Helping Clients with Part D Can Be a Violation

[DS4]

Using Medicare.gov, I really cant believe CMS would come down on an agent for simply helping(no commission) a senior enroll in Part D.
Going through the carriers website, maybe.
If that is the case, use Medicare.gov.
I'm AHIP certified for about 2/3's of the Part D plans.
If one of my companies is too far down on the ranking list, I then enroll the senior through Medicare.gov.
I personally enrolled over 100 seniors last AEP in Part D using Medicare.gov. This is the least of my worries.

 

[midwestbroker]

UPDATE:

According to the Medicare Marketing Guidelines Section 120.6:

However, if Plans/Part D Sponsors use licensed agents/brokers (employed or contracted) as customer service representatives, they cannot act as both a customer service representative and a sales/marketing agent/broker.

What I say about this (my own personal view):
Only use UHC agent based enrollment tools/platforms for e-enrollments. Helping a consumer complete an enrollment on a consumer facing website is a violation. Page 99 in the EDC Medicare Solutions Agent Guide (Version 2.3 Dated 2/5/2016) explains this in detail.

Medicare allows licensed agents to assist in enrollment as long as they are acting as a customer service rep (no compensation for enrollment).

 

[WCMason]

I received a call earlier this week from UHC regarding a possible web enrollment violation. A client of mine who completed a UHC Part D enrollment during the most recent AEP on their consumer facing website used my writing number and was contacted by them. He told their representative that I had met with him in person and enrolled him online on my computer. One problem: I had met with this client only once, a year prior, and enrolled him in a Medicare supplement by e-app and completed a paper Part D application with a different carrier.

Apparently he confused my electronic Medicare supplement application in late 2014 with the drug enrollment a year later. I did do an Rx plan review with him during the last AEP and recommended that he change to a UHC drug plan, and sent him a link by email to enroll in the plan.

Fortunately I was able to provide to the UHC person investigating this my email to him last Dec. with instructions on how to self enroll and an email with his reply to me that he had completed it, including a screenshot of the confirmation he sent to me by email when he completed it. Those emails are being reviewed to determine whether I can be exonerated from this violation. I was told this evidence would likely resolve the issue.

I have not been especially careful about keeping documentation of every interaction with my clients, but this provided me a good lesson on the importance of doing that.

 

[sman]

I received a call earlier this week from UHC regarding a possible web enrollment violation. A client of mine who completed a UHC Part D enrollment during the most recent AEP on their consumer facing website used my writing number and was contacted by them. He told their representative that I had met with him in person and enrolled him online on my computer. One problem: I had met with this client only once, a year prior, and enrolled him in a Medicare supplement by e-app and completed a paper Part D application with a different carrier.

Apparently he confused my electronic Medicare supplement application in late 2014 with the drug enrollment a year later. I did do an Rx plan review with him during the last AEP and recommended that he change to a UHC drug plan, and sent him a link by email to enroll in the plan.

Fortunately I was able to provide to the UHC person investigating this my email to him last Dec. with instructions on how to self enroll and an email with his reply to me that he had completed it, including a screenshot of the confirmation he sent to me by email when he completed it. Those emails are being reviewed to determine whether I can be exonerated from this violation. I was told this evidence would likely resolve the issue.

I have not been especially careful about keeping documentation of every interaction with my clients, but this provided me a good lesson on the importance of doing that.

Just received a similar phone call. I never met with the client (just a phone conversation). I walked her through the enrollment over the phone. When they called her she told them I helped her complete her application. Which is true in that I walked her through it step by step over the phone. Guess who won't be getting help from me this next AEP?

I was forced to complete an additional training course as the person at UHC said they wouldn't call the client back to confirm my recollection of the events. Said at this point they would just consider it a he said she said scenario and require that I do the additional training. First time in a decade I've ever had anything like this come up. All because of a Part D enrollment. What makes it worse is she isn't really a client other than for Part D. A friend referred her so I took care of it as a favor to the friend. Won't happen again.

If I assist anyone in the future with the consumer facing website I will be sure to have them send me an email stating they have completed their enrollment as a CYA.

 

[Norwayguy]

Just received a similar phone call. I never met with the client (just a phone conversation). I walked her through the enrollment over the phone. When they called her she told them I helped her complete her application. Which is true in that I walked her through it step by step over the phone. Guess who won't be getting help from me this next AEP?

I was forced to complete an additional training course as the person at UHC said they wouldn't call the client back to confirm my recollection of the events. Said at this point they would just consider it a he said she said scenario and require that I do the additional training. First time in a decade I've ever had anything like this come up. All because of a Part D enrollment. What makes it worse is she isn't really a client other than for Part D. A friend referred her so I took care of it as a favor to the friend. Won't happen again.

If I assist anyone in the future with the consumer facing website I will be sure to have them send me an email stating they have completed their enrollment as a CYA.

Great your guilty unless and until proven otherwise and your partner the carrier won't even bother with investigating just make you do an extra module and the carrier benefits if you don't recertify.

 

[vic120]

Wonder if the will remove the words licensed "agent assisted" enrollment process.

 

[sman]

Great your guilty unless and until proven otherwise and your partner the carrier won't even bother with investigating just make you do an extra module and the carrier benefits if you don't recertify.

Their "evidence" is what a 77 year old woman said about something that happened more than 4 months ago.

It is what it is, but you better believe I will have clients email me in the future stating that they completed the enrollment on their own. And this particular client won't receive any future assistance due to the fact that she has a Med Supp with the friend. He's going to have to help her from here on out.

 

[FLM2]

Just received a similar phone call. I never met with the client (just a phone conversation). I walked her through the enrollment over the phone. When they called her she told them I helped her complete her application. Which is true in that I walked her through it step by step over the phone. Guess who won't be getting help from me this next AEP?

I was forced to complete an additional training course as the person at UHC said they wouldn't call the client back to confirm my recollection of the events. Said at this point they would just consider it a he said she said scenario and require that I do the additional training. First time in a decade I've ever had anything like this come up. All because of a Part D enrollment. What makes it worse is she isn't really a client other than for Part D. A friend referred her so I took care of it as a favor to the friend. Won't happen again.

If I assist anyone in the future with the consumer facing website I will be sure to have them send me an email stating they have completed their enrollment as a CYA.

They are essentially doing this with every agent with a Part D enrollment through the consumer site-I only did 1 all year (a very close friend) who told UHC he came to my office and completed it there, that isn't acceptable either unless the agent leaves the room.

There isn't really a point in arguing with them, do the module (it takes less than an hour) and move on.

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Wonder if the will remove the words licensed "agent assisted" enrollment process.

They removed it several months ago...

 

[vic120]

They are essentially doing this with every agent with a Part D enrollment through the consumer site-I only did 1 all year (a very close friend) who told UHC he came to my office and completed it there, that isn't acceptable either unless the agent leaves the room.

There isn't really a point in arguing with them, do the module (it takes less than an hour) and move on.

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They removed it several months ago...

I still see it. In fact I copied and paste

http://www.mymedicareenroll.com/

 

[sman]

They are essentially doing this with every agent with a Part D enrollment through the consumer site-I only did 1 all year (a very close friend) who told UHC he came to my office and completed it there, that isn't acceptable either unless the agent leaves the room. There isn't really a point in arguing with them, do the module (it takes less than an hour) and move on. ---------- They removed it several months ago...

Yep. I did it right after I hung up the phone.