Part C

[Guest]

After the sale he asked if they knew of anybody interested in his plan, they said to go see his brother inlaw down the road.

The man went to the brother inlaws home and was invited in,

Could the agent have made a phone call to the inlaw from the client's house asking to stop by in about an hour? Would that be allowed? Or would he have to mail a letter? Would he be allowed to drop the letter off instead of using the USPS?

She also called the advantage company and said to please have this agent that dropped by her house to call her.

I guess she TOLD the company that the agent did not make an appointment first? I'm surprised the company even asked.

They asked why the agent dropped by and she told them he was going to get her on the same plan as her husband. The company called and questioned why he went to the house without an appointment, he explained and told that he was going on a med supp referral. He was told when he mentioned the advantage plan the whole call changed.

I don't buy the carriers's reasoning. I also sort of doubt that the guys appointment would be terminated that fast on such flimsy evidence and for just one 'incident.' You sure you got the story straight?

If true and it were me, I'd immediately call my lawyer and have her write a letter to the carrier threatening hell and high water for business interruption, etc. Since the appointment was terminated I would have nothing to lose!

They terminated his contract and it is still being investigated by CMS.

You are SURE that CMS is really looking into this? You sure you got ALL the facts here? Or are you just relating a 'story' told to you by this agent. Do you know him/her well?

What is the name of the carrier?

If you want to PM me the name of the agent I can contact him/her as I'd be happy to write this up into an article and submit it to the WSJ or NYT or some other media (some of you know that I'm a freelance writer, publisher, and basic PITA when I hear 'crap' like this. If true, this agent's story should be told... and I have the contacts to get it on the network news... or at least get someone looking into it. It's a good story... lots of angles... and with OE next month the timing is perfect. He/she would get ink and air.... maybe lots of it if picked up by the AP (which it would if I wrote it )... they would get their 15 minutes of fame!)

Al

 

[dandan]

Ok Al, I will try to answer your questions.


1. Could the agent have made a phone call to the inlaw from the client's house asking to stop by in about an hour? Would that be allowed? Or would he have to mail a letter? Would he be allowed to drop the letter off instead of using the USPS?

He was going to try to sell a med supp, his client had a med supp and he asked for the referral. No need for any of the above for med supp.

2.She also called the advantage company and said to please have this agent that dropped by her house to call her.

Thats what he told me.

3.I don't buy the carriers's reasoning. I also sort of doubt that the guys appointment would be terminated that fast on such flimsy evidence and for just one 'incident.' You sure you got the story straight?

If true and it were me, I'd immediately call my lawyer and have her write a letter to the carrier threatening hell and high water for business interruption, etc. Since the appointment was terminated I would have nothing to lose!

It is exactly what he told me.

4.You are SURE that CMS is really looking into this? You sure you got ALL the facts here? Or are you just relating a 'story' told to you by this agent. Do you know him/her well?

What is the name of the carrier?

If you want to PM me the name of the agent I can contact him/her as I'd be happy to write this up into an article and submit it to the WSJ or NYT or some other media (some of you know that I'm a freelance writer, publisher, and basic PITA when I hear 'crap' like this. If true, this agent's story should be told... and I have the contacts to get it on the network news... or at least get someone looking into it. It's a good story... lots of angles... and with OE next month the timing is perfect. He/she would get ink and air.... maybe lots of it if picked up by the AP (which it would if I wrote it )... they would get their 15 minutes of fame!)

Yes I'm just relating the story that I was told, I met the gentleman at a seminar discussing HSA's and getting CE credits. He was older and very friendly, he asked what I marketed.

I told him the senior market made up 80% of my business, and it went from there. From what he told me this is how it went down, I had no reason to doubt him.

He possibly is seeking legal counsel, I don't know. He was a polished older gentleman that seemed like he could handle the situation.

We exchanged cards I'm don't really feel comfortable calling him asking if he needs help with the situation. I don't see a reason for him to fabricate this story??









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[retread]

There are some salient points in this thread. I may be wrong in my interpretation, but I cannot see how common sense applied to insurance sales can be misconstrued as illegal activity. I think everyone is so intimidated by CMS threating language that they are paralyzed when they should be helping their client.

If a client has to have a particular formulary coverage to be insured, you must have knowledge of his medications to advise him. This is not the same thing as asking health questions to pre-qualify him on Health plans where it is specifically stated that they do not have to respond under guaranteed issue rights. If someone is guaranteed issue, there is no need to obtain health information, so don't ask. This is all the underwriting required. Note: The tobacco question for Med Sups is NOT a health question, and MUST be asked. The ESRD question for MAs MUST be asked, and IS a health question!!

For drug coverage, the situation is different. It is not a matter of whether he can qualify for a drug plan or not, but which plan to place him in. If there is only one drug formulary in your plan, and you are not selling any other, no need to ask further questions. However, if more than one formulary is offered, or more than one plan being represented, one has to be selected using the prospect's current prescriptions. I am not a one-trick pony show. I offer several different PDPs. A captive agent is not going to have this issue.

