CMS Compliance

[mariemerganser]

If a prospect solicates you (the agent) via phone as they either found your number online or through some other marketing source what are the rules? Let's assume the caller calls in and says "I would like to get some information on Medicare Advantage plans". Are you allowed to talk about every plan you offer and help them narrow down the search? Does the call have to be recorded? What needs to be tracked? Etc. Any feedback would be appreciated.

 

[wilkin]

You can give them general information over the phone, but anytime you present a MA plan you must go through all the material in the company sales kit, i.e. outline, disclosures, etc. You could not do that over the phone without first sending them the kit.

Whether you do a presentation by phone or in person, I believe you could compare different plans as long as you go through all sales kit materials from each plan.

 

[jdeasy]

If a prospect solicates you (the agent) via phone as they either found your number online or through some other marketing source what are the rules? Let's assume the caller calls in and says "I would like to get some information on Medicare Advantage plans". Are you allowed to talk about every plan you offer and help them narrow down the search? Does the call have to be recorded? What needs to be tracked? Etc. Any feedback would be appreciated.

Here is what one company, UHC, put out about that;

Situation; A beneficiary calls the agent in response to advertising, word-of-mouth or other information:

Acceptable Actions:
-Needs assessment
-Present any product

Acceptable Outcomes
-Immediate sale
-Schedule an in-home appointment {Requires scope of appointment documentation}
-Schedule attendance at a sales event
-Follow-up {send sales kit, schedule future activity or call}

Future permission to call
-For inbound calls, permission is automatically granted with no product restrictions as long as the inbound call is related to MA/PDP.
-Permission to call "duration" rules apply
-Caller may revoke permission to call

 

[GreenSky]

Here is what one company, UHC, put out about that;

Situation; A beneficiary calls the agent in response to advertising, word-of-mouth or other information:

Acceptable Actions:
-Needs assessment
-Present any product

Acceptable Outcomes
-Immediate sale
-Schedule an in-home appointment {Requires scope of appointment documentation}
-Schedule attendance at a sales event
-Follow-up {send sales kit, schedule future activity or call}

Future permission to call
-For inbound calls, permission is automatically granted with no product restrictions as long as the inbound call is related to MA/PDP.
-Permission to call "duration" rules apply
-Caller may revoke permission to call

Maybe we should all hire a fulltime, in-house compliance director to be certain we follow all of these ridiculous rules.

I intend to help my prospects and clients in the best way I know how. There isn't a chance in hell that any agent will be in compliance the majority of the time.

Rick

 

[retread]

You can give them general information over the phone, but anytime you present a MA plan you must go through all the material in the company sales kit, i.e. outline, disclosures, etc. You could not do that over the phone without first sending them the kit.

Whether you do a presentation by phone or in person, I believe you could compare different plans as long as you go through all sales kit materials from each plan.

I believe you are correct. The only caveat I would add is, you must get a recording of the inbound permission to make the appointment.

If you are not making an appointment, but an inbound sale, I would still record a statement from the caller prior to beginning my presentation. CMS has not thought through how agents field sales, so they have not addressed this particular issue sufficiently. Another post describing UHC's take on this seems reasonably designed to appease CMS.

 

[GreenSky]

The only sensible solution is to ignore this bullshit.

Rick

 

[mariemerganser]

So, if callers call in to us and want information we can review plans and then do the enrollment all in one shot over the phone? Seems as though the compliance rules really only affect the people who sit with clients face to face and/or do traditional ways of marketing.

 

[allhealthandlife]

Maybe we should all hire a fulltime, in-house compliance director to be certain we follow all of these ridiculous rules.

I intend to help my prospects and clients in the best way I know how. There isn't a chance in hell that any agent will be in compliance the majority of the time.

Rick

I wonder how many complaints come from agents being dishonest vs. many old people's inability to comprehend new concepts.

I have learned the hard way that even if you go slow and repeatedly ask the old person if they understand some will say yes just to be polite even though they don't have a clue.

CMS started this fire they should be responsible for administering a standardized private Medicare maze aptitude test to all Medicare beneficeries so that we can be safe that we are dealing with seniors that are up to the challenge to begin with.

 

[Non-golfing Agent]

They expect so much of us.

Isn't it nice to know they're cutting our commissions and we probably won't see any commissions deposited into our accounts until January because CMS and our politicians have absolutely ZERO consideration for us?

Thanks, Representative Marx!!!

 

[jdeasy]

I wonder how many complaints come from agents being dishonest vs. many old people's inability to comprehend new concepts.

I have learned the hard way that even if you go slow and repeatedly ask the old person if they understand some will say yes just to be polite even though they don't have a clue.

CMS started this fire they should be responsible for administering a standardized private Medicare maze aptitude test to all Medicare beneficeries so that we can be safe that we are dealing with seniors that are up to the challenge to begin with.

That happens quite a bit. I had a situation earlier this year on a preset appointment for Wellcare for a medicare/medicaid person. When I got to the appointment, the lady wouldn't open the door, just kept hollering at me, "what do you want" thru the door. I finally got her crack open the door and told her that I was to see her at 2:00. She said she knew nothing about it. I told her the appointment was just set 24 hours ago. She still didn't remember, but, invited me in. When I sat down at the kitchen table, there was a Wellcare brochure and app sitting there. I asked her what that was for and she didn't know. I asked her if I could look at it and she gave me permission. It was a completed app for Wellcare Duet that she had enrolled in the day before. I asked her about and she had no clue about what she had done. I asked her about getting on the phone with Wellcare and completing the app with the agent present. She said she remembered a "little" about doing that. She would have enrolled again with me that day if I had not seen the other app.

I'm sure that when they did the verification call, the lady could not complete it. Is the agent the one to blame there? She may have been more lucid the day before when he was there. She certainly had to complete the enrollment call as this was in May and Wellcare had mandated only teleapps and there was a confirmation number on the app he left there.

Who knows? The lady may have scheduled an appointment with another agent after me as well.