Low Income Clients = Complaints

If you've wondered why Dual Special Needs plans are expanding so rapidly, let me tell you in one word: MONEY.

CMS reimbursement rates on DSNP are much higher than MAPD plans and carriers are rushing to expand their DSNP offerings.

If you don't sell these types of plans, it's time to start. You can sell year round and the plans are very popular due to the extra benefits this population won't find on state Medicaid programs alone.

Yes, agents must take additional training to be able to sell these plans, but there is one thing missing in the training that is crucial to avoiding client complaints: verifying what level of assistance your prospect is receiving before you make your sales presentation.

Agents are confused, heck, I'd say that almost all of us in the system are confused with the different levels of Medicaid and the requirements between the carriers. One carrier will take anyone onto their DSNP, regardless of their level of assistance; while all the other carriers in the market will only sell their plan to Medicare beneficiaries that are FULL DUALS.

Here is the rub: when the agent meets with the prospect as inquires about their level of assistance, the client often give misinformation to the agent.

The agent bases his presentation on that info and then later when the client has to pay co pays--when the agent lead him to believe he was a full dual but really he was a partial dual, he is mad. He files a complaint and we all go to work to research the infraction, retrain to prevent it in the future and insure the complaint is answered in a timely manner so the agent isn't terminate.

The best practice is to call the carrier and VERIFY THE LEVEL OF ASSISTANCE the prospect is receiving before making the presentation. You can't tell by looking at your prospects Medicaid card and many won't have a card to show you anyway.

If you sell in the DSNP market, you tend to have more complaints anyway because this demographic typically has less education and more chronic conditions that make understanding these complex plans frustrating. Go slowly, don't rush into this market. Let your marketer help you prepare so you don't unintentionally makes mistakes which turns into complaints against you.