Medicare advantage plans

[Jennifer9922]

I’m just wondering what is normal for chargebacks? Do people get several chargebacks per month or is that too much?

 

[Brad G]

Charge backs are generally the result of rapid disenrollments. If you are receiving multiple charge backs, your enrollments are not sticking. Are you doing a thorough needs analysis and enrolling your clients in the best plans for them? Excessive rapid disenrollmenrs can result in contract termination.

 

[axeman462]

I’m just wondering what is normal for chargebacks? Do people get several chargebacks per month or is that too much?

chargebacks in the early years are normal, but if you are 5 or 10 years in and still regularly getting chargebacks then you are doing something wrong.

There is a term known as "Chargeback Hell" that commonly happens around the one year mark that often wipes out agents. I went through it myself. Went something like 2 months without any commissions.

 

[vic120]

I don't know, Don P keeps telling me its normal

I guess it depends on your situation, I normally just don't get too many chargebacks

I got 3 this year this includes AEP business, 1 Guys provider would not take out of network on PPO

The PPO we did had the same copay out of network as in network but the doctor just would not see him with the plan regardless

so I had to put him back the plan I previously had him on, Again I kept his buis just not on that carrier

Another guy, I had put him on MA because his premium got to be over $400 and he could not get approved because he had back injections, then he called June and we were talking and he said he was not getting injections anymore so i got him approved for med supp at a great rate

So again I kept his buis but not with that carrier

and one lady who was a referral by the way just nuts, We talked about med supp and she just could not see herself paying for plan N so we did MA plan and she called me back 2 days later like I stole her first born

I did do a bunch this year on various leads and some were DSNPS though I don't prefer it

I am just not getting chargebacks as I have been told I would though

I really feel it is how you sell the plan, if it is high pressure, I am sure that is why

I do have clients who say they changed due to some call with call center but the plan was nothing like what they were told and want to come back every year

 

[Chazm]

I get a few a year. It’s not normal imo

 

[Jennifer9922]

it’s confusing- I am enrolling them in the best plans but noticed several of them through Humana and it was surprising. I wasn’t sure if this was normal but thanks for the different input. I wasn’t sure if I needed to do something different to avoid that.

 

[straightnochaser]

It's really going to depend on how you're picking up these clients

 

[axeman462]

it’s confusing- I am enrolling them in the best plans but noticed several of them through Humana and it was surprising. I wasn’t sure if this was normal but thanks for the different input. I wasn’t sure if I needed to do something different to avoid that.

No matter what, something needs to change. You shouldn't be getting more than a few chargebacks a year.

The question is what?

If you are new to the business, it could be as simple as your knowledge of the business and product. If that's the case, then things will be fixed naturally over time. Higher than industry average chargebacks in the early years are normal.

If you are not new, then take a good hard look at your sales process.

How are you picking the plans for your clients?

Why are they cancelling?

How are you getting your customers?

Are you explaining the plans correctly?

Are you spending enough time in each stage of the sales cycle?

Are you doing a hard close, or is it happening naturally?

Are answering the phone when they call you after the sale?

There are probably a dozen other questions to ask yourself about the sales process, but those are a few just to get you started. You need to find a common denominator.
But again, if you are brand new, I wouldn't stress too much over it.

 

[MedicareWAA]

Chargebacks are normal. They will ALWAYS happen. Clients die, clients are “stolen”, etc. Good agents have them, but good agents don’t have many.

If you are a field agent:

Rapid (90 day) churn should be no more than 5 percent. Your goal should be less than 3 percent. These are the chargebacks that sting the most. They’re mostly avoidable if you’re being clear and careful. If you focus on T65, rapids should be no more than 2.5 percent.

Other first year chargeback ( > 90 day) churn varies by demographic. For all sorts of reasons, you shouldn’t have many if you’re selling mostly T65. If you sell lots of switchers, this first year “chargeback-able” churn should be no more than 10 percent. Many good agents do better.

Duals are the exception. They are slippery even for the best agents.

If you are a call center:

Most of these agencies see a roughly 20% 90 day rapid churn. The math won’t work for a 200+ seat call center unless it’s under 12%.

Other first year chargebacks (> 90 day) churn vary by demographic but it’s much higher than in the field.

Large call centers typically see a 45% annual churn of one sort or another - rapid, “chargeback-able”, and other. Sometimes they’re churning their own clients. More often, they’re churning back and forth between other call centers. It’s a shitty business model and it’s not sustainable. A race to the bottom.

Be sure to manage your complaints, too.

Good field agents should have no more than a 2 percent complaint rate, with most of those complaints dispositioned as unsubstantiated. Many agents are better than 1 percent.

Call centers are a shit show. Most of them have a 5-7 percent complaint rate, with up to half of those complaints dispositioned as substantiated. Consider that the largest phone agencies are writing like 250,000 Advantage plans every year. You’re looking at hundreds of substantiated complaints every month … what Humana would call “section A” complaints. Not trivial stuff.

I don’t think our industry overall fully understands or appreciates just how bad they operate, or how carriers hold them virtually unaccountable. In turn, CMS holds the carriers unaccountable. It’s almost unforgivable.

I hope this is helpful to you.

Walter

 

[DonP]

Chargebacks are normal. They will ALWAYS happen. Clients die, clients are “stolen”, etc. Good agents have them, but good agents don’t have many.

If you are a field agent:

Rapid (90 day) churn should be no more than 5 percent. Your goal should be less than 3 percent. These are the chargebacks that sting the most. They’re mostly avoidable if you’re being clear and careful. If you focus on T65, rapids should be no more than 2.5 percent.

Other first year chargeback ( > 90 day) churn varies by demographic. For all sorts of reasons, you shouldn’t have many if you’re selling mostly T65. If you sell lots of switchers, this first year “chargeback-able” churn should be no more than 10 percent. Many good agents do better.

Duals are the exception. They are slippery even for the best agents.

If you are a call center:

Most of these agencies see a roughly 20% 90 day rapid churn. The math won’t work for a 200+ seat call center unless it’s under 12%.

Other first year chargebacks (> 90 day) churn vary by demographic but it’s much higher than in the field.

Large call centers typically see a 45% annual churn of one sort or another - rapid, “chargeback-able”, and other. Sometimes they’re churning their own clients. More often, they’re churning back and forth between other call centers. It’s a shitty business model and it’s not sustainable. A race to the bottom.

Be sure to manage your complaints, too.

Good field agents should have no more than a 2 percent complaint rate, with most of those complaints dispositioned as unsubstantiated. Many agents are better than 1 percent.

Call centers are a shit show. Most of them have a 5-7 percent complaint rate, with up to half of those complaints dispositioned as substantiated. Consider that the largest phone agencies are writing like 250,000 Advantage plans every year. You’re looking at hundreds of substantiated complaints every month … what Humana would call “section A” complaints. Not trivial stuff.

I don’t think our industry overall fully understands or appreciates just how bad they operate, or how carriers hold them virtually unaccountable. In turn, CMS holds the carriers unaccountable. It’s almost unforgivable.

I hope this is helpful to you.

Walter

This is pretty spot on and I’ll add a some things . Thats why I’ve told all you work high vol leads 90% will be lis/duals . Unless your on the ground in person and can build face to face relationships stay away . As Walter says you’re in for a world of hurt and pain . The call centers are replacing each other left and right . They also target there own book after 13 months to get a bigger paycheck on a roll ti another carrier . It’s tough to do but the sticky mapd is T-65. Even how hands I’m with my dsnp clients I still have 12% that are flipped and I save 70% of them . I lose at most 2% non dual per yr