OEP

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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OEP Prep – An Agent’s Guide – Ep. 22

Prepare for Open Enrollment Period (OEP) with Episode 22! We start off this podcast talking about what to expect for traditional Medicare plans in the New Year. It looks like there will be a few price increases in 2020, however there is good news too!

We then go on to discuss the basics of OEP. What is OEP? What can beneficiaries do during OEP? What should agents be doing during OEP? We break down the DOs and DON’Ts of this period, so you know how to be compliant and successful! After listening to this podcast you will be prepared and ready for anything the Open Enrollment Period (OEP) throws your way!

Podcast Episode 22 – Open Enrollment Period (OEP) Prep – An Agent’s Guide Transcription:

Sarah: Welcome to Episode 22 of Selling SMART with Sarah Smith…

Jessica: And Jessica Vara!

Sarah: Now that AEP is over, we’re going to talk about how you should be preparing for OEP which is just around the corner! We’re also gonna talk about some price changes that are expected to impact Medicare plans in 2020.

Disruptive Waves [00:40] :

Sarah: 2020 is almost here which is just CRAZY!

Jessica: Yeah, I have no idea where the year went. It’s also so weird to think that we are gonna be in the 20’s. Also do you know what they call the 10’s? Is it that? Is it the 10’s or is it something else? It just doesn’t sound right to me haha I don’t know.

Sarah: Yeah, maybe if you guys know, because we obviously don’t haha leave a comment and tell us! Is it the 10’s is it the 2000’s? What the proper way to say this, we need to know!

Jessica: Yes we do! Haha but anyway… to bring us back on topic haha with it being the end of the year there are a lot of reports coming out about things to expect in the new year. And we found an article recently that had some interesting info about three major Medicare costs that are expected to jump in January. 

Sarah: Yep! Sadly, this isn’t the best news ever. Several premiums and deductibles on traditional Medicare will be experiencing increases in the new year.

Jessica: So the first one is the 2020 Medicare Part B standard monthly premium which is expected to increase by about $9.10 per month to bring it to $144.60 per month. And just for your reference, the increase from 2018 to 2019 was only by $1.50. So 2020’s is a pretty big jump in comparison.

Sarah: The next one is the 2020 Medicare Part B annual deductible and that’s expected to increase to $198 per year which is a $13 increase. And again this plan only increased by $2 a year ago.

Jessica: The last one is the 2020 Medicare Part A annual inpatient hospital deductible for traditional Medicare. That’s going to increase $44, compared to the $24 increase that happened a year prior. So now that cost is expected to be at $1,408 per benefit period.

Sarah: Obviously a lot of this depends on the beneficiary’s income for Part B, but overall these plans are looking at a pretty significant increase in 2020.

Jessica: On the bright side though, Medicare Advantage premiums for 2020 are expected to be 23% lower than they were for 2018! And it’s actually supposed to be the lowest it’s ever been in the past 13 years which is awesome!

Sarah: Yeah I think the main reason for that is CMS’s efforts to drive competition. The other thing too is that the number of Medicare Advantage plans available for 2020 is greater than ever. So not all bad news! 

Jessica: Yeah there are definitely things to look forward to in the new year!

All Aboard the Knowledge Train [04:10] :

Jessica: So now that AEP has officially come to an end, we can focus on Open Enrollment Period or OEP. 

Sarah: Let’s start with the basics! OEP is a one-time opportunity for individuals enrolled in MA Only or an MAPD plan to switch plans or drop their plan altogether. 

Jessica: And if you didn’t know, the purpose of this period is to help beneficiaries who are not satisfied with the plan they enrolled in during Annual Enrollment (AEP).

Sarah: Right! And during this period, beneficiaries enrolled in MA-Only plans or MAPD plans are able to switch to a different MA-only or MAPD plan, drop their Medicare Advantage plan altogether, return to Original Medicare and add a Part D plan. The period begins January 1st and ends March 31st. Which means you have that window to help bene’s who aren’t happy with their plans! However, OEP is different than AEP and has a few more guidelines that you have to follow in order to be compliant. And we all know how important compliance is! 

