Is this Really a CMS Violation?

[yellowbirdnj]

Don't worry about it. I just got a violation recently about my past agency putting the senior advisor words as my position. Got a call from the compliance guy at UHC who was really asking me for dirt on that prior agency. Like most investigations, it went no where. Just last week I got this strange call from a broker relations person at UHC who listed 7 infractions against me that were all find unsubstantiated. However, because your agency put the words senior advisor after your name, you are going to have to do an education module. Now keep in mind that these cards were done 4 years ago and since that time, 3 years, the agency changed the cards, and additionally I am now on my own with my own agency for the last year and have the words insurance producer on the cards. UHC didn't care.

 

[landandseadog]

I don't write for Healthspring, but it seems CMS is getting harder and harder on agents. I have thought about not writing MAPD's for a while now. As I am a very compliant agent, I am still afraid of their stupid "dings" I can easily get. They have to start realizing we are human and we are going to make these little faux pas as nobody was made perfect. That being said, Life and annuities pay much better without CMS breathing down your back. Sad, you can even help people anymore without having to worry about repercussions !

 

[kennethbroyles]

Thanks Midwestbroker! I needed to hear that. Honestly, this has caused me a lot of stress the last 24 hours and that's tough on this old heart. I am working with my upline to see what can be done but they are telling me essentially what you said. Hopefully, this won't effect my 2016 contracting.

I just want to commend you for your desire to "do the right thing for your clients and the Medicare members who need so much help." It is so easy to make a small oversight under the pressures of AEP, and the CMS regulations, and is easy to understand those agents here who want nothing to do with MAPD and PDP. I've been doing this for the last 8 or 9 years and at least that many times trying to get out of this segment, with no luck. After this many years and being one who does as you, and contracts with all plans, to know the market, and being able to offer and consult, the lost Medicare beneficiaries who I meet. Most of them really have no clue how to find the best choice or what to do after they are in a plan with a problem or question, it becomes a "calling" we have to do. After awhile you don't have to go look for business.

 

[cadylou]

I don't write for Healthspring, but it seems CMS is getting harder and harder on agents. I have thought about not writing MAPD's for a while now. As I am a very compliant agent, I am still afraid of their stupid "dings" I can easily get. They have to start realizing we are human and we are going to make these little faux pas as nobody was made perfect. That being said, Life and annuities pay much better without CMS breathing down your back. Sad, you can even help people anymore without having to worry about repercussions !

CMS doesn't care that you're human. They would love to get rid of agents in all markets. CMS runs the Federal Exchange and it's very clear that they want the agent out of the process. -

They only needed us to get people enrolled during this first & 2nd Obamacare enrollment since they made such a mess of things.

Next year, the enrollment will be at the same time as Medicare, so . . .some of us may have to choose which market to service. For me it will be Medicare, but always expect that if the government is making the compliance rules, they will not favor the agent.

 

[wehotex]

CMS doesn't care that you're human. They would love to get rid of agents in all markets. CMS runs the Federal Exchange and it's very clear that they want the agent out of the process. -

They only needed us to get people enrolled during this first & 2nd Obamacare enrollment since they made such a mess of things.

Next year, the enrollment will be at the same time as Medicare, so . . .some of us may have to choose which market to service. For me it will be Medicare, but always expect that if the government is making the compliance rules, they will not favor the agent.

Unless they decide that the Fair Market Value of our work is $100/year.

 

[sman]

CMS doesn't care that you're human. They would love to get rid of agents in all markets. CMS runs the Federal Exchange and it's very clear that they want the agent out of the process. -

They only needed us to get people enrolled during this first & 2nd Obamacare enrollment since they made such a mess of things.

Next year, the enrollment will be at the same time as Medicare, so . . .some of us may have to choose which market to service. For me it will be Medicare, but always expect that if the government is making the compliance rules, they will not favor the agent.

Time to be extremely organized and efficient. This year I was able to get a good number of my Medicare cases completed prior to the ACA open enrollment. I made the decision this year to only help those under 65 clients I currently have and not pursue new business. Of course, I picked up several referrals so I added some new business. But I also lost some due to the extreme rate increases of those who still had pre-ACA plans. I have several who either decided to go on a spouses group plan, go with Medi-Share or just go without and pay the penalty.

