I recently was certified to sell BCBS and Medicare Advantage programs...I had family and friends that were GM retirees and helped them with their new MA plans...I had a phone call from an agent on another board requesting that I call a couple of clients that were also GM people and did so.
I then contacted my MA and informed them that they wanted help in deciding which BCBS program was best for them.
My MA promptly informed me that I could have no further contact with them because it was a referral and it was a violation of the rules. When I asked for a definitive source from CMS they explained I would have to contact BCBS directly and have them explain it to me...they then in turn told me I would have to contact CMS and they would explain.
Is there clear direction that I missed on this? It cost me 2 sales and the potential for a couple more from the agent that was trying to help his clients and a me a fellow board member.
I know we can't cold call but this was not the case...I could not get a direct answer from either my MA or BCBS.
I was going to get certified with a few other companies but after this experience and the low commission on this it is questionable.
In retrospect I would have had the other agent tell them to call me.
I guess this is how the Feds do things, I can't even imagine what a SNAFU they will make of regular health insurance when they get their collective paws into the mix.
I posted on the other board and only got a response from one other member...guess there are not a lot of folks over there that are in the MA programs.
MA, MAPD,PDP plans are all regulated by cms. You cannot cold call anyone when soliciting these plans, referral or not. They must call you. I'm not even sure if your agent friend can call them and tell them to call you. If it were a Med supp. you would have been o.k. You may want to look into conracting with a couple med supp companies that are competitive in your area. Much easier to market and prospect and in my opinion are also better for the client in most situations, not all, but most.
MA, MAPD,PDP plans are all regulated by cms. You cannot cold call anyone when soliciting these plans, referral or not. They must call you. I'm not even sure if your agent friend can call them and tell them to call you.
Do you know how I find this out exactly? So the rules don't apply to all Medicare programs only MA, MAPD and PDP's?
Do the right thing for the client, and there is nothing to worry about.
I am a little confused...I would have more than gladly helped the client because they wanted to stay in the Blues...are you saying that I could have done this for them?
Last edited by IOA-MI : 11-13-2008 at 07:56 PM.
Reason: Automerged Doublepost
When it comes to referrals, the Medicare Beneficiary must initiate contact with you, either by phone, letter, or e-mail. I stood in front of a roomful of Financial Planners for the second time this month today, and stipulated that the process must be thus:
If they know of someone on Medicare, who wants to talk to someone about the options available to them, the Medicare Beneficiary must initiate contact with me, either by e-mail, or by a signed and dated letter, stating specifically that they want to meet with me do discuss their Medicare options for 2009, and by the way, including what doctors they see and medications they take would be helpful (mind you, I'm telling this to the Financial Planners, not the Medicare Beneficiaries; therefore CMS has no say-so as to whether or not I can tell the Financial Planners to tell their Medicare folks).
Once I receive that correspondence, I will call them to verify it, and to send them a very short form for them to complete and fax back to me, stipulating what they wish to discuss. This must come from each individual. If it's a husband and wife, both must complete it and fax it back.
Once I receive that form, I will call to make an appointment.
(Now, by knowing the docs and meds, I can call the Dr's. and see who they work with, and look up the meds on the formularies)
I then arrive at the appointment, go through the presentation, and go through the 32 points of the recommended plan.
Totally compliant, and a time saver for me when I get in front of the Medicare Beneficiary. When the beneficiary tells me they have a friend that I should talk to, I tell them that the process must be the same as it was with them, and that's the rules, put forth by CMS, and I cannot waiver.
YADA YADA YADA. Call the referral and tell them that Joe Smith said they should give you a call about health insurance but due to Medicare rules, they will have to call you. Give them your name and number and tell them to call if they would like to discuss their options.
Sorry, I've lost all respect for CMS. They're too dumb to catch honest agents who bend the rules. We have to, otherwise we'll go mad - mad I tell you.
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"People who think they know it all really annoy those of us who do"
All these steps can be taken care of in days, if not hours. It's no different than me getting information for IFP by way of a Personal Data Sheet, or for groups, with an Employee Census.
I believe in documentation. I sleep better at night.
All these steps can be taken care of in days, if not hours. It's no different than me getting information for IFP by way of a Personal Data Sheet, or for groups, with an Employee Census.
I believe in documentation. I sleep better at night.
And I respectively disagree with you. I'm not that great at being a follower and I have never hurt a client. I just don't have patience for people who get in my way. Your analogies don't apply. You play the game your way and I'll play it the way I've always played it - straight and I sleep fine. No one ever loses when dealing with me.
Strange that you disagree with someone who plays it straight, isn't it. Play a game of wits with me and you better be well armed.
I had a client call about me about the 2009 plans (he has a MAPD plan). He gave me 2 numbers to call that were friends of his.
I called them both about Medicare supplement. They wanted MAPD. So, now I do my scope of appointment form and meet with them after it is signed.
