Medicare: Avoiding a Sales Allegation

In my last blog post I talked about the lengths I go to during lock-in for my clients.  During my summer calls to my clients I make sure everything is running smoothly with their coverage and if they’ve been having issues I make it a point to drive out and meet with my clients in-person.    Now I’d like to move on to a less pleasant subject; knowing when to cut ties with problem clients and protect your license.

KNOW WHEN TO FOLD THEM:

A few weeks ago I had to answer an inquiry (called an allegation by most carriers) regarding an AEP enrollment in the Phoenix area.  I spent a ton of time doing pre-enrollment research for this lovely lady.  She is one of those HMO members who do not want an “expensive” Medicare Supplement but wants to have a full and unlimited universe of doctors and other providers.  I doubled down explaining the restrictions regarding provider access with HMO’s and checked all her docs.  She was well informed, intelligent and seemed satisfied with her change from one MAPD to another.

This was a carrier provided lead so I felt I had to make the extra effort to help this person.

Come April 27th the Carrier’s compliance “inquiry” hits my inbox.  I fully responded the next day and the finding is due shortly.  This is the first allegation sent my way in about eight years.  The customer service rep that generated the “inquiry” quoted the member as supposedly suggesting that I told her:

“All our local HMO’s are the same”, “The same providers are available on all the area plans”. Jeesh!

The next time I speak with her my inner Donald Trump will come out: “You’re Fired”.  I of course will be a little nicer about it, but I will not be doing any future business with her.  Unfortunately, it is too dangerous in today’s compliance atmosphere to take chances with clients that might intentionally or accidentally generate an allegation.  This is another good reason to be on the phone with your client, when possible, during troublesome calls to carrier customer service. Your contract and renewals are on the line, and I don’t need to have a hit against my E&O!

While I’m griping let me touch on one other couple I had to fire last year:

A married couple in the Phoenix, AZ area that were referred to me by a wonderful and valued 15 year client of mine who is a regular referral generator.  After an hour in the house I absolutely knew I should leave some packets and just walk away.  Nope, they were referred to me by a friend so I soldiered on. In the future, when I get the “walk-away” chills running down my spine I will do just that.

I visited this couple 3 times before enrolling them and 3 more times after enrollment in the first four months on their plans, a record for me. The wife was feeling ill for years and wanted a plan where a doctor would listen to her.  Bingo, I got her on the perfect plan for her needs that was clinic based.  During her first visit to her PCP she was diagnosed with diabetes and placed on injectable insulin.  Her previous doc of some five years had never tested her.  The PCP on our new plan probably saved her life.  She seemed appreciative at the time.  Her husband was one of those angry guys who just could not be satisfied.  He was on about 15 meds and was a medical disaster.  I worked with him relentlessly.  My thanks?  He somehow got connected to his plan’s local sales manager in Phoenix and told him that I was “worthless” and could not fix anything for him!  Well, I had worked for that sales manager years earlier and we were still good friends.  He knew my work ethic and ability to resolve problems.  Hence, no allegation, but he suggested I fire the couple.  If this client had called the national customer service line to complain it would have been another “inquiry”.

Bottom Line: When you get those chills down your spine, save your license and your contract and protect your renewals.  WALK AWAY!

Whether it’s helping you avoid compliance pitfalls or providing you with AHIP reimbursements and discounts, RB Insurance Group is here to make your life in the Senior Insurance industry a breeze.  Call us today to get contracted and learn how to get your 2018 AHIP reimbursed! 1-800-997-3107.