AOR issue

[fishfortwo]

I have a couple that have been on a local carrier for their MAPD for a couple of years. Someone got in the door and wrote them in a National carrier for AEP. A different agent saw them on December 13th. and said they should be in the plan that I had them in and used an SEP-Disaster to write them in that plan. Their plan never terminated. The local carrier said that because they made a choice to change plans in AEP that I was no longer the AOR.

I know the Green Mafia would still have me as AOR if they were in that carrier's plan and this happened. I know SEPs have priority, but the plan never terminated that they were on. I think this is happening because the local carrier is not too sharp on CMS rules, as we have had issues in the past with these types of situations.

I just wanted to get the forums input on this to see if I am missing something and they are correct or not.

 

[DonP]

Your carriers correct . During aep it’s last app in . It works differently than other times of yr. During aep the app that was written knocked your plan out for Jan 1st . The guy that came in Dec 13th with your same plan using a dst knocked the aep app out not your orginal plan . So it’s like your plan was terming Jan 1st no matter what . Many call centers will replace an agents good plan during aep and turn around before aep ends and rewrite the exact same agents plan . He now becomes the Jan 1st Aor even thought it was your same plan before aep started . Now if that exact same thing happened during oep when the second agent wrote your exact plan the Aor reverts back to you .I just learned how the Aor gig works during aep this yr. I wrote a lady a ppo during aep . In mid Dec i saw it came off my bob work Aetna . I checked Marx system and damm it’s the plan I wrote why am I not the Aor ? I call up Aetna . From my app on Oct 24 th 4 more apps were submitted on her . It just so happened the 4 th app was the same plan I wrote . Even though the last app was the same plan I wrote my app was knocked out . Now if that happened during oep the 4th all written which was the plan I wrote would have reverted back to me . But during aep no it’s truely the last app in . That said during aep that 1st agent could not have written your same plan . It would have been duplicate. But once he wrote a different app to replace your members plan it starts a free for all ant it’s truly “ last app in “

 

[fishfortwo]

Not the answer I was hoping for, but it makes sense. Thanks for the reply.

 

[goillini52]

I have a couple that have been on a local carrier for their MAPD for a couple of years. Someone got in the door and wrote them in a National carrier for AEP. A different agent saw them on December 13th. and said they should be in the plan that I had them in and used an SEP-Disaster to write them in that plan. Their plan never terminated. The local carrier said that because they made a choice to change plans in AEP that I was no longer the AOR.

I know the Green Mafia would still have me as AOR if they were in that carrier's plan and this happened. I know SEPs have priority, but the plan never terminated that they were on. I think this is happening because the local carrier is not too sharp on CMS rules, as we have had issues in the past with these types of situations.

I just wanted to get the forums input on this to see if I am missing something and they are correct or not.

Did you try to replace it during OEP?

 

[fishfortwo]

They are in the correct plan that I originally put them in. There is nothing I would change them to for OEP. I am just not the AOR now.

 

[NumbersGuy]

Depending on the carrier you may be able to become AOR again without rewriting. Some will accept a letter from the member asking you to be AOR. Worth reaching out to the carrier to see what their process is.

 

[DonP]

Depending on the carrier you may be able to become AOR again without rewriting. Some will accept a letter from the member asking you to be AOR. Worth reaching out to the carrier to see what their process is.

Aetna and WellCare will change the Aor now but he won’t get any commission until 2025 .

 

[StephanieCJ]

In Louisiana, carriers are required to accept AOR requests, even if they have a national policy otherwise. I do not, however, think that is the case in most states.