One of our agents called me yesterday to report that one of our area doctors had trained his office staff to prospect for insurance clients in the MAPD and Medicare Supplement markets. It just so happens this doctor is married to a Life and Health Insurance agent. This don't even come close to passing the smell test.
My first thought was to call him and see if he would share the leads with us, or promise him I would not practice medicine if he would stop selling insurance. On second thought, I just passed this information on to where something would be done about this.
This should get very interesting.
I know, before you guys and gals hop all over this one, [COLOR=blue]only in TN is someone qualified to practice medicine when they graduate from the 4th grade[/COLOR]. (Beat you to it Rick).
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Joe Moore
National Senior Benefits
Asurco Insurance Marketing www.finalexpenseagents.comwww.shenagents.com
PO Box 1954, Morristown, TN 37816
1-800-226-1004, 1-423-581-1004
One of our agents called me yesterday to report that one of our area doctors had trained his office staff to prospect for insurance clients in the MAPD and Medicare Supplement markets. It just so happens this doctor is married to a Life and Health Insurance agent. This don't even come close to passing the smell test.
My first thought was to call him and see if he would share the leads with us, or promise him I would not practice medicine if he would stop selling insurance. On second thought, I just passed this information on to where something would be done about this. This should get very interesting.
I know, before you guys and gals hop all over this one, [COLOR=blue]only in TN is someone qualified to practice medicine when they graduate from the 4th grade[/COLOR]. (Beat you to it Rick).
Is there anything about this illegal? Is it unethical from a medical practice standpoint?
I realize that it may represent a conflict of interest.
One of our agents called me yesterday to report that one of our area doctors had trained his office staff to prospect for insurance clients in the MAPD and Medicare Supplement markets. It just so happens this doctor is married to a Life and Health Insurance agent. This don't even come close to passing the smell test.
My first thought was to call him and see if he would share the leads with us, or promise him I would not practice medicine if he would stop selling insurance. On second thought, I just passed this information on to where something would be done about this.
This should get very interesting.
I know, before you guys and gals hop all over this one, [COLOR=blue]only in TN is someone qualified to practice medicine when they graduate from the 4th grade[/COLOR]. (Beat you to it Rick).
I don't think that there is anything inherently wrong with this but that doesnt mean that the doctor could not end out engaging in activities that are wrong. If people come in and ask about health insurance and the staff says "you can always talk to doc's wife who is in the business" then I dont see anything wrong with it. If however, he says, "you want an AARP Medicare Complete plan or a Mutual of Omaha supplment and my wife can set you up with that then he has crossed the line. First of all, he is not licensed to make that recommendation. Second of all, his recommendation impacts patient care and he is making a recommendation based on financial interests. If it turns out that patients think the doc is a good guy so the wife must be a good gal, then that is life and how referrrals work.
I actually think it is less incestuous than when an accountant is also licensed as an insurance agent because the accountant is being paid for independent advice but has a financial interest in his recommendations, but perhaps I digress.
------------------------------------ Spending Our Way to Prosperity
I don't think that there is anything inherently wrong with this
I look at it differently. I see plenty wrong with this. It is selling from a "bully pulpit", where the doctor's office has almost unlimited influence over the patient. Here is something that comes close to touching this:
An insurance agent cannot even get close to a drug store counter to talk to clients about these plans. There is an implied endorsement that CMS does not want an agent to be able to utilize.
At the very least, I see a true conflict of interest coming out of the doctor's office.
CMS is trying to prevent churning. We let doctor's start selling insurance, and insurance agents are not needed any more.
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Originally Posted by Russ
[COLOR=red]I'd love to be the spouse[/COLOR]. Continuous prospects....
I don't see a problem with it...maybe I'm wrong and in the minority.
Russ,
Just be sure when you marry a doctor he is good looking.
Last edited by Joe Moore : 03-25-2009 at 09:18 AM.
Reason: Posts merged
I too see something wrong with it from the HIPPA stand point. Say the doc's wife has told the insurance gal to give her all clients names that have ABC, GHI, IZY, and TYU companies because she knows she has a competitive advantage. Then the agent contacts the patient for the purpose of making a sale. That's unethical and illegal.
Using patient information of any kind for anything other than treatment or filing of claims is a violation of privacy.
Now on the other hand...
I have a doctor's office where the doc, his wife, the office manager, her husband, and one other lady are my clients. I get a ton of referals from them, but they never call me and tell me to call someone. They give the patient my card if they think, due to patient comments, that they may need assistance. They never discuss what company or plan I have "them" on at the time, but give me a shinning endorsement as a professional... PERIOD.
I too see something wrong with it from the HIPPA stand point. Say the doc's wife has told the insurance gal to give her all clients names that have ABC, GHI, IZY, and TYU companies because she knows she has a competitive advantage. Then the agent contacts the patient for the purpose of making a sale. That's unethical and illegal.
