Common Issues

Opening

Agent did not give the recording and information disclosure in any call.

Agent did not give the recording and information disclosures on all calls (wav #).

Agent did not state the SOA in any call.

Agent did not state the SOA in all calls (wav #).

Sales

Agent did not ask about group, VA or Tricare.

Agent did not ask qualifying questions.

Agent did not do a needs analysis.

Client did not have an election. The client Part A was effective 12/01/12 and Part B was effective
7/01/18. ICEP is available 3 months BEFORE PART B becomes effective. Client's birthday was 12/21/63,
only 55.

Agent used LIS as an election, instead of MDE. Client stated the state pays their Medicare Part B
premium (wav 1, 5:20).

The client said she moved in March, and that she had notified S.S about the move. The agent used MOV
as the election for the enrollment. This is only eligible the month prior to the permanent move and up to
2 months after the move. No other election was found.

Agent used the MOV election because the client didn’t sign up for a Medicare plan when the client
moved 3.5 years ago. Client did inform Medicare of the move. No other election was found.

Agent did not state the hospital coverage.

Agent did not state the Part B premium disclosure.

Agent stated Medicaid will pick up the copays (wav 1, 1:05, 6:50).

Agent stated the copays for tier 1-2 90 day supply mail order, but did not give tiers 3-4 (wav 1, 9:36).

Agent did not state the $405 Rx deductible for tier 4-5. Client’s Synthroid 100mcg is a tier 4.

Agent stated the PCP copay is $10, according to the SOB it is $20 (wav 1, 10:15).

Agent stated the PCP copay is $15, according to the SOB the it is $0 (wav 2, 10:20).

Agent did not state the $340 copay for days 1-5 in the hospital is PER day (wav 1, 15:20).
Agent did not state Medicare covered dental is $40 (wav 1, 20:22).

Agent looked up providers, before giving the HMO network disclosure (wav 1, 5:05, 15:22).

Agent stated Dr. Smith is in network, but did not verify the address (wav 1, 15:10).

Client declined the drug look up, agent did not emphasize the importance of (wav 1, 20:55).

Agent looked up drugs, before giving the formulary disclosure (wav 1, 5:40, 45:10).

Agent stated Pravastatin 40mg is a tier 2, according to the formulary the drug is not covered (wav 2,
15:10).

Agent did not state Levemir 100mg require prior authorization (wav 2, 10:55).

Client stated he takes Lipitor 40mg (not covered), agent looked up the generic form Atorvastatin 40mg
(tier 2), without confirming if the client takes the generic (wav 1, 15:05, 20:10).

Agent did not confirm if Alprazolam 0.5mg tablet is standard (tier 1), ODT (tier 4) or ER (not covered).
Agent looked up the standard form (wav 1, 30:55, 35:05).

Agent did not confirm if Hydrochlorothizide 25mg is a capsule (tier 1) or tablet (tier 2). Agent looked up
the capsule form.

Agent did not state Tramadol 40mg has a quantity limit of 30/30days, client takes 2 per day.

Client’s Hydrocodone 10-325mg is not covered, agent stated the client just needs to have his doctor fill
out a formulary exception (wav 1, 6:10).

Agent stated the client will pay $1.80 for their Metformin. According to the formula the drug is a tier 1,
which is a $5 copay (wav 1, 11:50).

Agent stated Dr. Jane Harorld is in network, according to the finder the doctor does not accept the plan
(wav 1, 6:25).

Agent stated Dr. Hake is not listed, but her facility, Aultman North, is covered (wav 1, 1:50).

Agent stated Dr. Metzger is not listed, but the client can still see the doctor since the facility, Aultman
North, is listed (wav 1, 15:10).

Agent stated Dr. William Duggan is located at 1413 Portage St. Client stated he sees the doctor at 6046
Whipple Ave, agent did not inform the client the Whipple Ave location is not in network (wav 1, 6:50).

Agent did not give the HMO network, formulary, pharmacy network or the Med Supp disclosures.

Enrollment Application
Client stated “sure” when asked permission to record. Agent did not ask for a yes (wav 2, 8:10).

Agent did not state “proposed” when giving the effective date during the Enrollment Statement (wav 2,
8:20).

Agent did not give the plan ID H1654-102 during the Enrollment Statement (wav 2, 10:55).

Agent did not state “HMO” during the Enrollment Statement (wav 3, 5:15).

Client stated “correct” to the Enrollment Statement, agent did not ask for a yes (wav 2, 4:10).

While giving the SOB disclosure, agent stated that they have already gone over the SOB (wav 3, 8:10).

Agent did not review the entire SOB, agent skipped dental, mental health and Rx coverage (wav 2, 8:50).

Agent play the HMO without OSB recording, instead of HMO with OSB (wav 4, 4:10).

Client stated “ok” to the 2nd recording, agent did not ask for a yes (wav 3, 8:40).

Client gave their name and a yes to the 3 rd recording, but did not state their DOB (wav 3, 8:40).

Agent stated “some things may or may not apply to you” before playing the voice log recordings (wav 3,
8:20).

Post Application & Variables

Agent enrolled the client into a chronic plan, but did not inform the client of the VCC form.

Agent enrolled a Medicaid recipient into a PPO, without permission from PM.

Agent stated that he works for Medicare (wav 1, 1:10).

Agent stated he works for Humana (wav 1, 1:20).

Agent stated according to Dr. Rob Smith’s website, he takes Humana. Provider’s website is not CMS
approved (wav 2, 10:15).

Agent referred to Silver Sneakers as “free” (wav 1, 18:20).

Agent stated this was the “best” plan in the area for the client (wav 1, 8:20).

Client stated her daughter helps with her healthcare decisions, agent did not attempt to get the
daughter involved (wav 2, 8:40).

Agent stated the plan will help with the 20% (wav 2, 8:10).
Agent stated the plan will eliminate the 20% (wav 3, 8:48).

Agent called in and stated she wanted a supplemental plan. Agent did not explain the difference
between a MA and Med Supp to confirm what the client is looking for (wav 1, 1:10).

Without prompting from the client, agent stated he has until Dec. 7 th to disenroll if he finds a different
plan (wav 1, 18:20).

Agent stated “you know doctors are crooks and want all your money” (wav 1, 9:10).

Client asked if he could see information before enrolling, agent stated the only way to view information
was to enroll. Agent did not offer a way for the client to view it before enrolling (wav 1, 55:50).