Blocking a MAPD disenrollment to retain clients- is it legal??

[DonP]

I do the same thing. To begin with, I always have “permission to contact”- never cold call. So the people who are returning “request for information” cards must be looking for something potentially better. I always make changes for the better. If I can’t- I leave it alone. This is legal. Interfering with a disenrollment is not legal. I don’t make the rules- CMS does - and the rule is very clearly stated every year in AHIP training. If I am wrong, please show me the CMS rule that states it- but it’s not there. I wish it was. I also know there are many inappropriate changes being made. I also want to protect my book of business. Everybody does. It does look like CMS is requiring carriers to beef up their surveillance of inappropriate and illegal agent activity- and are requiring them to report it to CMS. I’m just looking for answers to the problem that are CMS approved.

You obviously work leads . Tell me how you’re going to call a lead and get that lead to sign an soa and make an appt for 48 hrs later ? You’ll get stood up 90% of the time ? Tell me how you’re going to fight call centers in 2024 that don’t have get an soa on inbound calls? Every single call will be coded inbound . The call centers will be lieing and cheating like crazy . As far as contacting future disenrollments “ they contacted me “ . I only try to save future disenrollments if they’ve been a client over a yr .You are correct in one thing . We don’t know how non compliance punishment changes as carriers must sent the most serious to keep track . My friend recruits . He has an agent that got 4 very serious complaints in 6 weeks were the clients “ had no idea the agent signed them up”. All he got was written warning . Will that be grounds for termination if cms see’s next yr . Also if cms gets involved in punishment next yr will getting terminated with one company cause you to lose all mapd contracts ? We don’t know these answers

 

[PCBI]

How stupid. I have had clients call the BCBS 1800 line and call me bak telling me they told my client they dont need an agent bc they do it all “in house” They proceed and change my client from one plan to another which I cannot get bak. My client is furious but I just say call me first bc this has happened numerous times.

Soon agents will all be “in house” protected by corporate. Mark this post

 

[RunnerDude]

All valid points. I am also searching for how to navigate around all the changes. If clients are calling- you- that’s great. I have many that call me too- but nor always. I’m thinking that most of these changes by CMS are aimed at trying to curtail the call centers - not really towards independent agents- but we are unfortunately getting caught in the crossfire.

 

[AgentGeneral]

How stupid. I have had clients call the BCBS 1800 line and call me bak telling me they told my client they dont need an agent bc they do it all “in house” They proceed and change my client from one plan to another which I cannot get bak. My client is furious but I just say call me first bc this has happened numerous times.

Soon agents will all be “in house” protected by corporate. Mark this post

Something definitely going on with BCBS. Thats the only one I really have a problem with losing clients. I'm furious today as a matter of fact over BCBS (not the 1st time, I've always had not a great experience with them dating back to early 2000s with U65) not going into detail but inhouse. Something is up for sure.

Humana has the best way to track. Easiest for me anyway out of 8 carriers.

Had a few taken by call centers. Called a lady recently for a 90 day check in. She said "oh I just switched to a plan that gives me $102 in my social security check" and $3000 in food benefit a year. I said "oh really? Can I stop by to go over that with you?" It was a call center. Yes, they lied to her.

She was not QMB+ but did have LIS and MSP. She didn't pay her Part B to begin with. Saved it.

As for BCBS, I am done with that carrier. Only when I absolutely have to will I write it. This has been the only carrier that has been losing clients for me, minus a few from Humana. And yes its inhouse doing it.

Pivot and move on. Changes are always a given. Roll with it, or do a different business.

The shady is real around here and not just in the call center realm. That's just one pot hole to try to avoid.

 

[selfgen]

I know many Medicare agents who make it a routine practice to monitor "pending disenrollments" from their book of business, and then call (or visit) the clients to dissuade them from enrolling into a different plan. They then contact the carrier (prior to the end of the month) to cancel the new application- thus maintaining the beneficiary on their personal book of business. Am I missing something about CMS regulations? It is my understanding that this practice is illegal. Every year I take the AHIP training, and it clearly states that this is an illegal practice. So how are agents getting away with doing this? I have heard agents say that they are entitled to perform a "QA visit" to determine the reason for the client's dissatisfaction. Others say that carriers "allow this practice" if the client was enrolled over the phone or they called after seeing a Medicare TV commercial. Still others say that it is not illegal if the new plan hasn't started yet. I don't recall reading anything about these exceptions in AHIP training or through CMS/Carrier information emails or letters. I have lost many clients to other agents over the years but have never attempted to block the disenrollment. If this is a legal practice, I need to change the way I am doing business. Would love to hear your thoughts.

