CMS violation during AEP and lose your book of business

[SueNomie]

The problem is many agents rely on rumors ...”somebody told me this” and “somebody told me that”..Do not believe Everything a FMO says. All you need to do is simply read the Medicare marketing rules and guidelines each year. Also, do not believe anything Medicare says to you. When you call Medicare they are not employed by the federal government, their subcontractors that read off of a script. That is why if the government shuts down, Medicare keeps rolling......

 

[sshafran]

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.

That is Crazy.

"Here, let me look up your Rxs individually (rather than on planfinder) in 28 different plans... for $37 renewal..."

Nope. Nope nope nope....

 

[vic120]

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.

You can't make this stuff up

Medicare's own website is non-compliant, That kills me

 

[Bob L]

Amazing how quik some of these guys get their undies in a bunch if u dont nod ur head at all their wisdom.

I have no issues,lol. The demeaning comments are now the

“Hilarious”

priceless

What's the problem, is your "y" key busted on your keyboard? Your posts are insufferable. You might have a bit of a point about SOA's but that "u" and "ur" crap gets old in a hurry.

I was sitting here wondering, under what circumstances would CMS investigate "u" for not getting a scope when giving an existing client a bit of advice for the AEP? I don't know about "u," but my clients don't rush to the phone to call 800-MEDICAR when I talk to them without a scope. If we're being secret shopped, it is always so obvious we would be sure to procure an SOA. And when I make home visits I always get a scope right away.

But we do appreciate "u" worrying about us. Please add my name to the dozens on here who have never heard of this happening to anyone.

 

[GoPokes]

Fellow agents,
This is a crucial and mandatory issue that many agents oversee. Whether u have 5 clients or 500 clients each year before u talk to any of them regarding AEP they MUST sign a Scope of Appointment form (every year!!) Most carriers require SOA with application, but this does NOT completely absolve the agent that just wants to “check in” with their book of MAPD. You cannot just call ur clients and talk MAPD options a NEW SOA MUST be sent prior to contacting them.

I know this is crazy to send out 500 return letters w signatures for u big boys writing big numbers. But, this is a govt subsidized program and they will enforce removal of commissions on violations.

Sincerely thank
CMS

Ill take a guess as to why an entity would use such strong scare tactics, because it's really difficult to enforce the rule. It appears to be working in your situation. Im fairly confident the rules dont have a 1 strike policy, that will put you out of business.