Do I need an SOA if I conduct a phone appointment?
Per CMS, no. But, some carriers require an SOA regardless of the nature of your appointment. Beta recommends always capturing an SOA to illustrate that both your client and you understand what was discussed during your appointment and what was covered. It’s better to be safe than sorry.
What are the most common reasons an agent receives an allegation?
Member complaints due to plan coverage and costs:
- Always check your client’s prescriptions and verify them with Broker Support to ensure you’re noting the correct associated cost.
- Ensure that your client understands the cost of the plan for which they are signing up.
- Member complaints due to loss of primary care provider:
- Check the printed provider directory as well as the carrier’s online directory to verify if your client’s PCP is an option.
- If you have any insecurity about this information, always contact the carrier’s Broker Support line to verify the information so your client is satisfied with their PCP and plan choices.
Can I still sell if I receive an allegation?
Yes! Unless otherwise advised that your contract with a carrier is suspended, you are still able to sell plans by the carrier that issued the allegation.
Does my event need to be reported?
Any event which sales activity is intended needs to be reported. Educational events do not need to be reported. If you need more information or are unsure if your event needs to be reported please contact brittany@betabenefits.
How do I submit an event?
Each carrier has a different Event Submission Form. All you need to do is complete the form in its entirety and send it to us for submission with the carriers. You can request the forms and send the completed forms via email to email@example.com.
How far in advance do I need to report my event?
Even though CMS guidelines say that the event must reported 7 days prior, each carrier has their own internal policies and procedures for filing events. In order to guarantee acceptance of events (if you are in “good standing” with the carrier you choose to report to) we ask that you submit it by the 15th of the month prior. So, if you have an April event, the event needs to be reported by March 15th.
Why should I report an event if I’m just going to be secret shopped?
- In order to remain compliant with the regulations listed in the Medicare Marketing Guidelines, you must report an event where there is sales activity. Reporting your events grants you access to your literal sales tools; lead cards, scope of appointments, appointments and hopefully, applications!
- There’s no reason to fear a secret shopper! Think of a secret shopper’s feedback like getting a pop quiz. Just because you might not “pass” with flying colors, doesn’t mean you fail the class. You study a little bit more for the next quiz and ultimately, you become a better student. Welcome the feedback and knowledge so that you grow into a more knowledgeable and better-equipped agent.
Reporting suspected fraud, waste and abuse (FWA) is everyone’s responsibility. Any wrongdoing such as ethical concerns, potential conflict of interest, potential non-compliance or fraud, waste or abuse should be to Beta Benefits. (Beta) immediately. Taking action and making a report is an important first step to protecting your clients, book of business and the insurance industry.
Agents, providers, suppliers, other medical facilities, carriers or Beta Benefits may not retaliate against you for any good faith reporting of FWA.
Ways to report:
- Call 877-421-9939
- Email firstname.lastname@example.org
- Complete anonymous compliance reporting form below