UHC Tele-sales Stole my Client

Dec 7, 2015

  1. Heather
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    Heather Guru

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    I spoke to a client in October she told me she loved UHC and her plan wants to keep working with me, she has been my client 2 years, her husband for 7 years. I had them both on the PPO.

    At some point in the spring the wife became eligible for Medicaid, this I did not know but UHC did so they called her up and switched her to the Dual SNP and I am no longer agent of record.

    My complaints to the commission dept got me nothing but a form letter telling me what I already know. Every phone call and email on the matter is now being ignored.

    Has anyone else experienced this and what was the outcome? I know we are only talking $200 a year in renewals on her but its the loyalty part that bothers me the most.:no:
     
    Heather, Dec 7, 2015
    #1
  2. SecureHealth1
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    SecureHealth1 Guru

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    Their are a 1,000 scenarios this can happen in, cant win them all!
     
  3. yogooglethis
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    yogooglethis Guru

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    UHC as well as all the other MA carriers telesales dept. are paid for plan change enrollments so they are going to go after any prospect out there.Sometimes they are tipped off by UHC " My Advocate " service ,that helps members apply for medicaid, that there is a more suitable plan available now that they have medicaid.UHC also does a ton of targeted DM to reach the DE market for their SNP PPO

    I had this happen to me before so I learned along time ago to help my clients with their medicare savings program application when i first meet with them so that this doesn't happen to me again.I
     
  4. Heather
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    Heather Guru

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    She actually didn't get the Medicaid until almost two years later so I had no way of knowing. Anyway I contracted with some one else that has dsnp plan so I switched her over.
     
    Heather, Dec 10, 2015
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  5. TDFnCali
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    TDFnCali Guru

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    This isn't anything new... Keep tight tabs on your client, but realize u will lose a few regardless like this. It's happened to me.
     
    TDFnCali, Dec 10, 2015
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  6. wehotex
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    wehotex Guru

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    True dat. I personally assist ALL of my MA clients when there is a chance that they might qualify. Even among those, I still lose about 20% of them due to outside agents and competition. It's great that Heather was able to switch them to something else!!
     
    wehotex, Dec 10, 2015
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  7. ineedhelp
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    ineedhelp Super Genius

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    I had a H/W enrolled in UHC's PPO with $0 premium. Last year when notified that the PPO would have a $45 premium I called all my member's on the PPO plan and told them. This couple called me and wanted to switch to the HMO with a $0 premium which we did with an eff. date of 01/01/15. Three days before the end of the recent AEP this man called me and told me that shortly after I had enrolled them in the HMO they got a call telling them that they enrolled in the wrong plan and he felt pressured to switch, I only found this out last week and the telemarketer who called them had switched them back to the PPO and they've been struggling all year to pay that $90 premium which we were trying to avoid.

    Can't do a darn thing about it. And yes, they should have contacted me right away, but they're in their 80's and were very confused. I've decided that if UHC won't support me and my business, they will no longer get my business...
     
  8. vic120
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    vic120 Guru

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    Ok since every MA Plan,( I could think of) would have done the same thing, The question is who will get your buiz?
     
    vic120, Dec 11, 2015
    #8
  9. G.Gordon
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    G.Gordon Guru

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    Oh yes they can. There is an evidentiary trail that indicates they wanted to move away from the $45 plan. Filing an CMS complaint due to "undue hardship" will gain them a SEP to move. I used this last year when Coventry reported out of network (can't use) pharmacies as in network. The problem was discovered after AEP. I called and had M.gov move at least five to Humana since they lived in a town with one pharmacy and nothing else for 20-30 miles. Sure, I'm not AOR, but sometime it is more about the client than my $250/year.
     
    G.Gordon, Dec 11, 2015
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  10. Heather
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    Heather Guru

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    I received this in an email, it looks like my member was contacted outside of AEP so that is why I lost AOR status.

    All of the following qualifying enrollment requirements must be met in order for the original agent of record to retain AOR status:
    ∼ The impacted member must be currently enrolled in a UnitedHealthcare Medicare & Retirement
    managed Medicare Advantage plan with or without integrated Part D benefits; and
    ∼ The current member must switch from the current plan to another qualifying UnitedHealthcare
    Medicare & Retirement managed Medicare Advantage plan. Qualifying plan changes are as follows: MA to MA or MA-PD, MA-PD to MA-PD, DSNP to DSNP, CSNP to CSNP. (Note: Any other type of plan switch does not qualify for AOR retention, including Institutional SNP, Community & State managed DSNP, Medicare – Medicaid Plan (MMP), and PDP.)
    ∼ The plan change must be made during AEP with a January 1 effective date.; and
    ∼ The AOR must be a renewal-eligible agent and appropriately licensed, appointed, and product
    certified for the new plan; and
    ∼ The agent enrolling the current member in the new UnitedHealthcare Medicare Advantage plan
    must be a Telesales agent ineligible for Medicare Advantage renewals, or the plan switch may be via Web or paper enrollment application without involvement of a renewal-eligible agent.

    § Commission Payment
    ∼ For qualifying enrollments, the original retained AOR (and the AOR’s up-line, if applicable)
    will receive a new commission at the renewal year rate for the new enrollment beginning in April of the plan year.
    ∼ For non-qualifying enrollments, such as switching a member from a plan closure to a Medicare
    Supplement Insurance or Part D plan, the agent facilitating the plan switch will become the new AOR and, if eligible, will receive any commission payments per standard procedures.
    AOR and, if eligible, will receive any commission payments per standard procedures.
     
    Heather, Dec 12, 2015
    #10
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