AEP

Resolving Sales Allegations – Ep. 23

Episode 23 goes over an agent’s worst nightmare… sales allegations! Hopefully, you never have to deal with sales allegations, but if you do, don’t start sweating yet. Through this podcast, you will learn what to expect if you get a sales allegation. What exactly does it mean if you receive one? What’s the process? How do you make sure you don’t receive one in the future? How do you make the process go smoothly and quickly? Our Queen of Compliance, Gina Angelo, has all the answers! 

Also, we talk about the Presidential election that is just around the corner and what the polls are telling us when it comes to Medicare for All. How do voters feel about it? What does this mean for the future of our industry? We’ll go over the numbers and give you a starting point for your own research before you have to pick a candidate!

Podcast Episode 23 – Resolving Sales Allegations Transcription:

Disruptive Waves [01:00] :

Jessica: Happy New Year everyone!!! This is our first podcast in the new year and we are pumped for what is to come this year for Selling SMART. 2020 is going to be AMAZING! 

Sarah: Yes SO MUCH is going to happen this year I can feel it! And one of the big things that we all KNOW is going to happen is the Presidential election. 

Jessica: This is true, and as we all know, healthcare is a huge topic of discussion going into these primaries and debates. 

Sarah: Which is why we feel like it’s important to update you on some recent polls that have been conducted by Kaiser Health News and a few others. Obviously, polls change all the time. The article that we found on Kaiser Health News discussing these polls was published on December 3rd, so it’s fairly recent but we know people’s minds change all the time… so just wanna put that disclaimer out there.

Jessica: Yeah, also it may be good to go and check out the article. Kaiser Health News does a really great job of staying impartial and just reporting on the facts, but we know that whenever you’re hearing statistics and numbers, it’s always good to double-check your resources. We’ve gone ahead and made sure that they were legit and there wasn’t any kind of bias, but we’re human so we want to encourage you to use this information as a starting point to your own research to come to your own conclusion of these topics.

Sarah: Yes that is definitely a good idea! And also if any of you know the history of Kaiser I think it’s also good to let you know that we did some digging to see what their relationship with Kaiser Permanente and Kaiser Industries. Because when we first found the article, we were a little concerned that their relationship with those entities could make them biased. BUT! We found that in 1985 Kaiser Health News separated from Kaiser Permanente/Kaiser Industries and now their only tie is that one of the family members gets to serve on the board of Kaiser Health News.

Jessica: Right, so that’s also good to know. And if you want to go find the article yourself to do further digging it’s on the Kaiser Health News website and it’s called “Candidates Are Betting Big On Health. Is That What Voters Really Want?” and it was written by Julie Rovner.

Sarah: So now that we got all of that out of the way, let’s talk about what’s actually in this article.

Jessica: Yes! So obviously health care is a top issue for voters during this 2020 Democratic presidential primary race. Kaiser’s Family Foundation found in their latest tracking poll that 24% of Democrats and Democratic-leaning independents said that they want to hear candidates discuss health care. That number is twice the total for the next top issue which is climate change and four times the total for immigration which is the number three issue. 

Sarah: So it’s clear that health care is very important to voters, but the question that still remains is whether that interest is going to reward a candidate that backs up the “Medicare for All” type of plan or a relatively more modest plan like a public option where a person can voluntarily join a government health insurance plan.

Jessica: And based on conversations you’ve had and people you’ve discussed this topic with, you may have an answer in your mind of what you think voters want. However, the poll numbers didn’t conclude with a clear answer.

Sarah: Right, so on one hand, Democratic and Democratic-leaning respondents in the Kaiser Family Foundation poll said that when it comes to health care, the candidate they would trust the most is Bernie Sanders, who (as many of you know) has been pushing for a Medicare for All plan.

Jessica: Here’s whats a little confusing though. Those SAME people say that they prefer a public option, which is not what Bernie Sanders is pulling for. 

Sarah: Nope. Not at all. That’s what Joe Biden has been wanting. 

Jessica: Yeah, so I think it’s safe to say that’s NOT what many people would expect the polls to conclude. 

Sarah: So also, in a separate poll done by Quinnipiac University, 36% of respondents said that Medicare for All is a good idea while 52% say it’s a bad idea.

