Any Agents Suing Anthem for Unpaid Commisions

infoseeker

Super Genius
100+ Post Club
104
are there any Agents Suing Anthem for unpaid AEP Commisions? If so please forward me info for who i need my attorney to contact. thanks
 
I'd suggest before you go talking lawsuit against them, you dig out a copy of your agent contract and read what it says; (which I haven't done). My guess is there is language there that covers things like arbitration and plenty of pro-company language, including if you did file a suit you would be reimbursing them for legal fees, etc. Just a hunch here.

Anyway, read up before you do something like that.
 
are there any Agents Suing Anthem for unpaid AEP Commisions? If so please forward me info for who i need my attorney to contact. thanks

I found myself spending far too much time trying to get Anthem to pay me on senior business. I was owed on contracts as far back as Feb/Mar 2011.
If you badger them enough, you will eventually get paid.
Anthem now gets little of my senior business.
Plenty of other companies that pay commish correctly.
 
What state are you in? I have file a complaint with the CA Dept of Industrial Relations (Labor Board) I will prepare a complaint @ CMS for non compliant paymnt of renewal commissions. As well as the use of "AOR"
- - - - - - - - - - - - - - - - - -
[FONT=Arial Narrow","sans-serif]Please note that [/FONT][FONT=Arial Narrow","sans-serif]Anthem is NON-COMPLIANT WITH CMS GUIDELINES[/FONT][FONT=Arial Narrow","sans-serif], in the area of paying renewal compensation &the way Anthem has handled the use of the “agent of record” form.[/FONT]

“2011 CMS Medicare MarketingGuidelines – Agent/Broker Compensation guidelines”
Chapter 3 – MedicareMarketing Guidelines
For Medicare AdvantagePlans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, andSection 1876 Cost Plans (Rev.96, Issued: 5-17-11)
120.5.2 - Compensation Types
(Rev. 93, Issued:06-04-10, Effective/Implementation: 06-04-10)
42 CFR 422.2274(a) (3),423.2274(a) (3)

The regulations provide for two types of compensation -- initial compensation andrenewal compensation.

Initialcompensation is offered for the beneficiary’s initial year of enrollment in aplan. Renewal compensation is equal to fifty (50) percent of the initialcompensation amount and is paid in the five (5) years following a beneficiary’sinitial year of enrollment in a plan. It is also paid when a beneficiaryenrolls in a different plan but one that is a “like plan type” following theinitial year of enrollment.

120.5.4 - SpecificGuidance for Developing and Implementing Compensation Strategy
(Rev. 96, Issued: -5-17-11, Effective: 5-17-11, Implementation: 5-17-11) 42 CFR 422.2274(a),423.2274(a)

Following is specific guidancefor plan sponsors as they develop or modify their agent/broker compensationstrategy.

• CMS defines"year" as a plan year, meaning January 1 through December 31.

[FONT=Arial","sans-serif]For example, if a beneficiary turns 65 in and enrolls in a plan in September, thenthe initial year for that beneficiary ends on December 31st of that year, eventhough the beneficiary has only been in the plan for four (4) months. InJanuary of the next year, the plan would begin paying renewal payments to theagent that assisted this beneficiary.[/FONT]

When abeneficiary enrolls after January 1, the plan sponsor must pay the agent/brokerat the initial compensation level during that calendar year but may pay either the full compensation or a pro-rated amount based upon the number of months thebeneficiary was enrolled. The plan sponsor has the discretion to provide thiscompensation in a single payment or multiple payments at anytime during theyear. Compensation of the agent/broker for the remainder of the six (6)-yearcompensation cycle must be at the renewal compensation level. The renewalcompensation may also be paid at any time during each year of the cycle and maybe paid in a single payment or multiple payments.

• For the purpose of calculating compensation, the movement by a beneficiary from anemployer group plan to an individual plan (either within the same plan sponsoror between different plan sponsors) counts as an initial enrollment.

[FONT=Arial","sans-serif]•CMS does not differentiate between agents, brokers, general agents, generalagencies, TMOs, and distribution partners. It is the plan sponsor’sresponsibility to ensure that all of its contracted sales staff's compensationlevels abide by CMS rules.[/FONT]
 
Last edited:
Sorry it has taken me so long to get back to you. your reply was not emailed to me and just got back on the forum today. Wellpoint has not paid renewals or AEP business because they said my certifications were not complete till 2012 which is a complete falsehood. it shows i completed my MAPD certs in 8/31/2011 and my standalone part d 2012. my standalone Part d was completed in 2012. they claim i needed to do Part d in 2011. nowhere in writing on the certifications for Wellpoint does it say that. i fufill my CMS and product module required certifications.

