Appeals and Form CMS-1696, the Appointment of Representative

Humor me with this post. It deals with appeals.

Say your client Fred is really upset. He feels the prior authorization for his electric scooter should have been approved, but his Medicare Advantage carrier has denied it. It happens: Providers occasionally submit a weak authorization request and sometimes carriers might even make mistakes. When either of these happen, who do plan members like Fred turn to after a confusing conversation with customer service? He of course will call his insurance agent.

You can help your clients make an appeal with the Form CMS-1696. Image courtesy of iStock Photo


Back when I was young and foolish As a former carrier appeals supervisor, I know a few things about appeals. The following paragraphs assume you actually want to work with an appeal situation:

Start with customer service. A surprising number of issues might be resolved with a couple of calls. If your client isn’t comfortable on the phone or just can’t digest the information (this seems to be happening a lot recently), get on a 3-way call with him or her. Agents tend to be more attuned to customer service lingo.

If necessary you can help initiate step one in the process. An “organization determination” can even be done in advance to clarify if a procedure or service will be covered. If you have no luck with this, move to the more formal appeal process Level 1. A detailed overview of the steps through all levels of appeals is available here.

If your client is incapable of dealing with the process I suggest you become an unofficial advisor. Just note that carriers do not appreciate agents getting directly involved as the client’s representative in the formal appeal process unless you are a relative. It’s preferable that a client’s competent friend or family member become involved. You can coach the parties, but it’s not advisable that your agent name appear any documents. Your client can appoint a representative with a simple Form CMS-1696, which I’ve linked to right here. Include it with the rest of the appeal information.

I’ve utilized this form a few times on behalf of my older relatives who invariably buy their Medicare insurance from some other agent who does not return phone calls (We will deal with that type of unwelcome charity work in a future blog post).

For assistance with an appeal situation our affiliated agents can call me here at RBI. Just dial (800) 997 3107. I would not consider it charity work, so feel free to call or even email me.

Medicare agents: You can master the sales process

When I think back to my college days and the success of my friends who graduated with law degrees and MBAs, I feel proud of them and admire the hard work they put in to complete intense curricula. Part of me wishes I completed my degree with them.

I left Georgia Institute of Technology (Go Yellow Jackets!), the MIT of the South, in the middle of my junior year as a dual major in electrical engineering and information and computer sciences. I was and still am a nerd of the highest order, but when I entered sales as a profession shortly after I left college, many of my friends questioned my decision.

“Sales?!” they would always ask in bewilderment. “But Brandon, you had so much promise!” Rather than take offense, I was focused on becoming the most excellent sales professional I could be, regardless of whether I was selling security systems, high end jewelry, car service or insurance.

Image courtesy of Georgia Tech Facebook page


Want to know what the reward of that hard work was? I was soon earning more money than all my friends — including the lawyer — and still do almost 30 years later.  In most organizations, the top sales professionals can make as much as or even more than company VPs and the CEO.

And yet there are sales professionals who barely make a living.

While there are many factors that influence whether sales professional earn 6 figures or struggle to get by, the fundamental difference between these two extremes is mastery of the sales process.

There are only a few university programs that teach students to think of sales as a process they can master. You’re lucky if the organization you work for provides actual sales training. The insurance industry expends most of its time and energy on licensing, continuing education and carrier product training for agents, but offering training on the actual sales process is hard to get from Broker Support. As a result, many agents are Ready To Sell, but not knowledgeable on how to sell.

I want to introduce you to the sales process with this post. You may have heard of a similar sales process from a different trainer because there are multiple versions of it. Here is my outline of the process that can make you a successful insurance professional:

This process likely covers what you’ve been doing instinctively, but refining how you do it will make better use of your time and make you more effective at finding and closing more prospects. That increase in effectiveness will increase your income and allow you to grow your business to 6-figure earnings and beyond.

Stay tuned next week for more on the sales process and RB Insurance’s special offer for FREE access to my 6 Hours to 6 Figures training program.

Want to read more? Click here to subscribe to The Agent’s Advantage. RB Insurance will never sell, rent or share your information. You will receive one weekly newsletter from RB Insurance.