Jessica: And a NBC/Wall Street Journal poll from September found similar results with 67% of respondents saying they would support allowing people under the age of 65 to “buy their health coverage through the Medicare program,” while only 41% favored “adopting Medicare for All, a single-payer health care system in which private health insurance would be eliminated.” 

Sarah: Yeah so with that being said, people’s opinions may change between now and the primaries, but these are interesting numbers. 

Jessica: For sure! It will be very interesting to see what happens. Especially since this is the industry we work in and these are pretty major changes that they are talking about. So it’s very possible that this will have a huge effect on us and our every day lives.

Sarah: Right, so definitely do some more research, figure out what every candidate is proposing and be an educated voter!

All Aboard the Knowledge Train [09 :10] :

Jessica: So we are super happy to have our Queen of Compliance, Gina Angelo, on the podcast today! Gina, would you mind just giving us a brief overview of who you are and what exactly your position at SMA entails? 

Gina: So my actual title is SR Compliance Manager- though Queen of Compliance does have a really nice ring to it. Anyway, what I do actually has a number of sides to it when you think of compliance- it’s part sales, part marketing, part corporate, and part workforce. So for the sales side, I ensure I’m an outlet for compliant sales activity for our organization and all the thousands of our downstream agents and brokers. For marketing, I make sure ALL of our formats are being delivered in a way that’s compliant with all guidelines. From a corporate level, I have to see to it that the organization fulfills all obligations on a Federal, multi-state, and carrier relationship level. And in regard to the workforce- I create, deliver, and document all compliance training for all of our employees. I also create and enforce all of our Compliance Policies and Procedures.

Sarah: That’s awesome Gina! We’re happy to have someone like you keeping us all out of jail haha. So let’s just start with the basics in case we have some new agents listening. What exactly are sales allegations? 

Gina: A sales allegation is essentially an inquiry that is opened due to potential sales misrepresentation. Sometimes they can be called by a different name, such as a “grievance”, “investigation”, or “complaint”. They can really come from anywhere, such as from a bene or a member of their family, other sales agents, the Department of Insurance, or directly from CMS. And that’s just a few examples. One thing I will say as someone who’s previously worked in both sales and service directly with a national carrier is that many allegations are prompted based on a call from the beneficiary and are automatic. So if any type of dissatisfaction is noted, in order to make a certain action possible for the bene to resolve their issue, it prompts the inquiry based on what the service rep is told as the order of events. So often the allegations come back as unfounded/unsubstantiated.

Jessica: So obviously a big part of your job is dealing with these sales allegations and I know that is a very scary topic for agents. First of all, you’re kinda getting in trouble so no one likes that, but then I also think it’s scary because agents aren’t entirely sure what the process looks like. Would you be able to take us through that whole process?

Gina: So first I’m going to point right back to what I just said as to WHY the allegations often happen. Anyway, when the case is first opened the carrier’s compliance oversight team will perform an investigation. They usually send out a questionnaire- now sometimes this will be straight to the agent, to both the agent and also to me, or just to me so that I alert the agent of the matter and ask for their response. Now, you have to remember that these are TIME SENSITIVE- so you will have to provide your response and all supporting information within a short period of time, sometimes in as little as 24 hours. Some of the additional info you’ll need will be things like the bene application, the Scope of Appointment, any notes, drug lists or provider searches, or recorded calls. 

Sarah: What would be your advice to an agent if they get a sales allegation?

Gina: REMAIN CALM! Also, please don’t be argumentative- just cooperate. The more you resist and argue, the worse things will be for you, I promise. It reflects very badly on your part. If you feel there has been a misunderstanding, then you can state that in the additional notes or comments section of the response form, but definitely fill in ALL of the other portions of the questionnaire and absolutely DO NOT use an arrogant or hostile tone. Some results of these investigations are additional remediation, suspension, and even termination. Tread carefully.

Jessica: And what are some ways that they can make the process easier for you and run super smoothly so that it’s resolved as quickly and efficiently as possible?

Gina: All those things I just said. Retain your notes (securely of course) and just COOPERATE.

Sarah: Are there certain questions that you feel like agents have a lot when it comes to resolving sales allegations? And if so, what are they and what are the answers?

