Blocking a MAPD disenrollment to retain clients- is it legal??

[RunnerDude]

I know many Medicare agents who make it a routine practice to monitor "pending disenrollments" from their book of business, and then call (or visit) the clients to dissuade them from enrolling into a different plan. They then contact the carrier (prior to the end of the month) to cancel the new application- thus maintaining the beneficiary on their personal book of business. Am I missing something about CMS regulations? It is my understanding that this practice is illegal. Every year I take the AHIP training, and it clearly states that this is an illegal practice. So how are agents getting away with doing this? I have heard agents say that they are entitled to perform a "QA visit" to determine the reason for the client's dissatisfaction. Others say that carriers "allow this practice" if the client was enrolled over the phone or they called after seeing a Medicare TV commercial. Still others say that it is not illegal if the new plan hasn't started yet. I don't recall reading anything about these exceptions in AHIP training or through CMS/Carrier information emails or letters. I have lost many clients to other agents over the years but have never attempted to block the disenrollment. If this is a legal practice, I need to change the way I am doing business. Would love to hear your thoughts.

 

[policywunk]

I know many Medicare agents who make it a routine practice to monitor "pending disenrollments" from their book of business, and then call (or visit) the clients to dissuade them from enrolling into a different plan. They then contact the carrier (prior to the end of the month) to cancel the new application- thus maintaining the beneficiary on their personal book of business. Am I missing something about CMS regulations? It is my understanding that this practice is illegal. Every year I take the AHIP training, and it clearly states that this is an illegal practice. So how are agents getting away with doing this? I have heard agents say that they are entitled to perform a "QA visit" to determine the reason for the client's dissatisfaction. Others say that carriers "allow this practice" if the client was enrolled over the phone or they called after seeing a Medicare TV commercial. Still others say that it is not illegal if the new plan hasn't started yet. I don't recall reading anything about these exceptions in AHIP training or through CMS/Carrier information emails or letters. I have lost many clients to other agents over the years but have never attempted to block the disenrollment. If this is a legal practice, I need to change the way I am doing business. Would love to hear your thoughts.

It is a violation to call them but you can send mail. If they call you back it is perfectly compliant to facilitate the cancelation of a future plan. The vast majority of my recent saved enrollments was because client was cold called by call center and lied to about benefits or providers or both.

 

[RunnerDude]

Thanks for your response. This makes sense. However, the agents I know who are doing this are definitely calling the client or going to their home. I agree- many of the changes are inappropriate and not in the best interest of the beneficiary. I just finished AHIP for this year and it sounds like CMS is really beefing up on enforcement of their rules- requiring carriers to implement programs to monitor and report agent violations. Thanks for the idea about writing letters- I'll start using that.

 

[Fisher]

How can you see pending disenrollments?

 

[RunnerDude]

You can look on the agent website for each carrier. Log in to see your book of business. It will show you clients who are pending to be disenrolled at the end of the month.

 

[Fisher]

UHC gives me a choice of Active or Inactive. Humana gives me a choice of Active or Recently Inactive. Pending Inactive is not a choice with either carrier on my portals.

Are you a captive agent?

 

[RunnerDude]

Sorry- I misspoke. No I am not a captive agent.

 

[RunnerDude]

You can, however see who is about to fall off.

 

[pogo]

In Humana Vantage, you can see Future Terms, as in screen shot. Go to book of business, expand the Consumer Insights tab, select Future Terms, and click Apply

 

[Fisher]

You can, however see who is about to fall off.

Again, how?