MA Cold Call- Not

[Winter_123]

Let's establish upfront that there is no cold calling for MA's- period, so I am not trying to wiggle that around or do a work around on that rule.

Having said that, I am interested to know what others treat as the rules of the road when you are cold calling for med supp appointments and you come across, for example, someone who says, "I have a medicare advantage but my plan is going away" and or I have a medicare advantage and want to look at the other medicare advantage plans for 2010, etc. How do you handle or close-out that interaction? Assuming that you called only about med supps and were not playing games but uncovered someone interested in med advantage and assume further that you do in fact offer med advantage.

Striving as always to be compliant, I assume there is nowhere I can go with that in regard to the medicare advantage piece so if I am not going forward.on the med supp, I have no further avenue forward. If I mailed them some info and got a sales appointment approval form back then that would nevertheless be a med advantage appointment occurring as a result of a cold call which is not allowable.

What sayeth thee here? Am I correct in concluding that this is no-go in all ways in regard to the med advantage or is there an allowable strategy here.

Note again, I am not looking for advice on how to game the system. I understand that I could get an appointment on the med supp and then take the conversation toward a med advantage but I dont work that way if I have already scoped out in advance what the scenario is.

 

[Josh]

There are a few ways to handle it and it will depend on what happened. If they want help with the Med Advantage the advice from on high is that you're supposed to have them fill out a SOA form (mail it, drop it by, etc) and then proceed 48 hours after they've initiated the question. If they didn't bring up MA while you're on the phone with them, but did so when you made it to the house then you can have them sign a SOA form before talking about Medicare Advantage and you're fine. If you could prove with clear and convincing evidence in a court of law that you were really and truly only going after the Med Sup and this just happened along the way, you'll be well within compliance. The problem is when folks call about Med Supps looking for MA business and barely know the supp business or are doing it intentionally knowing they're going to write MA 90% of the time. That make sense?

 

[Tom Highway]

What if you record all your outbound calls so that you could have a clearly verifiable discussion where you called on med supps, and the prospect took it down the MA road.

At that point, you tell them that you cannot discuss this with them, per CMS guidelines, unless they either respond to a card that you can mail to them giving you permission to call them about medicare advantage, or if they call you asking about medicare advantage.

If they want to go the route of calling you, tell them that they have to hang up the phone and call you on their own. Then, you record the inbound call where the prospect asks YOU about medicare advantage.

If they want to go the route of mailing, ask them to be on the lookout for a card from you in a few days, and to kindly return it with the permission to call form signed.

How's that? I'm definitely with MPS in that you'll have to be able to document that you were calling for med supps with no intention of steering the conversation toward MA.

 

[Winter_123]

There are a few ways to handle it and it will depend on what happened. If they want help with the Med Advantage the advice from on high is that you're supposed to have them fill out a SOA form (mail it, drop it by, etc) and then proceed 48 hours after they've initiated the question. If they didn't bring up MA while you're on the phone with them, but did so when you made it to the house then you can have them sign a SOA form before talking about Medicare Advantage and you're fine. If you could prove with clear and convincing evidence in a court of law that you were really and truly only going after the Med Sup and this just happened along the way, you'll be well within compliance. The problem is when folks call about Med Supps looking for MA business and barely know the supp business or are doing it intentionally knowing they're going to write MA 90% of the time. That make sense?

I follow that but it does not remove my concern that it is not compliant "advice from on high" (whatever that might be, nothstanding, hopefully not just some zamboni at the FMO). In regard to going to see them about med supp and they raise the question of MA, that piece has never been in doubt. You can do the SOA and proceed.

As far as talking to them on the phone and then mailing the SOA to them or dropping by with it after the phone call, I think it is sheer speculation on our part as to whether CMS would consider it to be compliant. It makes sense to us so we figure it must be compliant. Unfortunately they dont work that way. Say for example you cold cold for supps and encounter someone who only wants to talk MA and, as you suggested, you mail them the SOA to return. The SOA form asks (with unitedhealth for example) what the "initial method of contact" was. The answer to that question is that you cold-called the prospect. Not good. You put the caveat in there that "if you can prove with clear and convincing evidence in a court of law." Uh okay. I think if CMS or your carrier dings you as a practical matter you are dead in the water.

I don't see a way to handle it. I think you have to take a pass on the prospect but I only asked because I am looking for other perspectives and might revise my thinking along the way, so thank you. Unfortunately many of the contract workers at CMS or at the carriers dont have a good track record of answering any question that might involve some complexity and when they do, it is usually wrong.

 

[Tom Highway]

If you go the route of asking them to call you, and then you record their inbound call, you can honestly mark "customer called agent" on the method of initial contact on the SOA form.

 

[Josh]

I follow that but it does not remove my concern that it is not compliant "advice from on high" (whatever that might be, nothstanding, hopefully not just some zamboni at the FMO). In regard to going to see them about med supp and they raise the question of MA, that piece has never been in doubt. You can do the SOA and proceed.