Gina: They like to ask me “why” they’re getting an allegation. Well, since it actually came from another source, I do not have the answer. It is generally an automated process, often spurred by a call to a carrier’s customer service department. If you wish to dig deeper, I can get you in contact with that carrier’s compliance representative who sent me the inquiry, HOWEVER you are still bound by the timeframe requirements. You cannot postpone the inevitable.

Jessica: What steps should an agent take after a sales allegation? 

Gina: Once the response is submitted to the carrier and received by them, the investigation will continue until a conclusion is reached. The time this will take can vary greatly. As soon as the outcome is given back I WILL LET YOU KNOW. There is no reason to email me multiple times a day to ask about it- I promise!!! Once they evaluate it, all allegations generally fall into 3 primary outcomes: founded/substantiated, unfounded/unsubstantiated, and inconclusive.

Jessica: So most of the time are they true then? 

Gina:  Most often, generally outside of AEP, they are unfounded. Immediately after AEP, I do see a bit of an increase with founded and substantiated cases at least percentage-wise of what I receive.

Sarah: What can agents do once the sales allegation has been completely resolved to make sure they don’t have another sales allegation against them in the future? And are there certain resources that they can turn to for guidance? 

Gina: It’s extremely difficult to ensure you never receive another allegation, as there are so many different actions that initiate them on so many different levels. However, after one happens you can work diligently to change the way you approach certain situations and topics, and perhaps adjust the way you do your sales presentations. Also- I am actively working to add more resources on our Storefront related to compliant sales activity- so be sure to keep an eye out for those. Each time a new one is released we try to let everyone know via email and/or social media. Also, you can always send an email to compliance@seniormarketadvisors.com or reach out to your sales contact with us.

Sarah: So a lot of what you have been talking about is related to you actually helping agents resolve these sales allegations. That really relates to agents who are with us at Senior Market Advisors, but what about agents who aren’t with an FMO? Do they go directly through the carrier or what does that look like?

Gina: So if they are already contracted with a carrier, whether it’s through a different FMO or direct with the carrier, they should have respective compliance contacts. However, if they find that they are not getting the compliance help that they need… maybe it’s time to make a switch? 

Sarah: That’s one this SMA helps with, you’ve got Gina Angelo right here to help you out with resolving all of those sales allegations.

Gina: Always here to help!

Jessica: Well this has been awesome, Gina! Thank you so much for sitting down with us and talking about probably one of the most “not fun” things about your job and an agent’s job haha but it’s important so we really appreciate you giving us your advice and insight! 

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Ben Newman on How to Be a Top Performer – Ep. 18

In Episode 18, Sarah and Jessica interview Performance Coach, Ben Newman. Senior Market Advisors has been working with Ben Newman for a few months and we knew that his knowledge needed to be shared with our listeners. He has been working with SMA leadership and employees to help our company improve through successfully growing and maintaining efficient company culture. Through our time with Ben Newman, we have come to know the power of his authenticity and engaging storytelling. No wonder he has become nationally recognized! This podcast is exactly what every agent needs to listen to during the start of AEP

Ben Newman is a highly regarded Performance Coach, International Speaker, and Best-Selling Author. He has worked with clients from Fortune 500 companies around the world as well as professional athletes in the NFL, PGA, NBA, MLB, UFC, and NCAA. Ben Newman has shared the stage with leaders such as Jerry Rice, Ray Lewis, Tony Dungy, Colin Powell, Brian Tracy, Ken Blanchard, Jon Gordon, and many others. In 2012 The Napoleon Hill Foundation recognized Ben as one of the Top 51 speakers and thought leaders in the world and his book, “Own Your Success,” was ranked by CEO READ as their #13 business book of the year. He currently lives in St. Louis, Missouri with his wife and their children who he says is the true measure of his success. In this podcast, Ben Newman shares with us the strategies he has implemented within his life and others’ lives to be a motivated top performer. 

Join us as we talk to Ben about “The Burn,” mental toughness, identifying SMART goals, and life lessons from his mother. We promise that if you use these techniques in your own life you will not only excel professionally but also personally. Ben Newman has the ability to help you reframe your mind and realize what motivates you. Figure out what your burn is! You’ll see an increase in sales, productivity, and overall happiness. Listen to the full podcast to learn the secrets of being a top performer!

