I referenced “charity work” on behalf of non-clients toward the end of my post on appeals and the CMS-1696 Appointment of Representative form a couple of weeks ago. I should have referred to these non-clients as Leads. As I mentioned then, this type of work is unwelcome, given that I don’t see the commissions for my services. I actually severely limit free Medicare advice in my business.
In my first few years in the field selling the old Medicare HMO products I assiduously avoided friends, relatives and their various cronies who wanted free help with their HMO. Having been advised by some old timer agents that working pro bono was a waste of time, I steered clear of helping these kinds of folks. After about 10 years into the Medicare insurance business I changed my tune when I met Ralph.
The exception that proves the rule
Ralph was a retired construction guy who was also married to one of my HMO clients. I was a captive employee agent at the time. Ralph was enrolled with a decent HMO plan offered by our main competitor in Arizona. He had a problem with a claim from an emergency room visit at Hayseed General or some such rural facility, while fishing up in Wyoming.
The doctor portion of his ER claim was billed separately and denied by the carrier as “out of network.” It amounted to over $500. My client, his wife, called me and asked if I could give them some advice before they sent out a check. I knew what probably happened even before I saw the bill. The doctors working at Hayseed General belonged to a private group separately contracted to provide ER services at that facility.
I’d seen this type of claim denial several times when I was an appeals supervisor, usually for services provided out somewhere in the sticks. We called the customer service department at Ralph’s HMO, but they refused to consider the emergency circumstances of his treatment. I typed up a quick appeal, had him sign it and was out the door in less than half an hour plus a quick stop at the corner post office. Ralph, of course, had no stamps!
A happy ending for everyone
Fast forward 30 days: Ralph’s appeal was sustained, and the doctors were paid by the carrier. Mrs. Ralph really appreciated the help. So much so, that just about every referred Medicare beneficiary living on her street is still my client.
That was a happy and profitable ending, but let me stress that I’ve become discerning about who I will help. I’m not an employee of the Bishop’s Relief Fund, and at my advanced age I still need to make an income that supports my “lavish lifestyle” and visits to Las Vegas.
Almost without exception, if I am assisting a non-client I ask them two questions. The first is “I take it your current agent has been unable or unwilling to help you?” and second “I’ll be glad to help if you will give me the opportunity to be your agent. Agreed?” A few beneficiaries have hemmed and hawed about the second question. Send those folks to their customer service department — don’t waste your time with them. I’ve found that a majority of people will hire me when I give them the benefit of my expertise.
You should have the same results. Bottom line: limit free Medicare advice, not because you lack compassion, but rather because your time and expertise are money.