A free Power of Attorney form can spare loved ones from additional grief

The Power of Attorney form (POA form), often referred to as the Life Care Planning Packet, can be one of the most valuable extras senior insurance agents can provide to their clients. They’re simple to complete — just a few printed pages or a website link. Agents know that building credibility requires constant effort, and providing these fillable documents to clients demonstrates a high degree of professionalism. In a distant, previous life I prepared Power of Attorney forms and other documents for clients as a paralegal. I was a total convert to the art of preparedness then, and for the last couple of decades in the insurance business my respect for this status has served me well.

For a case study on POAs and what they can mean for your clients, let’s go back to 2012, just before the Christmas holiday. A best friend and old college buddy, Jerry, planned a three-day trip to Las Vegas with me. Jerry was a successful businessman, had a nice home in Scottsdale and was fairly wealthy. He lived alone, had no siblings and his only two relatives were younger cousins back East with whom he did not communicate.

Jerry was meticulous in collecting the commissions owed him from the tech companies he independently and earnestly represented. He never missed a scheduled oil change for his luxury sedan. He always paid his bills early. He was younger than any of us buddies, in his early fifties. Unfortunately he absolutely could not confide to his two best friends in the universe that he had been diagnosed a few years earlier with congestive heart failure. Jerry’s condition was not readily evident, so he would view such a personal disclosure as a sign of weakness — it was just his nature. Then it happened.

Jerry called us to his bedside at Scottsdale Shea Hospital. His surgeon insisted he have a representative with Power of Attorney standing by during an imminent surgery. Jerry advised me that the procedure was merely a routine, “almost simple” surgical implantation of a pacemaker. He was still unable to share with his two oldest, best friends what was really happening.

I agreed to sign the hospital’s POA form and stay close by, available on my cell phone. After the unsuccessful attempt to implant what was actually a cardioverter defibrillator (ICD) unit, I was summoned to the intensive care unit by the surgeon and given all the accurate medical information regarding the surgery. The doctor was shocked Jerry had not told me about the severity of his condition.

Six days later, with his other best friend standing by my side, I gave the order to remove my old buddy from life support. Jerry had never appointed a Medical or financial Power of Attorney. There was no Estate Representative (or executor as referred to in some states) noted. Most importantly, he had not shared with us his wishes or instructions regarding this inevitable occurrence that my friend and I could follow on his behalf. We were the only two people he could really ever call.

Jerry could have avoided inflicting this type of stress and pain on his friends with a simple Life Care Planning exercise and a couple of frank discussions about his wishes. POA documents are usually available online for free from your state’s Attorney General website or equivalent office. Here is a POA packet provided by the Arizona Attorney General’s office for our local agents or just to get a general idea of what they contain.

Advise your client about free Life Care Planning documents that usually include a Health Care POA, Living Will (End of Life Care). A DNR or Do Not Resuscitate form is available if needed as well as other documents that can convey to family or friends the client’s own wishes and instructions. Encourage your clients to discuss medical matters and final wishes in detail and in advance with their trusted representative. That trusted POA might have to give the terrible order to terminate life support.

Call RB Insurance at (800) 997 3107 or email me to discuss the Power of Attorney form, final expense insurance and other aspects of end of life planning to show your clients you are truly looking out for their health and financial well being.

How to overcome fear of rejection in Medicare sales

I was taught by my high school psychology teacher that we’re born with only two fears — the fear of falling and loud noises. The rest of our fears are learned. From my experiences as a senior insurance advisor and personal sales mentor, there’s no doubt what the No. 1 fear is in our profession: Fear of rejection.

Sales professionals measure minutes between rejections: The phone calls to secure appointments, the “No thanks” they hear before they demonstrate their products and the “I changed my mind” even after what seemed like a successful sale. And yet fear of rejection creates a conundrum, a paradox, dare I say a contradiction for those of us whose very living depends on hearing the word “No.”

Read my last sentence again if you have to. If you analyze the sales process, you will find that “No” is often the gateway to “Yes.” It’s a necessary obstacle for us to overcome to achieve our ultimate goal: Leaving the appointment with a sale.