Over on the politics forum you'll see some people talking about premium increases now being less than before ACA. I don't have a single client who has experienced that. My own personal premium has doubled compared to two years ago and I now have a higher deductible than two years ago. i don't recall a time before ACA (dating back to 1998 when I went independent) where my insurance premiums have increased as drastically as they have in the last two years. Same goes for the majority of my clients (with the exception of those receiving substantial subsidies).

 

[somarco]

I didn't even know there was a politics forum. Must be where Winter disappeared to.

Whatever they are smoking, I want some. The smallest increase on 2014 to 2015 business was 20%, highest over 60%

Pre-2014 plans anywhere from 40% to 300%.

 

[GAJ638]

First, I have been in the business 15+ years and have NEVER had any complaints or violations alleged against me because I am diligent about being thorough and ALWAYS put client interests first.

I am very upset at what has transpired and can't believe it is a CMS violation so I am seeking other opinions.

I faxed a Healthspring MAPD application taken on 11/22/14 and it was received by the company on 11/23. On 12/2, I received a notice of a timeliness violation stating that I committed a violation because the application was "received more than 3 days after signature date."

I immediately looked into the situation and determined I had inadvertently written 11/12 instead of 11/22 in the agent area of the application for the date the application was received. Both the Scope & application dates signed by the client were 11/22/14- I had just mis-wrote my date.

I responded to Healthspring on 12/3 with the following:

"In response to the accompanying email, I attest that the application for (MEMBER) was executed on November 22, 2014 as indicated by her signature date on both the application and Scope of Appointment, which was required due to a request to discuss Healthspring. I inadvertently listed 11-12-14 in the receipt date in the agent section but all other dates reflect the correct 11-22-14 date which would make the application submission timely.

(MEMBER) is a long time client of mine and our meetings are always on Saturdays so her children can attend. Two of her children in attendance were XXX (Phone #) and XXX (Phone #) that will also attest to the 11-22-14 meeting date.

I have included a copy of the allegation email & copies of my calendar pages.

Please let me know if you have any questions or need anything additional.

Thanks!"

Today, I received notice that it is indeed a violation, now on my record, I have to do something, submit remediation forms, etc. Interestingly, the letter acts like the sales manager, who signed the letter, had discussed this with me but she hasn't. I got the original violation, responded and assumed "No problem" until today. Awww, the old ASSUMED.

So, Ye' Old Wise Ones of the forum, is this truly a CMS violation? Do I have any re-course to get this reversedremovedetc.

Thanks in advance!

I did the same exact thing last year(2013). Misdated the form by one week I think early in the AEP. Wrote it with UHC and towards the end of AEP I got a call reviewing my performance I guess. It was said that I had one violation. When I reviewed it I explained that it was an error on my part and that I almost always faxed in Apps within 24 hours. Nothing ever came of it. He verbally smacked my on the wrist and that was it.

Go figure.

 

[cadylou]

Time to be extremely organized and efficient. This year I was able to get a good number of my Medicare cases completed prior to the ACA open enrollment. I made the decision this year to only help those under 65 clients I currently have and not pursue new business. Of course, I picked up several referrals so I added some new business. But I also lost some due to the extreme rate increases of those who still had pre-ACA plans. I have several who either decided to go on a spouses group plan, go with Medi-Share or just go without and pay the penalty.

Over on the politics forum you'll see some people talking about premium increases now being less than before ACA. I don't have a single client who has experienced that. My own personal premium has doubled compared to two years ago and I now have a higher deductible than two years ago. i don't recall a time before ACA (dating back to 1998 when I went independent) where my insurance premiums have increased as drastically as they have in the last two years. Same goes for the majority of my clients (with the exception of those receiving substantial subsidies).

I didn't have any "small" premium increases. Also, because of the cancellations of pre-ACA style plans, most of my individuals who are entrepreneurs experienced premiums that doubled or tripled. Those folks don't qualify for subsidies, so they are stuck with enormous premiums. Mine doubled . . . .I'll have to check out the politics forum. Maybe there are "plants" out there telling stories . . . .

 

[sman]

Maybe there are "plants" out there telling stories . . . .

Yes, they are called liberals.