Using patient information of any kind for anything other than treatment or filing of claims is a violation of privacy.
Now on the other hand...
I have a doctor's office where the doc, his wife, the office manager, her husband, and one other lady are my clients. I get a ton of referals from them, but they never call me and tell me to call someone. They give the patient my card if they think, due to patient comments, that they may need assistance. They never discuss what company or plan I have "them" on at the time, but give me a shinning endorsement as a professional... PERIOD.
I had a lady that worked for a doctor's office that had a med-supp with me and would refer my name to those turning 65 or those that were unhappy with their present coverage.
I understand and agree with your points if it's a situation where the patient isn't aware of what's going on between doctor/doctor's office/insurance agent.
[COLOR=blue]Plans shall prohibit providers from steering or[/COLOR] [COLOR=blue]attempting to steer an undecided potential enrollee[/COLOR] [COLOR=blue]toward a plan or a limited number of plans offered[/COLOR] [COLOR=blue]either by the plan sponsor or another plan sponsor,[/COLOR] [COLOR=blue]based on the financial interest of the provider or agent,[/COLOR] [COLOR=blue](or their subcontractors).[/COLOR] [COLOR=blue]CMS is concerned about provider activities for the[/COLOR] [COLOR=blue]following reasons:[/COLOR]
[COLOR=blue]• [/COLOR]
[COLOR=blue]Providers may not be fully aware of all plan benefits[/COLOR] [COLOR=blue]and costs[/COLOR]
[COLOR=blue]• [/COLOR]
[COLOR=blue]Providers may confuse the beneficiary if the[/COLOR] [COLOR=blue]beneficiary perceives them to be acting as an agent of[/COLOR] [COLOR=blue]the plan.[/COLOR] [COLOR=blue]Providers should remain neutral in helping plans market[/COLOR] [COLOR=blue]to beneficiaries or in helping with enrollment decisions.[/COLOR] [COLOR=blue]Therefore, it would be [/COLOR][COLOR=blue]inappropriate [/COLOR][COLOR=blue]for providers to be[/COLOR] [COLOR=blue]involved in any of the following actions:[/COLOR]
[COLOR=blue]• [/COLOR][COLOR=blue]Mailing marketing materials on behalf of the plan[/COLOR] [COLOR=blue]• [/COLOR][COLOR=blue]Making phone calls or steering patients in any way[/COLOR]
[COLOR=black]It appears pretty clear, CMS does not want providers being involved in selling insurance.[/COLOR]
I have read the above post a number of times and in my opinion I think it sounds like more of a "recommendation" than an edict. I'm not disagreeing or agreeing with what it says, just questioning it as it applies to the situation mentioned at the beginning of this thread.
The first line states "[COLOR=blue]Plans shall prohibit providers".[/COLOR][COLOR=blue][COLOR=Black]It doesn't say that CMS prohibits it.[/COLOR][/COLOR][COLOR=blue][COLOR=Black]Isn't that clearly saying that the "Plans" are the ones who are expected to "police" the providers? If that is the case does anyone know how that could be done or enforced?
I don't have a real strong opinion on what the doctor is doing assuming that the information you received is 100% accurate.
Hey, if one of us had the opportunity to have the same arrangement with a doctor does anyone think that the agent's first thought would be to turn the doctor in as opposed to accepting his offer? Not me.
With the limited information I have, I do not see anything illegal or unethical about what he is doing. I do, however, see how a lot of agents could be jealous or envious of his wife. I am.
I think he is providing a valuable service to his patients by suggesting the name of an agent who they can trust to actually help them wade through the maze of crap that is happening in the senior market.
The doctor's wife is less likely to blow smoke up a prospects ah, nose than some "new kid" to the senior market who is only looking to make a commission.
Both the doctor and his wife have too much to lose if she jerks his patients around.
[/COLOR][/COLOR]
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Medicare Supplement Sales Training and Coaching.
"The Perfect Contact Management Program (CMP) for the Insurance Professional" www.YourInsuranceOffice.com
877.633.0808
Last edited by Frank Stastny : 03-26-2009 at 12:37 PM.
Frank,
I can see we have some disagreements on this one.