Look at that, I was compliant with Medicare and I took care of my clients.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
I had a client call about me about the 2009 plans (he has a MAPD plan). He gave me 2 numbers to call that were friends of his.
I called them both about Medicare supplement. They wanted MAPD. So, now I do my scope of appointment form and meet with them after it is signed.
Look at that, I was compliant with Medicare and I took care of my clients.
Would you be willing to share that form? Since I only sell BCBS I can't really do this since I don't sell Medicare Supps, so I will ask the same question I posed above...what are some good companies that I could contract with to sell Med supps?
How do you get it signed? Mail it to them? I'm sure CMS wants an original signature, not a fax. Meanwhile, another agent goes in and has the prospect sign the paper, telling them what it's all about and moves on to writing an app.
I'm sorry. The rule is stupid, inane and an insult to most of us, and I despise my fellow Americans at CMS who are so against me. I know terrorism when I see it. Most people would agree.
I agree with Rabbi and Rick. If CMS calls me I am going to mail them a form for them to sign before I talk to them.
The scope of appointment form is from the carrier direct. If you are selling MA plans they should give you one. This one is from a local carrier specific to them.
How did I get it signed? I handed it to them and then saw them at a later time for an appointment.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
I agree with Rabbi and Rick. If CMS calls me I am going to mail them a form for them to sign before I talk to them.
The scope of appointment form is from the carrier direct. If you are selling MA plans they should give you one. This one is from a local carrier specific to them.
How did I get it signed? I handed it to them and then saw them at a later time for an appointment.
BCBS does a follow up phone call approximately 10 days later and actually asks the client how they came about selecting me as their agent...with family and friends that is no problem because they always talk to me first...with a referral that could be a problem.
So I would have to be contracted with a company that sells med supps and slide in that way. Why are the rules different for these programs?
I know, I know we are talking the feds here.
So how about some good companies that are good to work with and pay better than BCBS?
Doesn't BCBS sale Med Supps? They do here in AR. Some good competitive companies here are United of Omaha which is a Mutual of Omaha company, Constitution Life, Loyal American. You should be able to go to your states Dept. of Insurance website and pull up all carriers that are licensed to sale Supps in your state including the rates. I would start there. What is competitive here may not be there.
Rarely do I respond to anything Rabbi writes but I have to agree with pretty much everything he said.
I made a BIG mistake the other day and called a referral and actually helped them. Guess I'll just turn myself in to CMS.
Rick
Rick,
I hear they are now paying a bounty. Let me turn you in and we will split the money (you may need it to bail yourself out).
Joe
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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
Rarely do I respond to anything Rabbi writes but I have to agree with pretty much everything he said.
I made a BIG mistake the other day and called a referral and actually helped them. Guess I'll just turn myself in to CMS.
Rick
Yeah Rick, I can hardly believe my eyes. You can turn yourself in but they will either not have a clue what to do with you or they will lose the paperwork.
Thanks to all who back me up. This country belongs to all of us and I have a right to protest every dumb rule. Remember anyways that rules can be broken. Laws are something different.
I just dropped an HMO agency because they know they have agents who churn but since CMS didn't care ,they didn't, and have kept the agents on. Now that is unethical. There were more reasons like no one there cared.
My cautious behavior has nothing to do with CMS and this little Medicare Advantage thing. It has more to do with the fact that I am a big believer in documentation. I've never even had a hint of an E&O claim in the past 11 years, and documenting everything, every step of the way, is how to avoid it.
This was drummed into me by my General Agent, when I started with Berkshire Life Insurance Company.
Please don't assume that just because I respectfully disagreed with you meant that I was under the impression that you don't run an ethical business, nor that it won't be prosperous. Quite the contrary.
I don't like surprises, and I don't like a "he said...she said" battle. When it comes to other people's money, and other people's health care, I believe in a paper trail.
A defining moment in my career: I was sitting in the conference room of an acquaintance I met in a Toastmasters group I was a member of. In with me, since it was my first group case at the time, was the gentleman who mentored me, and got me into the business. We were discussing an employee who had cancer at the time, and how it would affect the underwriting. My associate suggested the employer, my acquaintance, leave him off the census, get the policy issued, then "slip" him in as a new employee.
(wink, wink)
The acquaintance looked at both of us and said, "That may be how things are done in your business, but I don't run my business that way."
There's more to it than I am mentioning here, but the gist of it is, the acquaintance did not want anything to appear to be "not-above-board", since he had a business to run.
That stuck with me, and whether or not it you approve of my way of doing business (which makes no difference to me), that's how "I roll".
So Bob, are you usually disagreeable? It's not really a charming trait.
Besides, I'm a conservationist and don't want to waste paper. It's easier to be honest and open and have real feelings for others. You can offer your viewpoint but actually warning of a disagreement is an indication of a much deeper personality flaw. There is professional help for disagreeable people. My wife is getting some now. I have no use for disagreeable people and banish you to my growing ignore list of nasty people.
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