As far as talking to them on the phone and then mailing the SOA to them or dropping by with it after the phone call, I think it is sheer speculation on our part as to whether CMS would consider it to be compliant. It makes sense to us so we figure it must be compliant. Unfortunately they dont work that way. Say for example you cold cold for supps and encounter someone who only wants to talk MA and, as you suggested, you mail them the SOA to return. The SOA form asks (with unitedhealth for example) what the "initial method of contact" was. The answer to that question is that you cold-called the prospect. Not good. You put the caveat in there that "if you can prove with clear and convincing evidence in a court of law." Uh okay. I think if CMS or your carrier dings you as a practical matter you are dead in the water.

I don't see a way to handle it. I think you have to take a pass on the prospect but I only asked because I am looking for other perspectives and might revise my thinking along the way, so thank you. Unfortunately many of the contract workers at CMS or at the carriers dont have a good track record of answering any question that might involve some complexity and when they do, it is usually wrong.

What I suggested is "from on high" was referring to CMS themselves, not an FMO. That is what the response has been when they've been posed that question from carriers, UHC puts out nice little producer newsletters that have the exact details on that in addition to other sources. The reason why I'm asking with the burden of proof being "clear and convincing" is because if it's that solid then it would be easy to explain and they wouldn't have to give it more than a second look. If it's more in the grey area, obviously you'd have more cause for concern and that's what they're trying to avoid. On the SOA when it asks "Initial Method of Contact" it would be wise to site "phone call about Medicare Supplements" and it'd help if you were appointed with a bunch of Med supp carriers and had premium to point out that's what you did for a living and this just happened into your lap as a result of prospecting for other products.

A point worth noting is that in the event there was a perceived infraction of the law, CMS would take any action against the plan. If the plan or CMS felt something inappropriate had happened CMS and/or the plan would forward that information to the state insurance department who would then take any action against the agent if they felt any was necessary. If this is something that you're interested in enough to spend more time investigating you should contact the state and ask what their opinion would be since they would ultimately be the ones taking any action against you, but from a CMS perspective you'd be bullet proof if you really were writing med supps and ran into MA business when that was not what you were looking for. PM or e-mail me if you want to get into more detail than this.
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If you go the route of asking them to call you, and then you record their inbound call, you can honestly mark "customer called agent" on the method of initial contact on the SOA form.

That would be a complete lie. The initial method of contact would be when the agent called the beneficiary about their Medicare insurance. If you were in a situation where you went this route and the prospect said to an investigator "he called me about my Medicare and then told me to call him back" your credibility is effectively shot to hell. Is that really the way you'd want an investigation to start?

 

[Winter_123]

If you go the route of asking them to call you, and then you record their inbound call, you can honestly mark "customer called agent" on the method of initial contact on the SOA form.

Ummm.... I don't think so. I don't work that way. Definition of "honestly" varies from agent to agent.
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What I suggested is "from on high" was referring to CMS themselves, not an FMO. ?

Okay, thank you again.

 

[bobson]

I'd handle like the heroine dealer in Pulp Fiction when Vincent Vega is taking Uma Thurman's character to the heroine dealers house because she OD's. The drug dealer starts screaming on the cell phone call from Vincent Vega, "who is this? I don't know you, I don't know you."

 

[Tom Highway]

That would be a complete lie. The initial method of contact would be when the agent called the beneficiary about their Medicare insurance. If you were in a situation where you went this route and the prospect said to an investigator "he called me about my Medicare and then told me to call him back" your credibility is effectively shot to hell. Is that really the way you'd want an investigation to start?

Ummm.... I don't think so. I don't work that way. Definition of "honestly" varies from agent to agent.

We'll just have to agree to disagree then. Who are you really doing a disservice to if you totally withhold information that the prospect wants and needs? Do you think the spirit of these regs from CMS are to keep people from being informed or to keep people from being preyed upon? If your intention is to cold call for med supps to steer conversations toward medicare advantage, that's a totally different story.

I never said that I'd do something like this regularly or with the intent of calling people about medicare advantage, but I did say that several things have to happen, in succession, and that the burden of proof to have this recorded is on the agent.

1. Agent calls prospect ONLY talking about med supps
2. Prospect says they have medicare advantage and wants questions answered about medicare advantage, without being prompted in any way by agent
3. Agent informs prospect that, per CMS regs, they cannot discuss medicare advantage under these circumstances, and gives prospect the options of returning a permission to call card or calling agent back
4. Agent gives prospect the opportunity to choose or not choose to call agent back. If prospect does not call agent, agent CANNOT then call prospect.
5. Prospect initiates call to talk to agent about medicare advantage.

I honestly don't know how often this would happen in a real world scenario. And you talk about honesty - how many of you have called a prospect, at one time or another "to follow up on literature that was sent out" when you know good and well that YOU never sent out literature, or set up an appointment "because you'd be in the area tomorrow afternoon anyway", or a myriad of other things.

It's just a shame that CMS has gotten agents so shell-shocked that we even have to have this discussion in the first place. But it's a good discussion, and, believe it or not, I'm one of the ones like you, who does everything I possibly can to stay compliant.

 

[Winter_123]

It's just a shame that CMS has gotten agents so shell-shocked that we even have to have this discussion in the first place. But it's a good discussion, and, believe it or not, I'm one of the ones like you, who does everything I possibly can to stay compliant.

Fair enough.

Just us guys trying to survive and stay one step ahead of the grim reaper/CMS.