Rules

[IOA-MI]

Hi, I am new to this forum.

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.

Thanks,

 

[toc3]

Re: Rules?

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.

 

[theinuranceguy]

Re: Rules?

Do the right thing for the client, and there is nothing to worry about.

 

[IOA-MI]

Re: Rules?

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?

What companies do you suggest for other products?

Thanks for the response.
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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?

 

[Bob_The_Insurance_Guy]

Re: Rules?

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.

 

[The Rabbi]

Re: Rules?

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.

 

[Bob_The_Insurance_Guy]

Re: Rules?

Rabbi,

I respectfully disagree.

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.

 

[The Rabbi]

Re: Rules?

Rabbi,

I respectfully disagree.

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.

 

[midwestbroker]

Re: Rules?

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.

 

[IOA-MI]

Re: Rules?

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?

Thanks.