Jessica: Yes compliance is very important! No one wants to deal with any sales allegations. So in order to avoid that whatever you do, do NOT market to leads or clients during OEP. Marketing is strictly prohibited during this period, so be careful.

Sarah: OEP guidelines make it so that you are prohibited from KNOWINGLY targeting or sending unsolicited marketing materials to any MA or Part D enrollee during OEP. Now what does “knowingly” mean? It pretty much just takes into account the intent AND content of your message. 

Jessica: So this is where OEP gets a little tricky and people have the hardest time understanding. Cause how are you supposed to make any money or sales during OEP if you can’t market to beneficiaries. And that’s where I would remind people that there is a difference between marketing and communication. You can still communicate with your book of business, you just can’t open a discussion about OEP specifically and how it’s a period they can use to switch plans.

Sarah: Right, so with that being said, you CAN reach out to them to make sure that they’re happy with the plan they selected and you can also take that opportunity to educate them on the ins and outs of their new plan benefits.

Jessica: Exactly! And this gives them the opportunity to bring up to YOU if they’re not happy with their plan and want to look at other options. 

Sarah: Yeah cause remember the main reason you can’t start the conversation about it is for the beneficiaries protection. They don’t want people taking advantage of these different selling periods and talking people into different plans simply to make money. That would not be good!

Jessica: And don’t forget you can talk and communicate with your clients through a ton of different platforms. And I think this is where people tend to get confused because when people think about flyers, emails, and direct mail they think marketing which is not allowed. However, you CAN use flyers, emails, social media… all of these different outlets! You just have to be careful with what you put and say on these materials. 

Sarah: Yeah, you may not be able to talk about how bene’s can change their plans during OEP, but you can use those materials and have the content be educational or retention efforts. And that’s something you want to be doing anyway! You want to make sure you’re checking in on your clients and see if they are using their benefits and are happy.

Jessica: Yep! So go ahead and make those calls! Send those emails! You want to make sure your clients don’t forget that you’re there to help them with all of their Medicare questions and needs!

Sarah: And lucky for you guys, Senior Market Advisors actually has a ton of approved flyers and mailers on our Storefront that you can purchase if you’re an agent with us! However, if you’re a subscriber we’re going to give you a flyer to download for FREE!

Jessica: So just to wrap it all up, as you’re preparing for OEP here are the do’s and dont’s. First, DO market to those who are eligible for a Special Enrollment Period.

Sarah: And that includes people who are turning 65 soon and still haven’t made an enrollment decision, as well as dual-eligible and low-income subsidy beneficiaries who can make changes once per the calendar quarter during the first nine months of the year. 

Jessica: Also for 2020 you are now able to include GENERAL information about enrollment periods, including OEP. But just remember that when you send out marketing materials regarding SEP you CANNOT state WHAT OEP is or market it as another time people can switch plans!

Sarah: DO communicate with beneficiaries and send materials, have one-on-one meetings and provide information. Just make sure to do it in a way that’s compliant!

Jessica: Finally DO market 5-star plans if they’re available because those can be sold year-round!

Sarah: And now for the DONT’S! DON’T send unsolicited materials advertising the ability to make an additional enrollment change during the Open Enrollment Period (OEP).

Jessica: DON’T use messaging that markets the Open Enrollment Period (OEP) as a time people can switch plans. 

Sarah: DON’T specifically target beneficiaries who are in the Open Enrollment Period (OEP) because they made a choice during AEP, by purchase of mailing lists or other means of identification. 

Jessica: DON’T engage in or promote agent/broker activities that intend to target the OEP as an opportunity to make further sales.

Sarah: And finally, DON’T call or otherwise contact former enrollees who have selected a new plan during AEP to bring up OEP and ask them if they want to switch their plan.

Jessica: If you follow these guidelines you’ll have a smooth OEP and hopefully help some beneficiaries as well! 

Sarah: And if you have any questions about OEP feel free to contact our Sales Team! They will be happy to help you and answer any questions you may have!