PFFS Enrollement - Face to Face ANSWERED

[James]

You are confusing the verification call with the enrollment application. CMS requirements apply to this, not to taking the application.

Pyramid allows that agent and client to be on a conference call to SET UP the verification phone call. The agent may not be on a conference call with the client during this call.

Do what ever you would like to do. Some of us understand this and are not looking to interpret anything. I intend to follow the guideline that and IN WRITING from Today's Options instead of trying to decide for myself what I am allowed to do.

At this point, I give up trying to convince people what is right and wrong. I'll do it the way I have been instructed by various carriers and you do it the way you think is right.

Rick

I don't think I am, yet that isn't here nor there. Yet this much I know, I take whatever the Carrier esp in the marketing departments have to say with some skeptic critism. It is brought up in many discussions that one is against the product that Ins Carriers are horrendous at supervision of their products. Yet in other cases, where one is liking the product they will take the word of the Ins Carrier over let's say the CMS.

 

[retread]

GreenSky... At both my certification training seminars for Coventry and Today's Options, they stressed that face-to-face contact with prospects is required to enroll any MA plan. It is also made clear in their company policy manuals in the compliance sections, and referenced as a CMS requirement, not just company policy. These guys are not going to tie the hands of their income producing agents unless it is required by law.

James... You need to get some more training. Someone to help you with all the rules, not just a couple here and there. If you take one statement out of context, it may appear to be contradictory until you read the whole. I am trying to help with the subject, and am a little busy at the moment, so I am not posting often. I have covered the rules as much as my time allows. Suffice it to say, there are many more references I could site that confirms what I have said, but if you continue to resist the information, I can't help you.

One last comment... the procedures for enrollment has changed somewhat due to the compliance issues this summer. For example, Today's Options now requires the telephone verification to be made AFTER the agent leaves the client's residence. He is required to NOT be present during this call. This is opposite the procedure prior to June.

As far as online enrollment is concerned, the agent MUST be present while the prospect/client is enrolling online if he needs assistance. An agent CANNOT complete an online enrollment with the prospect/client on the telephone. If the prospect can enroll online by himself, you have to provide him your broker number or else you won't get credit for the sale. And yes, the prospect can enroll over the phone... just not via an agent. He can call the carrier and sign up. AN AGENT CANNOT ENROLL ANYONE IN AN MA PLAN WITHOUT BEING PRESENT! period! This is NOT true with Medicare Supplement plans.

 

[senior-advisor-indiana]

If the prospect can enroll online by himself, you have to provide him your broker number or else you won't get credit for the sale

You are very confusing. So they can enroll themselves and use oour number? That would mean we do not need to be present?

 

[honestagent]

Some of the agents on here have corroborated their statements. Thank you for sharing.

It's a carrier stance and NOT a CMS stance. I have access to resources that I'm sorry I cannot share nor disclose, but it's all very true. You DO NOT have to do a face to face - but each carrier will have their own criteria and you must follow these rules accordingly or consequences will be enforced.
Pyramid, for example, was very clear what can and will happen should certain rules not be followed in terms of ethics and procedures.

Bottom line: know CMS' rules in addition to the companies' rules you represent and you will be A okay.


Btw, did anybody say... 'got supplements?'

 

[James]

These guys are not going to tie the hands of their income producing agents unless it is required by law.

Only thing I said is that you can not enrolled someone while performing out bound calling, I didn't see in any mention of your post that would lead me too think I'm wrong? Yet this sentence says it all and supports my other statement, Insurance Carriers are horrendous when it comes to supervision of agents and how their products are being represented and sold. May it be UL's, EIA's or MA's, they will not only view the law, but make a mockery of it in all too many cases.

As far as online enrollment is concerned, the agent MUST be present while the prospect/client is enrolling online if he needs assistance. An agent CANNOT complete an online enrollment with the prospect/client on the telephone. If the prospect can enroll online by himself, you have to provide him your broker number or else you won't get credit for the sale. And yes, the prospect can enroll over the phone... just not via an agent. He can call the carrier and sign up. AN AGENT CANNOT ENROLL ANYONE IN AN MA PLAN WITHOUT BEING PRESENT! period! This is NOT true with Medicare Supplement plans.

