Is this a CMS Violation.

Jul 7, 2015

  1. TN_agent
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    situation:

    T65 is cold called. They absolutely did not send in a reply card or give their name/number to anyone about Medicare. Started out talked about supps, work their way to MAPD plan. No scope of appt obtained, the entire presentation was given over the phone and then an app was mailed to the T65 completely filled out, she only had to sign it and mail it in.

    Agent is non-resident calling from out of state. Appointed with one MAPD and one med supp carrier only (so presumably not a captive if selling with other carriers).

    Is this a CMS violation? I believe it is a carrier violation, as far as I know independent agents are only allowed FTF for this carrier/plan. Beneficiaries can mail in apps but only if actual presentation was FTF.

    Someone correct me if I am wrong. Beneficiary is upset and thought her sister had given this lady her name (she did not and even if she did that is a CMS MAPD marketing violation as well AFAIK).
     
  2. vic120
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    Is this a CMS violation? I believe it is a carrier violation, as far as I know independent agents are only allowed FTF for this carrier/plan. Beneficiaries can mail in apps but only if actual presentation was FTF.

    Wrong FTF is not required, Scope is not required in phone sale

    The only issue I see is unsolicited contact, If it were a mailer lead and internet lead (with compliant internet site) or a call in referral or a call in from compliant advertizing then no problem,

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    Agent is non-resident calling from out of state, I sell in over a dozen states, Although I do lean heavy med supp I do some 15 to 20 % of my buis MA in various states
     
    vic120, Jul 7, 2015
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  3. TN_agent
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    vic120,

    So you are saying that the unsolicited contact for MAPD marketing is a CMS violation, right? This lady is adamant she never gave anyone permission to contact her via mailer. She doesn't own a computer so did not fill out her info online. She did not hang up and call the lady back, it was all done on one call.

    I was told by the carrier during training that phone sales are not permitted in this state for this product for independent agents. I don't doubt that there is variation across carriers and states for this sort of thing. However, I don't know why they would give non-resident independent producers permission to do something that resident independent producers are not permitted to do.
     
  4. vic120
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    So you are saying that the unsolicited contact for MAPD marketing is a CMS violation, right? This lady is adamant she never gave anyone permission to contact her via mailer. She doesn't own a computer so did not fill out her info online. She did not hang up and call the lady back, it was all done on one call.

    This if true would be a violation However many might send in a card or make internet inquiry and for some reason not realize it, I have seen it a million time even when they Signed mail card

    I was told by the carrier during training that phone sales are not permitted in this state for this product for independent agents. I don't doubt that there is variation across carriers and states for this sort of thing. However, I don't know why they would give non-resident independent producers permission to do something that resident independent producers are not permitted to do.

    Who told you this I sold medicare advantage over the phone at a brokerage before going independent and was trained by humana

    I have since as independant sell for many carriers as well as know many at one of my FMO's that do the same in fact I am the odd one out that prefers to sell supp, However it is perfectly legal to sell MA over the phone.

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    And just to clarify there are some very few carriers that require face to face only and there are a few that do not require face to face but if you speak to the wrong person there they will tell it is required

    I had this trouble with one carrier when I first got appointed, They required training with each local manager and after 5 that did not have a problem I ran into one that did not want to put me through local training as he said that face to face is required to sell MA all MA every where I had to go higher up to correct the situation

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    Besides don't you think if it were Illegal the Ins company can see the apps coming in from different states in my case a dozen states from NY FL CA

    Or do you think there systems are just not able to catch that

    I mean when I was brand new and had bad training I wrote my 1st term life plan where the Idiot that trained me told me the way its done in to esign for client on my end , I think he thought it would be funny for me to get a call

    You know I got a call from ins company that day because they can read the IP address
     
    vic120, Jul 7, 2015
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  5. yogooglethis
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    Agent could have problems with carrier if they violated their specific marketing rules requiring f2f and It is a CMS violation to bait and switch but agents never get busted for this unless consumer files a complaint and carrier/CMS detects a pattern of systematic ob cold calls for med supps converted to MA sales.However if it's a one off situation and 90% of agents business is med sups then it probably wouldn't be considered bait and switch
     
  6. jdeasy
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    Could be a violation. Looks like it's probably not. What is the consumer's complaint? Does she not want the plan she signed up for?
     
    jdeasy, Jul 7, 2015
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  7. midwestbroker
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    The challenge is how did they get from a Medicare Supplement to a MAPD plan? Per CMS guidelines, the Medicare beneficiary has to initiate interest, not the agent. Without a recording, it is the client's word vs. the agent.

    Depending on what the client said, it may be tricky. However, being the beneficiary had to mail back the application, that may be the saving grace of the agent as the beneficiary had to complete the process, not the agent.
     
  8. vic120
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    This assuming this is a cold call or a teli lead, How do any of us know this wasnt an internet or mail lead?

    the OP also says agent is only appointed with 2 companies.There is just too much assumption here.

    What are we talking about getting the Agent in trouble with CMS. How would anyone here like to get that issue because some agent made wrong assumptions.

    I have had calls from clients because they were told the same thing by some agent.A couple in Fl had Maj med with me, then they had MA with me, the following year I switched one to a new MA and the other to Supp. The waife called me in tears saying they needed to cancel her husb MA because this agent told them It is not legal for me to sell it over the phone and needed to do face to face.These are 2 are still my clients to this day, But I have lost a few to that.

    I also have a client Aetna med supp in CA called me wanted to cancel his plan because some agent told him since Aetna is based out of TN it would be illegal for him to buy ins across state line, He is still my client

    The point is there is way too much misinfo and assumptions thrown out there in the field
     
    vic120, Jul 8, 2015
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  9. WCMason
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    We know by the first sentence of the OP: "T65 is cold called." I suppose it could have been from an internet or mail lead, but if so the OP is incorrectly calling it a cold call.
     
    WCMason, Jul 8, 2015
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  10. vic120
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    The OP also said agent is only appointed with 2 carrier's, That tells me the OP is over assuming out of the gate.

    Also how many times do you have a lead card signed and prospect said I never did that, or an Internet lead same thing untill you say I have here on tues at 145 pm from Browser: Chrome
    Operating System: Windows Vista (NT 6.0)
    Device Type: Desktop

    Than they so Ohh I was just looking at some quotes, Even teli leads, I have never spoke to so and so , Wait who is this on recording from your number, Ohhh

    Just because prospect said that does not make it true
     
    vic120, Jul 8, 2015
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