Here are my thoughts on this:

I do this routinely. I have very high retention with my clients; they typically stay with me once they get with me. Most of my clients know that if they want to consider changing plans that they just need to call me.
However, some of my clients get duped by telemarketers into changing plans. It’s rare for one of my clients to upgrade their plan through another agent or a telemarketer. Most of the time, the plan that I enrolled them in is their best option.
So if one of my clients is changing plans with another agent, 95% of the time it’s a telemarketer and 95% of the time, the new plan is not a better option.
In 2023 alone, I have probably rescued 30 of my clients from telemarketers who were trying to enroll them into a “provider-sponsored” Humana plan with a very limited network of providers. 99% of the time the clients were not made aware that it was an entirely different network of providers than their current plan.
90% of the time the clients PCP was not even on the plan.
Telemarketers are out of control! I have had to clean up behind them all year long. It actually helps me because it creates a tighter bond between myself and my client, because they get to see me actually step in and fix a problem and get them back on the proper plan; they see that I’m looking out for them.
A lot of times the client is apologetic and swears that they won’t deal with telemarketers anymore.
So I am thankful that some carriers have this resource available to agents. I do not use this tool to go begging my clients to change their mind about switching plans. I use this tool to inform my clients that a telemarketer did not properly explain the plan’s benefits and that switching to the new plan would not be an upgrade; many of their providers are not on the new plan.

 

[RunnerDude]

Here are my thoughts on this:

I do this routinely. I have very high retention with my clients; they typically stay with me once they get with me. Most of my clients know that if they want to consider changing plans that they just need to call me.
However, some of my clients get duped by telemarketers into changing plans. It’s rare for one of my clients to upgrade their plan through another agent or a telemarketer. Most of the time, the plan that I enrolled them in is their best option.
So if one of my clients is changing plans with another agent, 95% of the time it’s a telemarketer and 95% of the time, the new plan is not a better option.
In 2023 alone, I have probably rescued 30 of my clients from telemarketers who were trying to enroll them into a “provider-sponsored” Humana plan with a very limited network of providers. 99% of the time the clients were not made aware that it was an entirely different network of providers than their current plan.
90% of the time the clients PCP was not even on the plan.
Telemarketers are out of control! I have had to clean up behind them all year long. It actually helps me because it creates a tighter bond between myself and my client, because they get to see me actually step in and fix a problem and get them back on the proper plan; they see that I’m looking out for them.
A lot of times the client is apologetic and swears that they won’t deal with telemarketers anymore.
So I am thankful that some carriers have this resource available to agents. I do not use this tool to go begging my clients to change their mind about switching plans. I use this tool to inform my clients that a telemarketer did not properly explain the plan’s benefits and that switching to the new plan would not be an upgrade; many of their providers are not on the new plan.

I wholeheartedly agree with you. However, AHIP doesn't seem to support interfering with a disenrollment. The language they use (per AHIP) is that an agent is not allowed to interfere with a disenrollment. This is what confuses me. I know you are doing what's right by the client, but where does it say this is acceptable practice in CMS guidelines. I just fear getting called out by CMS or a carrier.

 

[somarco]

If someone wants to leave, more often than not, the agent has not created enough VALUE to make the sale sticky.

Granted, many of the folks who would buy based on how much perceived "free stuff" is in the package may not be the type who will stick around long. More trinkets on the product, birthday and holiday cards probably won't overcome the ADD short attention span buyer.

If they were easily convinced to buy from you history will probably repeat when another silver tongued devil comes along with a slick sales pitch. They are susceptible to manipulation.

You are essentially offering the same product as everyone else but with ONE difference . . . YOU. Unless they see the value YOU bring to the table they will follow the next one that knocks on their door with a shinier product.

When they can move from one product to the next without barriers there really is no anchor to keep them. You have to figure out what makes them tick and give them what they want instead of focusing on what they need.

 

[RunnerDude]

Yes- that is true. But the question is- is it legal (by CMS standards) to contact the client in the process of disenrolling for the sole purpose of retaining the client (no matter how crappy the new plan is for the client)?

 

[somarco]

Yes- that is true. But the question is- is it legal (by CMS standards) to contact the client in the process of disenrolling for the sole purpose of retaining the client (no matter how crappy the new plan is for the client)?

If CMS says contacting the client in an attempt to dissuade them from disenrolling then I would suggest following their guidelines. While one may argue that the rules are not fair and that there is no way there are enough CMS police to enforce the rules, keep in mind that if you are caught there are penalties.

My block is 100% Medigap and I am not bound by marketing rules set forth by CMS. I can contact clients anytime without repercussion. I don't send bday cards or Christmas cards but I do send sympathy cards when a spouse dies.

If someone decides they want to change to another plan without telling me then I assume I have not done enough for them to value my advice. Many times they will call and ask if changing would be a better option. I use that opportunity to ask about their health and update their scripts (even if it is not AEP).

If they want a less expensive Medigap plan sometimes I can help them, sometimes not.

If they are considering MAPD then I suggest they make sure all their providers (including hospitals and clinics) are par providers for the plan they want. Some clients are on dialysis or infusion therapy and all of them accept OM but a MAPD PPO is a different story. In these situations I ask them if they have looked at their OOP for these services vs what they pay now.

My monthly newsletter does a lot of heavy lifting as far as goodwill is concerned. Almost every month someone will thank me for discussing a particular topic that was of interest to them.

I offer a product they can get from almost any agent or direct from the carrier. Not only is my product the same as everyone else but so is the premium. So the only way to distinguish myself from the others is to create VALUE through information and education.

Also, I don't sell on price but I do talk about market stability.

All these things resonate with my client base which makes it very stable.

 

[Chazm]

Sweet! Thanks, Pogo - 9 years contracted w/Humana and I have never known this. Appreciate it.

No way that tab is correct. I clicked on future terms and it shows 81 people. They list all the people that I have on Careplus. Maybe Careplus is the issue.