Originally Posted by Frank Stastny
Joe,
[COLOR=blue][COLOR=blue]Hey, if one of us had the opportunity to have the same arrangement with a doctor does anyone think that the agent's first thought would be to turn the doctor in as opposed to accepting his offer? Not me. [/COLOR][/COLOR]
[COLOR=blue][COLOR=red]I would love to have this type of set-up for myself, and every agent I could find. CMS may not police it, but seem to want the Plans to not tolerate this type of unfair competition. I see this as unfair competition.[/COLOR]
[COLOR=blue]With the limited information I have, I do not see anything illegal or unethical about what he is doing. [/COLOR]
[COLOR=red]I think if she were to be provided leads when someone asked about insurance coverage, then I have no problem. But when the office staff is supposed to be trained to prospect every patient, to try to get them to change to whatever she is selling, I have a problem with that.[/COLOR]
[COLOR=blue]I do, however, see how a lot of agents could be jealous or envious of his wife. I am.[/COLOR]
[COLOR=red]I agree, she will probably make more money than the doctor. What if you were the agent and she was destroying the book of your business by the office staff attacking every patient to change their insurance. [/COLOR]
[COLOR=blue]I think he is providing a valuable service to his patients by suggesting the name of an agent who they can trust to actually help them wade through the maze of crap that is happening in the senior market.[/COLOR]
[COLOR=red]I would not have an issue, if it was a referral when someone inquired. But training the office staff to prospect everyone? Working at WalMart's, our agents can do little more than say "Good Morning" without it being a CMS Violation. They cannot prospect. Doctor's offices have a captive audience, and are usually much more believable to the prospect than you and I would be without the referral. [/COLOR]
[COLOR=blue]The doctor's wife is less likely to blow smoke up a prospects ah, nose than some "new kid" to the senior market who is only looking to make a commission. [/COLOR]
[COLOR=red]If she understands what she is doing. I have never heard of her in the insurance business, and she is about 30 miles away from us, an area we have worked regularly. She is not an "old pro" in this business. She may be the "new kid" herself, or she may have had a dormant license, or just moved to the area. I don't know.[/COLOR]
[COLOR=blue]Both the doctor and his wife have too much to lose if she jerks his patients around.[/COLOR]
[COLOR=blue][COLOR=red]I agree, but the doctor and wife may not see it as jerking them around. They may look at it as a chance to double their income. They themselves may have been sold a "bill of goods", especially if she is new to the business. She does not have his last name (not sure that makes a difference), and for all I know she may be 22 and he may be 70, or she may have been with him for 50 years. [/COLOR][/COLOR]
[/COLOR]
[COLOR=blue]CMS guidance specifically states:[/COLOR][COLOR=blue]Plans [/COLOR][COLOR=red]shall prohibit providers from steering or[/COLOR] [COLOR=blue][COLOR=red]attempting to steer[/COLOR] an undecided potential enrollee[/COLOR] [COLOR=blue]toward a plan or a limited number of plans offered[/COLOR] [COLOR=blue]either by the plan sponsor or another plan sponsor,[/COLOR] [COLOR=blue][COLOR=red]based on the financial interest of the provider or agent[/COLOR],[/COLOR] [COLOR=blue](or their subcontractors).[/COLOR]
[COLOR=black]I have not heard, but wonder who gets the "Scope of Authority" form? The office staff or the agent?[/COLOR]
[COLOR=black]CMS may not police it themselves at the present time, but the above verbiage strongly suggests to me they don't want to see this type of marketing be allowed. I would bet if the Plans did not stop it, CMS would get into the action pretty fast. An occasional referral may be fine, but not on a wholesale sell-them-all type basis.[/COLOR]
I know I just joined this forum, but OMG!!! An office staff trained to prospect and direct existing, senior, medicare clients to his wife???!!! Are you serious?! Jealous? maybe, unethical? definately!! There is no way this is "right"! or I'm in the wrong business.
Frank,
I can see we have some disagreements on this one.
[COLOR=blue]CMS guidance specifically states:[/COLOR][COLOR=blue][COLOR=Green]Plans[/COLOR] [/COLOR][COLOR=red]shall prohibit providers from steering or[/COLOR] [COLOR=blue][COLOR=red]attempting to steer[/COLOR] an undecided potential enrollee[/COLOR] [COLOR=blue]toward a plan or a limited number of plans offered[/COLOR] [COLOR=blue]either by the plan sponsor or another plan sponsor,[/COLOR] [COLOR=blue][COLOR=red]based on the financial interest of the provider or agent[/COLOR],[/COLOR] [COLOR=blue](or their subcontractors).[/COLOR]
[COLOR=black]I have not heard, but wonder who gets the "Scope of Authority" form? The office staff or the agent?[/COLOR]
[COLOR=black]CMS may not police it themselves at the present time, but the above verbiage strongly suggests to me they don't want to see this type of marketing be allowed. I would bet if the Plans did not stop it, CMS would get into the action pretty fast. An occasional referral may be fine, but not on a wholesale sell-them-all type basis.[/COLOR]
Joe
Friendly disagreements are one of the things that makes this board so good.
I'm really not trying to start an argument, I don't think it is unfair competition. I don't believe that she is doing anything that any other agent wouldn't take advantage of. (You forgot to underline the word Plans above. That is the operative word in the statement.)