If unchecked, fear of rejection can turn into call reluctance.  Call reluctance paralyzes us and keeps us from prospecting, going on sales calls, following up on prospective clients and asking for referrals. Most of us have faced call reluctance in our careers, and we know the damaging effects it can have.

For sales people, fear of rejection is like the common cold.  If you have some or all of the symptoms, take two of these and call me in the morning:

Don’t take rejection personally. Rejection in sales comes in many forms.  It often manifests as buyers’ anxiety about whether they can afford your product. Sometimes presenting the right product at the wrong time to a potential buyer results in rejection.

Think of the last time you declined an offer and the reason you gave for turning it down. Your lack of interest was most likely concerning the product, not the person talking to you. Maybe you were simply too busy to learn more about a special offer. Recognize that “No” is the easiest way for people to avoid a discussion, even if the end result would be to their benefit. You can’t take any of these rejection scenarios personally!

Understand the difference between a rejection and an objection. A rejection can shut a sale down, but an objection breathes life into the sales process. Rejection means “to refuse to consider.” A rejection shuts down the sales process before buyers even know if what’s being offered is beneficial to them or not.  Objection is “a viewpoint offered in opposition.” Do you see the difference?  In sales, we actually need the objection.  As evidenced by SPIN Selling and other notable sales training programs, most sales only occur after several objections.

For example, “I don’t want to buy a car” is a rejection, but “I would never buy a white car” is an objection.  You can proceed to counter an objection by demonstrating the benefits of your product, “How does titanium silver strike you?” or “Many people love white cars, but are concerned with maintenance. What if I offered free weekly washing and once a year detailing?”

In the next few posts, I’ll review the sales process because when it’s properly executed start to finish, you can mitigate the effects of rejection and properly handle objections.  For now, realize that sales requires a thick skin and the ability to live in oblivion to the fear of rejection!

ICYMI: Harbor Health Plan drives the competition in Detroit

We had a great time in Michigan during our Harbor Health Plan Benefit Rollout meetings last week. We gave away a 10” Android Dragon Touch tablet in each of our meetings, so congratulations go to Michigan agents Mike Flaker, Dave Irwin and John Sheriff on their new gear (It will come in handy for submitting online enrollments during AEP)! It was my first time visiting Detroit, and I had a great time learning about the Motor City.

Randall Dervishi attended our meetings as well. He was hired last December as the market manager in Detroit for Harbor Health, and he has been visiting a lot of DMC doctor’s offices over the summer getting them acquainted with the Harbor Health name. Tenet Healthcare owns both Harbor Health and DMC, so there’s a natural working relationship between the two companies.

Downtown Detroit image used courtesy of Flickr user ifmuth under Creative Commons License

About the plan

Harbor’s network has greatly improved from last year. It has all of the hospitals in the tri-county area (Wayne, Oakland and Macomb) under contract except the Henry Ford System. Currently there are over 1,200 PCPs and about three times as many specialists ready to serve clients enrolled in one of Harbor’s two Medicare Advantage plans available for 2016.

A $0 premium MA plan will be available in addition to a more robust $47 plan pending CMS approval. Both have a great maximum out of pocket (MOOP) rates and include dental and fitness benefits. Harbor Health has a great plan benefit design with no referrals necessary to see an in-network specialist. This feature is unique to Harbor Health — no other plan in Michigan is doing this! Most Medicare Advantage plans are shrinking their networks and limiting their clients’ choice. Harbor Health is doing just the opposite.

If you’re interested in viewing the plan benefits (Remember, CMS still needs to approve them) or want to contract or certify with Harbor Health just this second, email me or call RB Insurance at (800) 997 3107.

RB Insurance is ready to make it happen for you

Of course we discussed our exclusive AHIP reimbursement program for agents, Brandon Clay’s 6 Hours to 6 Figures mentorship series plus RBI’s direct mail marketing pieces. I’m also looking for seminar presenters for the 2016 benefit year. I need a total of 20 presenters so if you’re interested in being a presenter, please email me.

