Violation: Running Drugs on Medicare.gov

Nov 5, 2015

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  1. midwestbroker
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    midwestbroker Guru

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    If you are running drugs for your clients on Medicare.gov (ie helping your clients enroll into a Part D plan on Medicare but not being the AOR) you can be subject to a violation if the client calls and complains about the plan they pick.

    Yes, even though you are not the AOR, the fact you assisted the client still leaves you responsible.

    We (Senior Marketing Specialists) are working on a complaint through a carrier of an agent who did just that (mind you I have done this with my clients as well, but never had a complaint).

    How severe is the violation? Most carriers use a points system, so the more points you have against you (late apps, no PCP assignment, etc) the worse any future violations can become.

    Moral: If you are assisting your clients, you may still be responsible.
     
  2. Newby
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    Unless the person helping them has no license, no training and no knowledge. Like the person at the senior center in most small towns.
     
    Newby, Nov 5, 2015
    #2
  3. finalexpenseguru
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    finalexpenseguru Super Genius

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    if the agent isnt appointed with the carrier that they help the client enroll in how can the agent get in trouble?
     
  4. WCMason
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    Good point. If an agent isn't appointed then where do they tally the points in their point system?
     
    WCMason, Nov 5, 2015
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  5. GreenSky
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    My concern has always been acting within the scope of your license. If you are not licensed (meaning qualified - AHIP?) and there is a complaint it is possible that the state will be involved.

    "Hello State DOI? This is CMS. We have a complaint about an agent helping their client enroll in a PDP without proper certification."

    "Thanks for that information. We'll investigate, pull his license and have him neutered."

    Rick
     
  6. sman
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    Do you have documentation that shows a person could be held liable? I mean, I know we all can, but if there is something that CMS cites in writing, we could all use that. I've already considered sending instructional videos to my clients next year on how to run the comparisons themselves so that I won't even be involved in the Part D process. More for time savings than anything else. But now to avoid the liability as well. I help many clients enroll in plans that don't work with brokers. It's bad enough that we get paid so little, but now getting in trouble after enrolling someone in a plan that we don't even get paid on just isn't worth the risk anymore.

    I'm fortunate in that all of my PDP clients are Med Supp clients as well and I doubt very seriously that any of them would make a complaint. But it's getting to where it just isn't worth it anymore.
     
    sman, Nov 5, 2015
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  7. alldaytuesdays
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    alldaytuesdays Super Genius

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    That's just ludicrous....but it's definitely to, and well past, the point where it is not worth it anymore, especially when you take into account the Medicare.gov website's inaccuracies.

    This year, I sent step-by-step instructions for running your own meds through Medicare.gov. Have had lots of clients do it themselves, but they still want to send to me, confirm their thoughts with me, etc. So it hasn't really reduced my Part D workload by much. I like the video idea for next year.
     
  8. Todd King
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    Todd King IMO/FMO Owner

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    You could always get appointed with SilverScript as a referral agent. You only get a 1 time $25 payment for it, but at least you're compliant.
     
  9. sshafran
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    My book of business is smaller than your book, I'm positive, and it's more apparent than ever that I'm wasting a lot of time on the PDP's.

    It doesn't take me long to run the comparisons and tell them their lowest PDP. What takes long is the questions especially on carriers I don't work with. I don't want to be rude and say, "go ask them," but when you have several hundred clients even one or two questions per client beyond "this is your lowest estimated PDP" can accumulate to hours and hours during AEP.

    Yes, it generates referrals. But at what cost in time?

    I "could" go with this approach, "This is the lowest estimate but I do not have time to discuss details - just trust my judgment" but I doubt that would go over well. Sure, most would trust, but it "feels like" I'm brushing them off.

    I'm not brushing them off...but questions like, "What's the difference between 30 day at pharmacy vs 90 day at pharmacy" actually requires entering the Rx's differently into the system. Mail order is easy to answer...

    When I recommend a switch to a current client - and they ask for the exact amount of savings with the new PDP - calculating that takes time. Sure, just a little bit of time.... but it adds up.

    People without computers asking for estimates at each and every stage... it just gets monotonous. Sometimes I just send them the .pdf - but then they call because the printout is confusing. (And, frankly, it can be confusing and I do want to help, so I don't blame them for calling to ask. At all. I just don't get paid for answering...)


    I know I've been rambling in this post - but my bottom line question is - has any agent found a way to get to "this is the lowest estimate but I do not have time to discuss details" with their clients - without sounding like you are brushing them off.

    It's natural for them to follow up with, "By the way, Scott, What does the Spiriva cost in the donut hole?"

    It's really an irrelevant question when looking at annual costs... but they want to know and I answer them - but answering questions like this hundreds of time during AEP when people are calling in is simply "new business prevention" and 100% unprofitable. We make next to nothing on this time sucker...


    or

    "Scott, we go to Wal-Mart now and the printout you gave us shows Wal-Mart pricing, but we were thinking about switching to CVS. Can you run us the estimates for CVS?" If you say yes, that will take at least 3-5 minutes to do even when you have the drug ID and date (which I keep for everyone). You have to go to to Medicare and switch the pharmacy and see if it makes any difference.... then answer them... and the phone just rang again.


    Some times I think that I should just stop doing drugs. OR find a way to be more efficient. Maybe hire an assistant to do this part? It wasn't as much of an issue last year because my book was smaller.
     
    Last edited: Nov 5, 2015
  10. sman
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    sman Guru

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    Yes, stop doing drugs, it's bad for your health.

    In all seriousness, I think we all get the same scenarios. I have one lady who just couldn't wrap her head around why the higher premium plan cost less. In addition, she had multiple scenarios. I ended up running 6 different comparisons for her and finally spelling it out medication by medication of what her copay would be and the light bulb finally went off. I normally wouldn't have done it, but she's been a great source of referrals for me.

    I mentioned creating a video tutorial for next year to Bob(somarco) and he sent me an email with 5 links showing Part D tutorial. I may be using those next year.

    My nature is to want to help. But I just get tired after running so many comparisons and answering so many questions. A good number of my clients take what I say as the gospel. But some just take way too much time. I think the most frustrating part of all is when they forget to tell you about a medication or they don't pay attention to the list on the comparison and at a later date they say "oh, I'm not taking that anymore". Usually AFTER you've already completed an enrollment. And then removing that medication means a different plan for them.

    Definitely time to make some changes.
     
    sman, Nov 5, 2015
    #10
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