Follow us on social media and share our podcast postings with the #SellingSMART to be entered to win an Amazon Echo Dot!

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Medicare Plan Finder Tool: What’s Changed? – Ep. 17

Episode 17 discusses the latest update to the Medicare Plan Finder Tool on Medicare.gov. As you may have heard, this tool has been significantly altered with AEP right around the corner. Find out what exactly has been changed and why agents everywhere are talking about it. 

As we go through all of the Medicare Plan Finder Tool revisions, we will highlight the following categories: saving information, preferred pharmacies, overview of costs, total costs, provider networks, star ratings, drug cost assistance, printed drug list, navigation issues, out-of-pocket max, and old records. Learn what is new and what has remained the same, so that you can figure out the best strategy when enrolling beneficiaries this annual enrollment period.

Finally, we will conclude on a positive note with an interview with agent Paul Coleman. No matter what is going on in the industry, we always try to focus on the good and the lives we can impact for the better professionally and personally. 

Medicare Plan Finder Tool: What’s Changed? – Ep. 17 Full Transcript

Sarah: Welcome to Selling SMART with Sarah Smith….

Jessica: And Jessica Vara!

Sarah: Today’s episode is all about the updates to the Medicare Plan Finder Tool on Medicare.gov. So we are going to switch it up a bit on this podcast. We are going to combine the Disruptive Waves section with All Aboard the Knowledge Train because this massive update we have for you will affect your every day selling this AEP…

Jessica: Yes, hopefully you have heard by now that the Medicare Plan Finder tool on Medicare.gov has had a HUGE update recently. The new Medicare Plan Finder tool went live on Medicare.gov on October 1st which unfortunately didn’t give agents much time to play around with the changes and get comfortable with the new tool before AEP. 

Sarah: So if you haven’t familiarized yourself with these changes already, you really should before AEP! These changes will affect how you use the tool during appointments to get beneficiaries the right coverage for their needs. 

Jessica: Forbes had a few articles on the most important changes to the Medicare Plan Finder tool. So let’s break down the changes and then we can dive in to how they will affect you. 

Sarah: Starting with how you save information… 

  • Saving Information – One of the biggest potential issues for agents is the ability to save information. The only way to save information now on the new Medicare Plan Finder Tool is to have an account on Medicare.gov. But here’s the catch: to create an account you need to have a Medicare number and you might need to add some other other health information. Now you could technically fudge that other information, but you have to have a Medicare number. This means agents may be unable to save information. This also means that if a beneficiary who is new to Medicare and not yet 65 wanted to browse plans and save information to discuss with an agent, they wouldn’t be able to do so as far as I can tell when I was messing around today with the new Medicare Plan Finder Tool.(Source

And now time, for an SMA Value Ad:

Are you an insurance agent or agency looking for extra marketing support, but not sure where to start? Senior Market Advisors can give you the tools you need to grow your business. Need leads? Use SMA Storefront to customize generic one-of-a-kind marketing materials. Have leads but nowhere to house them? Other FMO’s may charge you for their CRM tool. But at SMA, we give you a personalized CRM account for FREE! Have leads… but no way to quote them? Lucky for you, SMA offers FREE access to the CSG Quoting tool. This tool can cost you thousands of dollars elsewhere, but with SMA, access is completely FREE! Not getting paid the commissions you deserve? SMA has strong relationships with each carrier, so you can count on top-tier commissions. Interested in learning more? Visit us online at www.seniormarketadvisors.com/podcast or give us a call at 844-334-6066.

