Talk About MAD

[jdeasy]

I was following up a sup lead today for a man and wife. After I did it (the sup) they wanted to change their part D. but I told them they had to sign a paper and wait 48 hours and therefore would have to be screwed for another year because aep would be over by then. Talk about pissed I almost lost the sup sale.

You did not have to wait 48 hours. But, even if that was an issue for you, you could have helped them get into a PDP on line or by phone and just not have gotten paid for it. I've helped, at least, 10 people get into a different PDP that I don't represent. I use my computer and help them enroll on line. I don't get paid for those, but, I helped my clients. That will come back to me someday, somehow.

 

[GreenSky]

You could have helped them immediately. The 48hr. rule is for non-health related products.

MA, PDP and Med Supps are okay for the same visit.

The rule is stupid but there really is no excuse for any agent working the Medicare market to not know it.

Now are you even madder?

Rick

 

[jdeasy]

That is the way I understand the rule 48 hours and I think you could still get in trouble helping sign someone up whether you get payed or not sense your licensed. No where close to the risk for me.

You misunderstood the rule and your clients suffered for it. But, you still have time to go back to those clients and get it fixed before midnight.

 

[GreenSky]

That is not how I understand it at all, some guy sends me a lead for a sup and I go sell one with no pre set appointment or scope there is no way to do pdp or MA at that time. If you are your breaking the law. IMOP

You can fill out the scope at the meeting. But how did you manage to see the client without at least calling (I'm assuming this was not just a referral) and setting an appointment. Someone had to set the appointment.

As far as the law is concerned, my goal is to help my clients. If CMS objects, so be it. I have a fiduciary responsibilty to do my best. Anything else would not be acting within the scope of my license.

Rick

 

[jdeasy]

That is not how I understand it at all, some guy sends me a lead for a sup and I go sell one with no pre set appointment or scope there is no way to do pdp or MA at that time. If you are your breaking the law. IMOP

No, I'm breaking the law. besides, it's not a law, it's a CMS rule. In the beginning, {Sept}, that rule could have interpreted the way you are stating it. That rule has been relaxed by CMS to allow for "walk-ins" or other situations when the client brings it up. You would have to get the SOA form signed, but, you could then go ahead and discuss PDP plans.

However, even if you felt that was pushing the envelope, you could have told then that they had to set a separate appointment to discuss the PDP and then set the appointment for 15 minutes later, leave and come back. It also allowable now to get the SOA signed at the beginning of the appointment as long as it's not feasable to get it signed in advance. In your case today, it wasn't.

For example, a potential client could call me up right now needing to get a pDP or change their PDP before midnight tonight. If I'm inclined to go meet with them, I can. I would have them sign the SOA upon arrival and then enroll them in whatever plan they chose. This is perfectly legal and, more importantly, ethical and the right theing to do.

I looked this up after the previous posting. There was an MIPPA Regulations update put out on Dec. 23. In says in part;

"Previous guidance: Agents must review only the products agreed upon {the "scope"} at the in home appointment. If a prospect wants to discuss a product that was not previously agreed to at the initial appoinment, the agent cannot discuss that product at that time.

UPDATED GUIDANCE: If the consumer requests information outside the original Scope of Appointment, a new Scope of Appointment document may be signed immediately and the meeting may continue with the new scope."

 

[GreenSky]

Yeah, what JD said!

Rick

 

[jdeasy]

That sounds great and if you have the new relaxed rules I need to have them if the rules changed again in the last few months. I had no pre set appointment was only there on other business nothing to do with MA or PD.

I added on to my previous post with the new regulations and I quoted it. That same new interpretation was the one that said the SOA could be signed at the beginning of the appointment.

 

[Winter_123]

I added on to my previous post with the new regulations and I quoted it. That same new interpretation was the one that said the SOA could be signed at the beginning of the appointment.

Jim asked about a scenario where he had no Scope of Agreement in place because he just went there on a med supp appointment which does not require an SOA. Some of the replies talked about scenarios where the agent has an SOA but something beyond it comes up.

Anyhoo. What is allowable and not allowable when there is no SOA but the client brings up PDP's at the appointment? Is this a show stopper or can you do an SOA there or what is the story this month?

Thanks.

 

[Todd King]

In fact they should not be changing rules at all during AEP and if they have to they have to allow at least one month for people to get the info before the new rules. This stuff is a total damn mess the way it is being handled.

Whether they should or not is beside the point. They did! I think we all agree that they shouldn't be changing in the middle at all. If you didn't get this info, then reconsider your FMO. JD is trying to help you with this. What he is telling you is the truth, now go get it if you can and do the right thing by your client!

 

[jdeasy]

Jim asked about a scenario where he had no Scope of Agreement in place because he just went there on a med supp appointment which does not require an SOA. Some of the replies talked about scenarios where the agent has an SOA but something beyond it comes up.

Anyhoo. What is allowable and not allowable when there is no SOA but the client brings up PDP's at the appointment? Is this a show stopper or can you do an SOA there or what is the story this month?

Thanks.

You could then schedule an immediate appointment to discuss the PDP as long as you get an SOA signe before discussing it.

From that same update;

"Previous guidance: Agents must clearly identify and obtain agreement from prospects about the products they intend to discuss during an in-home appointment.

UPDATED GUIDANCE: Agents must clearly identify and obtain agreement from prospects about the products they intend to discuss during any personal or individual marketing appointment."

And;

"Previous goidance: The Scope of Appointment form cannot be signed at the beginning of the appointment.

UPDATED GUIDANCE: Forin-home appointments, every effort should be made to complete the SOA documentation in advance. If that is not possible, it MAY be signed immediately before the start of the in-home appointment. For "out-of-home" appointments, the agent can have the consumer agree to and sign the SOA form immediately before the meeting begins."


I agree with you guys that rules should not be changed in the middle of the game. But, these were needed changes to too cumbersome regulations. Even CMS could see that they went too far.

And, if we are going to be selling this stuff, it's our responsibility to be informed of these changes. Every company I represent sent me these changed regulations. How could an agent not be aware of them? The only MA comapny that I'm not certified with is Humana. I don't know if they sent the changes out or not. Everybody else did.

I didn't certify with UHC for this AEP, yet, they still send me these MIPPA updates.