Conversely, if you are offering a client a PDP and he doesn't have much need for coverage because he is healthy as a horse, you should put him in the lowest cost plan available, even if it has a high deductible. He will obviously not exceed the deductible, so it is a no-brainer. However, if he is taking some high-dollar drugs, and you put him in a cheap plan that doesn't cover his medication(s), you are not doing your "due diligence". The only conceivable way to accomplish this is to ask him "what medications are you taking?" You are trying to help him, not cherry pick for the carrier.

 

[AgentOrange]

Look guys, health care is killing everybody across the country but mainly Seniors. It is hard for them to pay the B premiums, D premiums, drug copays and then another $100.00 to $200.00 plus for a sup that covers 20%. I think as long as we as agents stay stewards for our clients and dont enroll them in upstart or shadey companies the bad MA carriers will be phased out and the good ones that actually cover will only get stronger.

 

[GreenSky]

Look guys, health care is killing everybody across the country but mainly Seniors. It is hard for them to pay the B premiums, D premiums, drug copays and then another $100.00 to $200.00 plus for a sup that covers 20%. I think as long as we as agents stay stewards for our clients and dont enroll them in upstart or shadey companies the bad MA carriers will be phased out and the good ones that actually cover will only get stronger.

So, are you suggesting we don't use WellCare?

One of the problems with the bad carriers being phased out is that the good/bad change from year to year.

Humana and UHC are good companies but (at least in the areas I work), bad PFFS plans. Pyramid has a great plan but lots of claim problems.

Blue Cross of California is the largest provider of health insurance in California but with only a couple of exceptions, don't offer what I consider good plans. In fact, they write only Select Medicare Supplements. If you go to a non PPO provider, you pay the Part B deductible. And yet they still promote Plan F!

WellCare is huge, promotes a plan for Medi-Medi (PFFS) that absolutely sucks and is under FBI investigation. However, some of their other plans such as the true SNPs are good. Are they a bad company?

The fewest tje carriers the worst it is for consumers. Nothing good has come of PacifiCare buying FHP and then UHC buying PacifiCare. From 3 companies to 1. All we have lost is a lack of choice and competition. Has anyone gained by Wellpoint buying up half of America?

What is needed is a PRIVATE watchdog agency or agencies to offer ratings of plans/benefits/carriers. Something like UL Laboratories. Everything the government touches turns to crap. CMS is responsible for the problems with MA and PDP. Not the carriers. Get the governement out of insurance and prices will drop and coverages will increase.

Rick

 

[Guest]

Blue Cross of California is the largest provider of health insurance in California but with only a couple of exceptions, don't offer what I consider good plans.

Could you elaborate on that? Not arguing or disagreeing, (I know better), just wanting to understand the analysis you use to reach the conclusion.

In fact, they write only Select Medicare Supplements.

What do you mean by SMS?

If you go to a non PPO provider, you pay the Part B deductible.

Hmm. I thought all the Blue Cross CA supps were PPO. No?

And yet they still promote Plan F!

How can their F be different than anyone else's F... unless you are talking about the high-deduct F sub-plan?

Thanks.


Al

 

[GreenSky]

Could you elaborate on that? Not arguing or disagreeing, (I know better), just wanting to understand the analysis you use to reach the conclusion.


What do you mean by SMS?

Hmm. I thought all the Blue Cross CA supps were PPO. No?

How can their F be different than anyone else's F... unless you are talking about the high-deduct F sub-plan?

Thanks.


Al

Al:

I've made this offer to you previously but you didn't want to do it. I will once again offer to teach you insurance if you fly into Burbank.

As far as Med Supps - they are not PPO plans. PPO equals network. There is no network.

Blue Cross writes Medicare Select Plans. Ask your rep.

If you must be in the Blue Cross PPO network for their supplements (Select), why do you need coverage for excess charges? (There is an answer for this but I don't want to get to advanced.

Honestly Al, some of us study insurance. I have taken courses which led to designations - CSA, CIC, MSAA, CBC - not because they impress me (which is about all they are worth), but for the KNOWELDGE.

You might do the same.

This is not meant to be a put-down of you intelligence, just your lack of study of what you might be selling.

As I said, fly into Burbank and you will begin your study of your chosen hobby.

Rick

 

[senior-advisor-indiana]

Select plans do have a network but just for hospitals. Atleast that is the way it is here.

 

[Guest]

This is not meant to be a put-down of you intelligence, just your lack of study of what you might be selling.

Sigh. I'm sorry I asked. I should know better.

Fly to Burbank to see you? Why? You are a legend only in your own mind, Richard.

Al

 

[GreenSky]

Select plans do have a network but just for hospitals. Atleast that is the way it is here.

Blue Cross of California is the only select plan I know of in California. They are select only in that you must go to their contracted docs for the Part B deductible to be waived.

Rick