Sarah:

  • What’s frustrating is that the old Medicare Plan Finder Tool on Medicare.gov would save your information and create a profile for you including your zip code, current coverage, and current subsidy level and it would sit up in the corner while you were doing a search and it would add information as created. This no longer saves, so you’ll have to start over every time you want to use the site. 
  • This also includes the “Retrieve My Saved Drug List” This was an awesome feature for agents and benes alike. You could go through the website, add the drugs and you would be able to save that drug list and it would give you a drug list id number and the date it was created. And then you could just go back in and input the drug list id number and the date it was created and it would retrieve that drug list and you wouldn’t have to go back and populate drugs every time. Many beneficiaries are taking many drugs. Some are taking 10 prescriptions, 20 prescriptions, who knows! So entering those in every single time is just a total hassle. This also was helpful if a bene wanted to use it to print their drugs to take to the pharmacy. Nope, that feature is gone as well 🙁
  • Another thing about the Adding Drug page that’s been updated is that the old page used to show you whether the drug you input was generic and if there were generic options available to lower costs. When I was in there today I did not see this feature anywhere so if that’s a feature that is available, I don’t think a beneficiary would easily find it.
  • You also used to be able to refine plan results. For example, if you only want MA only plans or MAPD plans you could choose between them. As far as I can tell, there’s no way to filter for those fields. You can filter by carrier and star ratings and then filter by coverage options like vision, dental, hearing, transportation, and fitness.

Jessica:

  • Preferred Pharmacies – The new Medicare Plan Finder tool will make finding preferred pharmacies a challenge. The older version had two methods to retrieve this information. You could find the Pharmacy network and see a chart of all preferred, standard, or out-of-network pharmacies in a specific zip code. Another option was to click on the View Drug Cost Summary on the comparison page. This would create a comparison of pharmacies and identified if it was preferred, standard, or out-of-network. The new Plan Finder tool does not have either option available for identifying preferred pharmacies. If you want to find preferred pharmacies, you would need to change pharmacies and then compare costs. This is an inefficient method and depending on the drug, may not be accurate. (Source
  • Old site would show which pharmacies were preferred while on the Selecting Your Pharmacies page. That no longer exists so if a bene was looking for this information, they probably wouldn’t even find it.
  • Overview of Costs – In the past, agents could click on a link on the Overview page of the Legacy Plan Finder and find all the information surrounding the plan’s cost and sharing information. This information does not appear on the updated tool. (Source)

Sarah:

  • Total Costs – The older Plan Finder tool easily displayed total out-of-pocket drug costs for the year, including monthly premiums and costs for prescriptions. The new Plan Finder estimates yearly costs at retail or mail order pharmacies, but they do not include the premium. To get this cost you would need to multiply the premium by 12 and add that cost to the estimated costs. There have been reports that CMS is aware of this flaw and is working to fix it but we haven’t heard an update on this just yet but hopefully they will fix it before AEP starts. (Source)

And now time, for an SMA Value Ad:

Looking for extra marketing support? SMA Storefront is your one-stop shop for all your marketing needs! Use SMA’s Agent Storefront to customize generic marketing materials like posters, mailers, flyers, rack cards and business cards! We give you the ability to add your logo and contact information so every piece is one of a kind! Planning to host a marketing event? Order pre-designed banners and giveaways directly from Storefront! Continue your knowledge on sales techniques by viewing the Building Your Business video series and downloading Medicare-related whitepapers! Customize your marketing, educate yourself and get the tools you need to succeed, all with SMA Storefront! Interested in learning more? Visit us online at www.seniormarketadvisors.com/podcast or give us a call at 844-334-6066.

Sarah:

  • Provider Networks The older Plan Finder had a link to the plan’s provider network site. This allowed agents and beneficiaries to find in-network physicians. However, the new Plan Finder does not have this link, so it may be difficult to find this information. (Source)

Jessica:

  • Star Ratings – Star ratings are an important factor when enrolling in a plan. The new Plan Finder tools does not have information on people who left the plan (or why they left) and the rating for “ease of getting prescription filled” is no longer available. (Source) Right now the “Star Rating” just says “Coming Soon”… hopefully this feature will be added soon?
  • Drug Cost Assistance – The old Medicare Plan Finder Tool had a link to “lower your drug costs.” This link will take you to a page that would identify any assistance available for a specific medication. However, the new Plan Finder tool’s link takes you to a generic medicare.gov with 6 ways to get help with your prescription costs. (Source)  

Sarah:

