David Taylor Jr
Guru
- 295
Casual conversation to setup an appointment? YES! If they want to talk about it then and there just have them fill out an SOA since there is no longer the 48 hour requirement. You complain way too much.
Last edited:
CMS violation during AEP and lose your book of business
- Thread starter PCBI
- Start date
- Thread starter
- #12
PCBI
Guru
- 483
- 16,884
I had a call from CMS one time investigating a complaint. It was on a medication that the customer was complaining to the RX company that they wouldn't cover his name brand he was fighting going through step therapy to see if he could take the generic. He just didn't want to take the generic. His complaint was not about me at all because I told him from the begining that none of the RX plans were covering the name brand because the generic was available and much cheaper.
But during the call with CMS they asked me how I KNEW that none of the RX plans were not covering the name brand. I told them I plugged it in to the Medicare.gov RX look up tool. (Don't EVER say that to CMS.) The Medicare.gov RX tool is not compliant. You are required to look up the RX's on the insurance company's RX look up tool not Medicare.govs. They said the Medicare.gov one is never as accurate as the company ones are and it is not acceptable for agents to use it. They made a big stink about me admitting to using that but did not write me up for a violation.
I know that 99.9% of agents use the Medicare.gov RX lookup. But just be aware that it is considered non-compliant and is just intended for "initial consumer research" not the "final RX lookup by an agent" as far as CMS is concerned.
But during the call with CMS they asked me how I KNEW that none of the RX plans were not covering the name brand. I told them I plugged it in to the Medicare.gov RX look up tool. (Don't EVER say that to CMS.) The Medicare.gov RX tool is not compliant. You are required to look up the RX's on the insurance company's RX look up tool not Medicare.govs. They said the Medicare.gov one is never as accurate as the company ones are and it is not acceptable for agents to use it. They made a big stink about me admitting to using that but did not write me up for a violation.
I know that 99.9% of agents use the Medicare.gov RX lookup. But just be aware that it is considered non-compliant and is just intended for "initial consumer research" not the "final RX lookup by an agent" as far as CMS is concerned.
- 4,707
Like Newby said above. Medicare.gov updates formularies twice per year! Once in the fall and again in the winter. Carriers update regularly.
David Taylor Jr
Guru
- 295
Oh brother, what facts?
The complaining is hilarious.Clients that I have on an a MAPD call me during AEP. I ask how their plan has been. If they like it and if I know the plan hasn’t changed at all or got better I let them know they don’t have to do anything.
The company is sending them a ANOC with their changes. All is good, no scope needed.
Client on MAPD calls me during AEP and I know their plan is having big changes or they don’t like their plan? I set an appt, go to their home, sign a scope and show them a new plan right there.
It’s not hard. You don’t need a scope prior to the appt, just prior to talking about a particular plan and it’s options.
You’re supposedly 82 correct? Why not just retire into the sunset. It’s seem to be needed
David Taylor Jr
Guru
- 295
Exactly what I was saying and he tries to make me feel like an *** but he clearly does not seem to know what is going on anymore. Agree, just retire man.
Clients that I have on an a MAPD call me during AEP. I ask how their plan has been. If they like it and if I know the plan hasn’t changed at all or got better I let them know they don’t have to do anything.
The company is sending them a ANOC with their changes. All is good, no scope needed.
Client on MAPD calls me during AEP and I know their plan is having big changes or they don’t like their plan. I set an appt, go to their home, sign a scope and show them a new plan right there.
It’s not hard. You don’t need a scope prior to the appt, just prior to talking about a particular plan and it’s options.
You’re supposedly 82 correct? Why not just retire into the sunset. It’s seem to be needed
- Thread starter
- #18
PCBI
Guru
- 483
Great post. Many agents use medicare.gov
- Thread starter
- #19
PCBI
Guru
- 483
Clients that I have on an a MAPD call me during AEP. I ask how their plan has been. If they like it and if I know the plan hasn’t changed at all or got better I let them know they don’t have to do anything.
The company is sending them a ANOC with their changes. All is good, no scope needed.
Client on MAPD calls me during AEP and I know their plan is having big changes or they don’t like their plan? I set an appt, go to their home, sign a scope and show them a new plan right there.
It’s not hard. You don’t need a scope prior to the appt, just prior to talking about a particular plan and it’s options.
You’re supposedly 82 correct? Why not just retire into the sunset. It’s seem to be needed
Maybe when u in 5-10 states with the big boyz u might see the light with 500 clients.
Until then the complaining simply gets the worms in the can squirreling alive again and gets the information rolling. I would have thought u had an eye for that. Guess not
- Thread starter
- #20
PCBI
Guru
- 483
Sorry u feel like an ***. Nobody’s responsible but urself