For the pièce de résistance, we’ll be back in Detroit on September 24 — check our events calendar for the specifics. We’ll be discussing the confirmed 2016 plan benefits and talking about how to sell Harbor Health versus the competition in the tri-county area. For our afternoon session we are pleased to have none other than Brandon Clay himself sharing his successes and delivering his signature advice on how to become a trusted senior insurance advisor.

Please feel free to share this information with your fellow trusted senior insurance advisors. I would love to see them at our meeting in September!


Medicare could cover end of life counseling as early as Jan. 2016

Advance care planning could become a standard part of Medicare as early as January 2016, CMS announced last month as it seeks public comment on a proposal to reimburse providers who start a conversation with beneficiaries about their final wishes.

According to a statement released by CMS on July 8, “The proposal includes a number of provisions focused on person-centered care and continues the Administration’s commitment to transforming the Medicare program to a system based on quality and healthy outcomes.” Also known as end of life planning, the service being considered consists of providers ensuring an individual’s care preferences are respected in the event of a critical health situation like terminal illness. 

Find tips on how to help your clients make sure their health care preferences are respected and adapt your senior business to policy change at the end of this article. Image courtesy of iStock


Gently opening a conversation about advance care is “an important step in the right direction” for health care, Dr. Joseph Agostini writes for Aetna’s Health Section. “By making the end-of-life conversation a regular part of delivering high quality care, doctors may be more inclined to broach the subject with patients, their family members and loved ones … The policy change would also encourage physicians and their patients to talk about care preferences and plans before potentially tough and emotional decisions have to be made under the stress of a serious medical condition.”

This is the second time end of life planning has been proposed by the Obama administration. It was dismissed by conservative fixture and 2008 Republican vice presidential candidate Sarah Palin as part of political opposition to the Affordable Care Act (ACA), who likened it to a government-sponsored “death panel” in a post to her Facebook page six years ago.

Nonpartisan Kaiser Family Foundation has prepared a Frequently Asked Questions article about Medicare’s role in end of life care that goes over how end of life care responds to the sensitive nature of dying as well as the increased costs end of life care presents for the health care program. According to the FAQ, just over a third of people age 65 and older surveyed in 2013 incorrectly believed ACA established a “death panel” to make decisions on their behalf due to earlier political uproar.

The proposal has been reintroduced with language that makes it clear end of life planning affirms Medicare beneficiaries’ command over their health care (Click here to view it). It states “For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them.”

The FAQ also states beneficiaries accrue high costs in the last year of life because many of them experience multiple serious health issues at the end of their lives. According to Kaiser, “Roughly one-quarter of traditional Medicare spending for health care is for services provided to Medicare beneficiaries in their last year of life — a proportion that has remained steady for decades.” End of life planning seeks to decrease these costs for the program by making sure undesired care is not provided.

“Getting someone the right care at the right time is more likely to be of value in the long-term for everyone involved, including patients and their families,” Agostini writes about the cost-saving aspect of end of life planning.

Agents can be proactive as end of life planning receives greater recognition. Being sensitive to clients’ needs and wishes by advising them on Medicare’s changing policies is the first step — clients need to be aware of what is added to Original Medicare and what additional benefits Medicare Advantage may provide in the future. Reviewing Physician Directives, which are encouraged by all hospitals and skilled nursing facilities, is another course of action. Building a mutual relationship with a financial planner to establish a back-and-forth referral channel for clients interested in setting up or adjusting wills is a way to adapt and find new clients. Adding final expense with legacy safeguard planning to your sales portfolio is another option for helping clients make sure they are not caught unprepared.

Call RB Insurance at (800) 997 3107 or email Sales Manager Charlie Ferrell to learn more about end of life planning and Physician Directives.

Subscribe to The Agent’s Advantage to receive updates about advance care planning and other Medicare policy news from the agent’s perspective. RB Insurance will never sell or share your information.

The easiest (and most effective) Medicare marketing practice? Staying in touch!

Last week I wrote that referrals maximize your hard-earned Medicare book of business and shared just five of the best ways to stay in touch with your clients as part of your Medicare marketing. This week I’m sharing five more tips that should get you thinking about marketing your Medicare business the way big companies think about their campaigns.