  • Printed Drug List – This is kind of something I talked about earlier. The old Medicare Plan Finder Tool had a drug list that could be printed on a simple, one-page document. Many beneficiaries would take this to their physician appointments. However, the new Plan Finder does not have a one-page option. Instead, beneficiaries would need to to print each page of the drug lists, and only 3-4 drugs fit per page. (Source)
  • Navigation Issues – The new Medicare Plan Finder Tool has several navigation issues. These issues include locations changing when searching for pharmacies in two locations, no option to view all plans on one page, and less sorting options when filtering  plans. (Source)
  • Out-of-Pocket Max – the out-of-pocket maximum on the comparison page is wrong. Instead, it shows estimated total costs for the year. (Source)

Jessica:

  • Old Records – Records from the old Medicare Plan Finder Tool will not migrate into the new one. This means agents and beneficiaries will need to take extra time when entering data and there is a higher chance of errors. (Source)

Hopefully you were able to print off drugs lists or any other old records you had for your clients, but if not it may be a good idea to start doing that in the future. That way if any major changes happen again you will be prepared! We live and we learn!

Sarah:

Yeah this is a really frustrating thing. I think a lot of agents really just didn’t know that all of these changes were coming. They didn’t know that all this information would be purged. Now there is just no access to it. And it’s annoying for agents who may have used the Medicare Plan Finder Tool to house information to use to prepare before appointments. It just makes the whole process more tedious. 

Jessica:

But with all that let’s try to stay on the positive side! I mean really this is just the government is making this big push to make it easier for Medicare-eligibles. And they want it to be easier for them to find information and to learn about plans that are out there. I think that is the intent but as technology changes we are bound to hit bumps in the road and this appears to be one of them. But hopefully in the grand scheme of things, it will all work out in the end.

Sarah:

Obviously, these updates are causing agents huge headaches and are not ideal, but as you should know if you listen to our podcast regularly, we try to stay positive.

This is there biggest overhaul they’ve done to the site in years. So it’s not surprising that there is bugs and things that they didn’t prepare for or they missed. So hopefully it is a work in progress and will improve. We know all these changes are not ideal but as you know if you listen to our podcast regularly, we always try to end on a positive note.

Sarah: If you want to learn more about how Senior Market Advisors can be your home for success this AEP, give us a call at 844-334-6066. If you want to be featured on the podcast, visit www.seniormarketadvisors.com/podcast and click on the button that says “Share Your Story.” 

Sarah: Want more Medicare sales related content? Follow Senior Market Advisors on Facebook, Instagram, and Twitter – links in the description. We post new episodes every other Friday so make sure to follow and like us to stay up to date with all the newest content! If you’re liking our podcast, share our posts with the hashtag SELLING SMART to be entered to win an Amazon Echo Dot! 

Jessica: We appreciate you joining us this week on Selling SMART 
Sarah: with Senior Market Advisors!

SMA AEP Kickoff: LIVE Recording – Ep. 16

Join us for the Senior Market Adivors AEP Kickoff event in Nashville, TN! Episode 16 is different from all previous podcast episodes! We are proud to present our first podcast on the go just in time for AEP! Sarah and Jessica set up the podcast at an event where Senior Market Advisors hosted a select group of agents across Tennessee and our carrier partners. The AEP Kickoff took place at TopGolf! The perfect place to talk business and also have fun!

In this episode you’ll get a sneak peek of some of the 2020 benefits offered in the Tennessee market for carriers like Aetna, Cigna, Amerigroup, BCBS of TN and more! You’ll also hear about some of the amazing value adds that Senior Market Advisors provides to our contracted agents. We hope you enjoy the presentation and it feels like you are in the room with us!

Then we conclude with a couple interviews with two agents, Ray Dover and Eric Peek who share their advice for agents in preparing for AEP and some feel good stories. Our agents talk about reasons they got into the healthcare industry and how they connect with their clients. Senior Market Advisors believes in serving the underserved and that is clear as you listen to statements made by our agents. It isn’t about getting the sale, it’s about helping beneficiaries find a plan that is right for them. Some of our agents have ended up forming relationships with their clients that last for years! Remember that as we move into AEP. This isn’t just a season for sales, it’s also a time to make a difference in your community. We promise, you’ll find AEP and your job rewarding if you approach with the mindset of helping others! Get motivated and get excited because AEP is right around the corner!


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