Can a Person Set MAPD Appointments for an Agency?

[Tom Highway]

If an independent agent has BRC cards with permission to call, can that independent agent hire someone to be an appointment setter, and call those leads, set appointments, and record the scope of appointment? Does the person calling need to be licensed? The person setting the appointments cannot answer questions about plans, but I don't know if they'd need to be licensed too.

Are there any regs on how the appointment setter is paid - does it have to be on a per appointment basis or on a sold appointment basis - in other words, can they be paid only if the appointment results in a sale?

 

[Josh]

If you want to pay them per sale, they have to have a license. One way "around" that is to take a little bit of a risk yourself and set the criteria for what you're willing to pay for, i.e., if you know you close 1 in 4 and you're willing to pay a $50 per sale commission, you could pay $12.50/appt. Obviously there is some risk of paying for appointments and not getting sales, but to my knowledge that's as close as you can get without actually crossing the line.

What's the hesitation in an agent setting their own appointments?

 

[Tom Highway]

Thanks! It's not so much a hesitation about agents prospecting, I'm just thinking about being the one setting the appointments for someone I know who has an agency with several MAPD agents.

Tt's just that in AEP, an agent in the field is paid on apps turned in, so the more time spent kneecap to kneecap with beneficiaries, the better.

It's just a time of the year when taking the time to set appointments when someone like me could do it for this one agency only, I could do it a lot cheaper, and let the agent be selling as many plans as they can.

If someone has to spend two hours or more each day during AEP setting their appointments for the next day, those are hours that could be selling, and if it's a married couple, they could be losing $400+ in those two hours. If I am doing that for a few agents, it's a good deal for them, and I get a little extra cash.

It's just something I'm exploring.

If you want to pay them per sale, they have to have a license. One way "around" that is to take a little bit of a risk yourself and set the criteria for what you're willing to pay for, i.e., if you know you close 1 in 4 and you're willing to pay a $50 per sale commission, you could pay $12.50/appt. Obviously there is some risk of paying for appointments and not getting sales, but to my knowledge that's as close as you can get without actually crossing the line.

What's the hesitation in an agent setting their own appointments?

 

[retread]

I may not respond to your every question, but I should point out that at least one carrier that I am contracted with says that "the agent is fully responsible for all leads and appointments."

It is their interpretation of MIPPA... that the agent cannot say "but I didn't say <insert here>..., that was what was on the lead card" or that "I didn't tell the beneficiary <insert comment here>..., the appointment setter said it."

In my reading of MIPPA, I have to say that I agree with this interpretation. It seems clear to me that CMS holds the agent ultimately responsible for any and all infractions of marketing to beneficiaries. This has undoubtedly resulted in a number of lead companies losing business.

And for this reason I will not hire a telemarketer or appointment setter for any MA marketing. For direct mail, I scrutinize any lead card solicited to me and only use those that I consider compliant (which means they are generic), or else use those offered by an MAO.

 

[Tom Highway]

Oh yes, you are right on track! Believe me, I did MAPD sales myself, so I know about the lines that cannot be crossed.

For me, I don't think I'd be just offering up my services to any Tom, Dick and Harry, at least for MAPD. Heck, I may end up being a total flop, and that's why I'm thinking of doing this for the person I already know with lead cards that aren't being actively worked anyway. I'm assuming that I'll succeed though, and may do some more appointment setting for them, it's a good arrangement for us both. If I end up doing this, I will record every conversation for the MAPD appointments, and email the agency each conversation, whether it resulted in an appointment or not.

Yes, the agent will be the one responsible, but I'm just wondering if there's any difference in what each of the plans have in their in-house appointment setting (or outsourced appointment setting) departments and what I'd be doing. I mean, at the end of the day, say Humana has a call center that sets appointments for employee agents. They're held to a pretty high standard, which I think I'd also be held to if I did this as an independent appointment setter.

I also know that there's a big difference in what you can do to set a MAPD appointment and what you can do to set a more qualified Med Supp or FE appointment or callback.

Great point though. Thanks!

Forgot to say, your signature is as funny as heck. Sounds sort of like something those two grumpy Muppets would say. Waldorf and whatever the other one's name is. Funny though.

I may not respond to your every question, but I should point out that at least one carrier that I am contracted with says that "the agent is fully responsible for all leads and appointments."

It is their interpretation of MIPPA... that the agent cannot say "but I didn't say <insert here>..., that was what was on the lead card" or that "I didn't tell the beneficiary <insert comment here>..., the appointment setter said it."

In my reading of MIPPA, I have to say that I agree with this interpretation. It seems clear to me that CMS holds the agent ultimately responsible for any and all infractions of marketing to beneficiaries. This has undoubtedly resulted in a number of lead companies losing business.

And for this reason I will not hire a telemarketer or appointment setter for any MA marketing. For direct mail, I scrutinize any lead card solicited to me and only use those that I consider compliant (which means they are generic), or else use those offered by an MAO.