Why do you think big companies spend millions of dollars on TV commercials, newspaper inserts and other promotions? They know that building a successful brand requires a consistent approach to reaching consumers. In our world of information overload, you may not notice most of the ads on the sides of your favorite web sites, print magazine pages or even the ads before the latest viral YouTube video, but some of them are bound to capture your attention. My wife just bought a 20 oz. Coke simply because it had my name on the bottle — part of  Coca-Cola’s instantly effective Share A Coke campaign.

Balancing innovation with consistency in messaging is vital to any brand’s success, and that includes your senior insurance business. Having a great product for sale is only a beginning — you  have to reach out to consumers with advertising to succeed. It also takes continuous messaging to enter consumers’ consciousness. What if a big brand like Coca-Cola stopped its marketing efforts after the first try? It would have wasted precious time, energy and money. So will you if you don’t commit to marketing your Medicare business!

It’s possible your clients have forgotten you just three weeks after giving you apple pie and ice cream at the kitchen table when you went over Medicare Supplements with them. It’s much more likely they have forgotten about you if the last time you contacted them was your initial appointment last AEP. That’s why you have to conduct your business like the big corporations do — stay in touch! 

Think of your business, your products and your clients.  What types of ongoing communications yield greater client satisfaction, repeat business and referrals? Here are the next five in My top 10 ways to stay in touch with clients:

6. Hold educational sessions. Depending on your industry and product, your current clients might benefit from additional education.  If you’re in insurance or financial services, the list of topics is endless. These meetings are not designed to be sales events, but are set you up to let your clients know you’re there for them as a trusted advisor.

7. Connect with social media. OK, so your clients probably shouldn’t be adding you as a friend on Facebook, but they can follow your business and “Like” it.  There When used effectively, social media can help you reach clients in innovative new ways.  Of course, make sure to keep these outreaches strictly business!

8. Video messages. YouTube, Vimeo and other services make it possible for anyone to present relevant information to a worldwide audience.  You can make a message or series of messages that provide greater insight into your products and your services.  You can even create your own channel that your clients can watch and refer people to. I know a life insurance agent that does short, information-packed videos to teach his clients about the different forms of insurance.  This establishes his credibility and allows new clients a way to get to know him prior to calling.

9. Send emails. We all get more emails than we can read each day.  You could use form emails to send to your entire client base through a CRM, but a personal email is more effective.  You could send a “thinking of you” email that contains an interesting article.  You can also send new product information that attaches all the company bells and whistles to make it compelling and interesting.

10. Conduct a survey. Do you really want to know what your clients think or what they want? You should, because that’s the key to determining how to get them to buy more or refer more people to you.  Several online survey platforms like Survey Monkey will allow you to send a simple, short survey and even offer an incentive for their feedback.

As you stay in contact with your clients, not everything you do will be a hit. Some things will miss.  What matters is being consistent and being motivated to serve. The effort is worth it, so stay in touch!

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My community marketing story: Special Olympics Utah

Community marketing was one of the easiest, but also one of the most challenging things I did when I was actively writing new business for my agency in Utah. As an agent selling Medicare Advantage, Medicare Supplements, Dual Special Needs and now final expense products for the past 10 years, I’ve found that being actively involved in my community was rewarding spiritually, but also in the sense that it helped me market my business.

Community marketing is a fairly simple concept. It means getting yourself in front of as many individuals who could use some advice about their health insurance coverage options as you can. The best part is connecting your business with your interest in giving back to your community can still be compliant with the Medicare Marketing Guidelines.

It’s fairly inexpensive to market yourself to the community. You may have to pay for a booth at informal events like senior expos or join a group, but it has a great return on the investment if your volunteering leads to even one sale. Community marketing requires a bigger investment of time and energy, so be forewarned: Staying with it for the long haul can be tough, and not always having the advice and guidance you give lead to a sale can be discouraging.

