In most cases, Medicare agents try to do their best to ensure their clients are in a plan that fits their medical as well as financial needs. However, there are times when a client may be unhappy with the service they receive for one reason or another. When this occurs, they may decide to file a grievance with either a carrier or the state. If this happens, agents need to know ho wto handle complaints properly to avoid making things worse.
Medicare agents understand that handling carrier complaints is part of our profession, as CMS continuously updates the rules to conduct business. Addressing the issue quickly and correctly is essential. Here are some suggestions for handling complaints and ensure compliance and avoid escalation.
Try to prevent complaints
The best way to handle a complaint is to try and avoid them as much as possible.
follow all CMS guidelines.
Make sure you know all the rules before you host an event whether it is educational or a sales event, there are definite rules to follow. Be sure you have all the updated regulations before you do anything that could lead to a complaint.
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Collect Scopes
This is a big one! It is imperative that you collect a SOA and be sure you do it in the correct way. The Scope is an important tool that not only protects the Medicare beneficairy but the agent as well. Scopes prove that you had permission to talk to the beneficiary and what you had permission to discuss. There are a few different ways to collect a scope; in writing, electronically (by email) or with a voice recording.
Learn how Retireflo can help you maintain compliance
Check client information
Before you enroll a client in any plan, you must ensure they have the best choices available to them. Agents must check all their current providers to ensure they are in network with the plan the client chooses. It is also very important to check all medications and explain how the plans cover each medication.
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How to handle complaints
Watch for carrier communications
Check your emails regulary and be sure to pay attention to any carrier communcations you receive.
If there has been a complaint field agianst you, the carriers normally communicate it to you via email. This helps avoid delays in your response and gets allegations cleared up in a timely manor. Because complaints have a deadline for a response, not repsponding in a timely manor, could make things much more difficult.
Think before responding
If you receive a complaint or allegation, it is important to take time and read it carefully. Be sure to follow carrier instructions before you respond. In most cases, you will be asked to answer some questions in response to the allegation. Answer each question as accurately as you can.
Provide documentation
Make sure to provide any supporting documents you have. Documents may include; scopes, enrollment recordings or even a copy of the signed application. Be prepared to provide any evidence the carreir may request that can help support your actions.
Contact your upline
If you currently have an upline, it is a good idea to have them review your answers before the response deadline and provide any constructive feedback. They should suggest any needed revisions to help ensure the situation is resolved. Be sure to edit your answers if necessary.
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