I really don't get this but it supports exactly what I have been saying, the "Whole" of the idea is too prevent agents from being able to slam people into MA's, that was one of the basic underlying reason for the whole uproar to begin with! That is the main reason why you just can not call clients and place them, we been there and done that and the bad apples will use that too slam people on these plans!

 

[Cenla Agent]

I can say that for 2007 with Humana outbound calls to members to enroll them via 3-way call was a no-no. It was permitted if the member called you and I think you had to have met with them earlier and presented the plan in person. (All of my enrollments were face to face.)

IMO, there are enough problems with the members understanding these plans when you spend 90 mins or 2 hours going over them in person without getting into phone enrollments without having ever sat down with them, regardless of what the rules are. Add lock in to that, and you're asking for trouble, IMO. But let everyone be convinced in his own mind.....

Here we go again with experienced licensed agents not being able to agree on what the rules are even after the moratorium and recert and it makes me that much closer to saying that this market (MA specifically) may be more trouble than it's worth.

 

[Cenla Agent]

Humana will also be doing the outbound verification calls a few days after the agent has left. (Dunno if all carriers are doing this or not, but IIRC the outbound calls with the agent not present were part of the agreement during the moratorium). A manager told me they are basically going to scare the hell into the member for enrolling in PFFS (emphasizing that no provider is required to accept it, etc.) and will ask them once again if they are sure that's what they want to do. If they say no, the app will not be submitted to CMS.

GreenSky... At both my certification training seminars for Coventry and Today's Options, they stressed that face-to-face contact with prospects is required to enroll any MA plan. It is also made clear in their company policy manuals in the compliance sections, and referenced as a CMS requirement, not just company policy. These guys are not going to tie the hands of their income producing agents unless it is required by law.

James... You need to get some more training. Someone to help you with all the rules, not just a couple here and there. If you take one statement out of context, it may appear to be contradictory until you read the whole. I am trying to help with the subject, and am a little busy at the moment, so I am not posting often. I have covered the rules as much as my time allows. Suffice it to say, there are many more references I could site that confirms what I have said, but if you continue to resist the information, I can't help you.

One last comment... the procedures for enrollment has changed somewhat due to the compliance issues this summer. For example, Today's Options now requires the telephone verification to be made AFTER the agent leaves the client's residence. He is required to NOT be present during this call. This is opposite the procedure prior to June.

As far as online enrollment is concerned, the agent MUST be present while the prospect/client is enrolling online if he needs assistance. An agent CANNOT complete an online enrollment with the prospect/client on the telephone. If the prospect can enroll online by himself, you have to provide him your broker number or else you won't get credit for the sale. And yes, the prospect can enroll over the phone... just not via an agent. He can call the carrier and sign up. AN AGENT CANNOT ENROLL ANYONE IN AN MA PLAN WITHOUT BEING PRESENT! period! This is NOT true with Medicare Supplement plans.

 

[honestagent]

Humana will also be doing the outbound verification calls a few days after the agent has left. (Dunno if all carriers are doing this or not, but IIRC the outbound calls with the agent not present were part of the agreement during the moratorium). A manager told me they are basically going to scare the hell into the member for enrolling in PFFS (emphasizing that no provider is required to accept it, etc.) and will ask them once again if they are sure that's what they want to do. If they say no, the app will not be submitted to CMS.

Cenla, how do you know Humana will be doing this, if you don't mind me asking? Are you a captive?

 

[Cenla Agent]

Cenla, how do you know Humana will be doing this, if you don't mind me asking? Are you a captive?

I was captive a couple of years ago but not now. IIRC it was in the recertification. But I was also told about the outbound verification calls by someone who is captive. I also remember seeing something about outbound calls being mentioned in a story about the moratorium, that the outbound calls are something that CMS and AHIP wanted.

 

[insurance0707]

I saw that also on the online recertification for Humana. It said, be sure and prepare them for the verification call because Humana will ask them several times if they still would like to enroll in the plan.