Members participate in the Unified Relay Across America in anticipation of the Special Olympics World Games, held July 25-August 2. Image courtesy of Special Olympics Utah’s Facebook page

Medicare and other health coverage options for children and young adults with physical and intellectual disabilities

I volunteered with special Olympics Utah when I first got started in the business after an appointment with a parent whose son had Down Syndrome. She told me there were a lot of parents like her who had no idea what programs were available for their children for health insurance other than Medicaid. In fact, Medicare serves individuals over the age of 18 who also have a physical or intellectual disability. One thing led to another, and that Saturday I showed up for an event was a timer for the 100-yard dash. I watched the kids and teens all afternoon, and they introduced me to their parents.

I went to several Special Olympics meetups in the next few weeks and was introduced each time as The Medicare Guy because I knew a lot about Medicare and Dual Special Needs Programs that I could share. Whenever I got a phone call about “Where can I take my daughter to get her teeth cleaned?” or “Where can I find hearing aids for my son?” I had the answer. I knew which DD case managers did the best job of helping their clients manage things like adult day care and how to apply for community grants to help them pay for the cost.

I met a lot of people and listened to many stories as I helped out with events. Sometimes I couldn’t do anything for them other than listen and help them figure out what the best fit for their health and financial situations were, but the fact that I helped them breathe a little easier means a lot to me.  I never walked away without asking people to refer their friends and family to me for their own questions.

There’s nothing better than saving someone $300 per month when they make $,1000 or less or helping a family find the right coverage for their special-needs children. You will be their friend for life, and they will tell all of your friends about you.

Call RB Insurance at (800) 997 3107 or email me to learn more about serving Medicare’s many members through community marketing. Click here to subscribe to our blog for more insights on how you can build a portfolio of products to market yourself and build your Medicare book of business.

Referrals maximize your Medicare book of business

Probably the most effective way to find your next client is by looking to the clients you already have.

Referrals are the Holy Grail of building your Medicare book of business. The credibility and trust you have built with one client automatically transfers to your new one, so you start from a hero status, not at ground zero, if your first client is a raving fan. Closing rates on referrals have always been high, too, which means referrals maximize your investment of time and energy into your business. And yet most agents still don’t ask their clients for referrals!

When I inquire as to why, many feel they haven’t earned or warranted them.  They think they haven’t built the connection that establishes the right to ask for and expect referrals. However, communication is the key to building any relationship, and oftentimes it’s the well timed, small outreaches that make us more memorable than any over the top gestures. When you communicate to create raving fans, get repeat business and generate referrals, you are simply making sure you are on the top of their minds when a friend, coworker or relative mentions a problem you can help solve.

Getting referrals is not nearly as hard as some sales people try to make it, but you do have to have a strategy. Here are my top 10 ways to stay in touch with clients:

 1. Organize your clients. Where is your list of clients right now?  If you’re like the average senior insurance agent, they’re on the floor of your back seat, stuffed in your leather portfolio, packed in your trunk or stashed in folders.  A lot of good they are going to do you in there. Get organized — at the very least, get your clients in an Excel spreadsheet. Trust me, you will be glad you did!

2. Use a Client Relationship Manager (CRM). Once you have your clients organized and electronically archived, take the next step and upload them into a CRM. This will allow you to conduct specific outreach campaigns, set up reminders and do a host of other structured, “high touch” activities. Free CRM obviously has no cost, but the most robust and agent-focused CRM I’ve seen is the Medicare Sales Engine.

3. Send a Thank You. This is the icebreaker for all your future communications. It sets the stage for elevating your clients to raving fans status.  Write them by hand (No rubber stamps!) and include a personal note to make it memorable.

4. Call them after 30, 60 and 90 days. The best time to solidify the sale and the relationship is during the reinforcement phase after the sale. Set yourself up to respond to service issues and product problems when you call and put yourself in the position to get repeat business and referrals. Show your client you care by asking how their family is doing and remember any health issues they may have gone through and needed your assistance with.

5. Remember them on special occasions. Your CRM is fantastic for reminding you about client birthdays, product anniversaries, annual reviews and more. These contacts have to be personal in nature to set them apart from what others are doing.

As you build your year-long strategy, the key is not to saturate your client with frivolous outreach or give them a sales pitch each time. You want to make sure they know you will stay in touch! I’ll share the remaining top 10 items next week.