts with the carriers though.

 

[Blaize]

I just finished the Wellcare/Centene certification. They had a slide with an SOA update which stated:

A Scope of Appointment must be obtained at least 48 hours prior to a scheduled personal marketing appointment or meeting, except in two situations:

1. When a beneficiary requests an appointment within four days of the end of a valid election period, including the AEP, OEP, SEP, ICEP, or the month, based on eligibility.
2. When a beneficiary inititates an unscheduled in-person meeting, inbound call, or otherwise.

Contacting a beneficiary at the individual's home without an appointment, even with a signed Scope of Appointment, is unsolicited door-to-door contact.

 

[Chazm]

Then why is the correct answer, get a SOA and schedule a call for the next day?
In the OPs scenario, they could get a SOA and conduct the apt.

 

[Brad G]

I know, I questioned that as well. I just completed the Anthem (Elevance) training and certification and the inbound call was also stated as an exception.

Regarding the Wellcare/Centene, what is meant by "or otherwise"?

 

[Fisher]

Regarding the Wellcare/Centene, what is meant by "or otherwise"?

I read that as being a Get Out Of Jail Free card. But I've been doing this long time and am probably a pretty bad influence so pay no mind to my nonsense.