I guess I would like more clarification as to what the staff is really doing and if and how they were "trained". "Trained" can mean a whole lot of different things. The agent could also be embellishing just a tad when he told the story.
Your agents in Wal-mart are not selling Med Supps, they are trying to place MA plans. CMS can, and does with vigor, dictate what agents can and can't do in regard to MA plans. Currently there are no CMS rules and regs governing the sale of Med Supps the way they do with Part C plans.
Every time an agent makes a phone call or knocks on a door they are "trying to destroy my book of business". I look upon it as free enterprise and good healthy competition. It helps keep me on my toes and is a very good reason to provide excellent service.
Every Med Supp policy I sell is taking business away from some other agent who has failed to provide excellent service to their clients. I love lazy agents, they more than anything else have contributed to my success.
If his wife is a "new kid" and really doesn't know what she is doing or not acting in the best interest of her clients it will surface fairly quickly. Always remember "Time wounds all heels".
Haven't you ever had any of your clients call their friends and relatives on your behalf and suggest that they contact you for a better deal on Med Supps? I have had a lot of clients do that for me. They may call and suggest that I give someone a call and I ask them if they would call them first and say that they have given me their number.
There is no scope of appointment with Med Supps. If it is an MA plan the agent is not allowed to make the initial contact. Once the prospect contacts the agent then the agent is the one who will request the signature.
His wife is working with a pretty limited number of people. It's not like he has every senior in a 100 mile radius as a patient. I would guess that only a small percentage of his patients are on Medicare unless he is a geriatric doctor and there are very few of them around.
If she is 22 and hot, and he is 70 I may have just found a new "hero".
I guess I just don't see that it is a problem to the same degree that you do. Maybe because it isn't happening in my backyard. However, I do not limit my prospecting to a small geographic area. I sell Med Supps all over the state of Missouri. I even do a little business in Colorado.
One doctor doing something like that really isn't going to have any impact on me or my "book of business". If every doctor in Missouri and Colorado were doing that then I would have to work a little harder. I have never been concerned about competition.
I don't blame you for being upset though, you have to cover your agent's 6.
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Originally Posted by mustbesharon
I know I just joined this forum, but OMG!!! An office staff trained to prospect and direct existing, senior, medicare clients to his wife???!!! Are you serious?! Jealous? maybe, unethical? definately!! There is no way this is "right"! or I'm in the wrong business.
I still would like to know what constitutes being "trained". I doubt seriously that the staff is making a "presentation".
The thing that would piss me off royally is if the staff is violating DOI rules by giving information about the policy without being licensed.
I have been this business for a long time and I have just about seen it all. When I first started selling insurance I had a manager who I had to give a daily activity sheet to showing who I contacted and if I thought they were a good prospect. I found out that he was calling them and selling them insurance saying that I was just a trainee and just making the initial contact for him. The area office manager thought that was hysterical. "Time wounds all heels."
This can be a very dirty business. Nothing really surprises me anymore and there is very little that I really get upset about.
You and I both know that the majority of agents, if their spouse was a doctor, would attempt to do the same thing. Marketing to seniors is becoming more difficult every year. The more difficult it becomes the dirtier it gets.
Ten years ago it was actually fun. Today, and especially since the advent of PFFS plans, it has turned into a cluster ah, mess with a lot of agents doing and saying what ever it takes just to make a commission check. That is what has caused all this crap with CMS. It isn't because of agents like you, Joe and me.
If I want to get pissed off about something there are a lot bigger fish that I would like to fry. I'm sure his wife is not making a huge impact on sales to seniors if what she is doing is having any impact at all. As Joe said, he has never heard of her, that tells me that she really isn't a major player or making a huge dent in either an agents book or the senior market.
Yes, the doctor is wrong in permitting that to happen. So are a lot of other things that doctors do that are much more damaging. Just like a lot of the crap that insurance say and do.
She may have said "no prospects, no pu___. Or, "You can't have one without the other."
Last edited by Frank Stastny : 03-26-2009 at 11:54 PM.
Reason: Posts merged
If she is 22 and hot, and he is 70 I may have just found a new "hero".
[COLOR=blue]What is it the ad says? If it lasts more than 4 hours, seek medical treatment? I bet he would consider it more a miracle, than a medical emergency. [/COLOR]
She may have said "no prospects, no pu___. Or, "You can't have one without the other."
[COLOR=blue]For all I know about this, for every 10 sales, he may get a FREE Ride. [/COLOR]
[COLOR=red]Frank,[/COLOR] [COLOR=#ff0000]I can just hear some of the women on this forum now. "Damn Dirty Old Men".[/COLOR]
Doctor in MAPD/Med Sup Business?
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