Can they terminate me for suing them? what do you suggest? Thanks

Thanks Greg my email is [email protected]

What state are you in? I have file a complaint with the CA Dept of Industrial Relations (Labor Board) I will prepare a complaint @ CMS for non compliant paymnt of renewal commissions. As well as the use of "AOR"
- - - - - - - - - - - - - - - - - -
[FONT=Arial Narrow","sans-serif]Please note that [/FONT][FONT=Arial Narrow","sans-serif]Anthem is NON-COMPLIANT WITH CMS GUIDELINES[/FONT][FONT=Arial Narrow","sans-serif], in the area of paying renewal compensation &the way Anthem has handled the use of the “agent of record” form.[/FONT]

“2011 CMS Medicare MarketingGuidelines – Agent/Broker Compensation guidelines”
Chapter 3 – MedicareMarketing Guidelines
For Medicare AdvantagePlans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, andSection 1876 Cost Plans (Rev.96, Issued: 5-17-11)
120.5.2 - Compensation Types
(Rev. 93, Issued:06-04-10, Effective/Implementation: 06-04-10)
42 CFR 422.2274(a) (3),423.2274(a) (3)

The regulations provide for two types of compensation -- initial compensation andrenewal compensation.

Initialcompensation is offered for the beneficiary’s initial year of enrollment in aplan. Renewal compensation is equal to fifty (50) percent of the initialcompensation amount and is paid in the five (5) years following a beneficiary’sinitial year of enrollment in a plan. It is also paid when a beneficiaryenrolls in a different plan but one that is a “like plan type” following theinitial year of enrollment.

120.5.4 - SpecificGuidance for Developing and Implementing Compensation Strategy
(Rev. 96, Issued: -5-17-11, Effective: 5-17-11, Implementation: 5-17-11) 42 CFR 422.2274(a),423.2274(a)

Following is specific guidancefor plan sponsors as they develop or modify their agent/broker compensationstrategy.

• CMS defines"year" as a plan year, meaning January 1 through December 31.

[FONT=Arial","sans-serif]For example, if a beneficiary turns 65 in and enrolls in a plan in September, thenthe initial year for that beneficiary ends on December 31st of that year, eventhough the beneficiary has only been in the plan for four (4) months. InJanuary of the next year, the plan would begin paying renewal payments to theagent that assisted this beneficiary.[/FONT]

When abeneficiary enrolls after January 1, the plan sponsor must pay the agent/brokerat the initial compensation level during that calendar year but may pay either the full compensation or a pro-rated amount based upon the number of months thebeneficiary was enrolled. The plan sponsor has the discretion to provide thiscompensation in a single payment or multiple payments at anytime during theyear. Compensation of the agent/broker for the remainder of the six (6)-yearcompensation cycle must be at the renewal compensation level. The renewalcompensation may also be paid at any time during each year of the cycle and maybe paid in a single payment or multiple payments.

• For the purpose of calculating compensation, the movement by a beneficiary from anemployer group plan to an individual plan (either within the same plan sponsoror between different plan sponsors) counts as an initial enrollment.

[FONT=Arial","sans-serif]•CMS does not differentiate between agents, brokers, general agents, generalagencies, TMOs, and distribution partners. It is the plan sponsor’sresponsibility to ensure that all of its contracted sales staff's compensationlevels abide by CMS rules.[/FONT]
- - - - - - - - - - - - - - - - - -
Im in NJ but the commsions are for OH.

Sorry it has taken me so long to get back to you. your reply was not emailed to me and just got back on the forum today. Wellpoint has not paid renewals or AEP business because they said my certifications were not complete till 2012 which is a complete falsehood. it shows i completed my MAPD certs in 8/31/2011 and my standalone part d 2012. my standalone Part d was completed in 2012. they claim i needed to do Part d in 2011. nowhere in writing on the certifications for Wellpoint does it say that. i fufill my CMS and product module required certifications.

Can they terminate me for suing them? what do you suggest? Thanks

Thanks Greg my email is [email protected]
 
Last edited:
Look at your contract. It will probably state what you agreed to do in the event of a dispute on comm's. Like Arbitration, or such. Check it out first.

I've had similar issues with Anthem regarding comm's and certification dates. I had a few cases that I re-wrote from one plan to another, MAPD that had a more comprehensive forumlary and 0 co-pay for pcp. They issued a new ID card to client with same policy number as old and stated since I wasn't certified at the inception of the clients MA contract, (like 08' or 09') that they wouldn't/couldn't pay a comm due to CMS rules (BS). They did install me as AOR. One would think that it would be one way or the other, can't pay and can't be AOR, or be the AOR and get paid. Screwed up deal.

Anyway, I have read CMS guidelines for payment of comm's and nowhere in that reg does it say they can't pay for such a thing. So as it is they avoid paying the former rep due to the re-write, and they refuse to pay me because of the re-write.

I think the risk you run if you were to file suit is you could be paying for their Atty costs, so be very careful there.
 
Last edited:
To the original poster:

First step is to hire an attorney. If you can't afford one, hire one from Legal Shield (formerly PrePaid Legal).

Second step is to call them and give them the specifics of your case.

Third step is to fax/email them the paperwork that supports your claim(s).
 
If you are in fact owed these commissions, if you badger Anthem enough, you will eventually get paid.

And man do you have to badger them. I'm still working on two Med Supps that were issued last June. I didn't realize until January that I hadn't been paid on them. Still trying to get it resolved.

If you have a sales rep, don't bother enlisting them for their help. They are virtually useless. A true waste of money for the company.
 

Latest posts

Back
Top