Episode 23: Resolving Sales Allegations

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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!

Transcript

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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