Insuring Instant Karma For One Dirty Agent

, , , , , , | Legal | May 16, 2020

I work in Medicare insurance, getting people coverage through part C and part D. My job has many, many rules, and serious consequences for breaking them. One caller’s situation stands out.

She called in the middle of February, distraught, because another agent had called her and signed up for a new plan. 

This — in the first minute of the call — was my first red flag. It is illegal for a Medicare insurance agent in Wisconsin to cold call anyone, as well as to enroll them in a new insurance plan on an outbound call; agents can only ever enroll people who called them.

After sign-up, she’d run into trouble getting her prescriptions refilled, so she’d wanted to talk to her agent again. She’d spent more than a week trying to get in touch with him and had eventually found my number, thinking that my office was Medicare itself.

My office’s name does have Medicare in the title, but we always immediately clarify that we do not work for the government.

My workplace has an unusual approach to callers: no matter what they called about, spend at least ten minutes helping and continue to help for as long as they need. We are a sales office, but we’re paid hourly and our commission is negligible in order to support this behavior.

I start asking questions and track down the plan she’s been signed into. My first bit of good news is that it’s a plan that I’m contracted with; I can pull up the full contract and can figure out the answers to every one of her questions, but with every question she asks, my internal alarm bells chime a little louder.

Insurance agents are supposed to be responsible to their customers. Whoever this other agent was, he left her not knowing most of what she needed to know; he’d effectively bullied her into changing and then left her high and dry.

The medicine issue was actually coincidental; I told her what she needed to tell her pharmacist to clear things up but asked her to stay on the line and answer a few more questions, and I checked to make sure her family doctor was in the network of her new plan.

He was not, and the other agent had not even told her that changing plans would have restricted her from seeing him. This could have cost her thousands of dollars!

That medication issue that sent her to me saved her from an untold amount of hassle. The plan change could only go into effect at the beginning of the next month; the new plan wasn’t in place yet, and we could overwrite or cancel it just by submitting the paperwork.

I did one last piece of digging. Election periods are the times of year that a person is allowed the opportunity to change their coverage. If this other agent had submitted a change, what had he used? He hadn’t mentioned this to my caller at all. A quick rundown of options left only one answer. The other agent had used an election period called OEP to change her coverage.

OEP is effectively an emergency exit at the start of the year for when someone finds out that their plan is not suitable to their needs. Agents are prohibited from advertising or even mentioning OEP on calls; the customer must request a change or express distress before OEP can be brought up. Using OEP without the customer knowing or even understanding what was being done? Egregious.

So, I go through the paperwork with her and get her signed back into the plan that she had originally, and I give her the appropriate phone numbers to check up with her plan to ensure that she won’t have any trouble. But before we disconnect, I have one final errand for her.

I give her the phone number of the Commissioner of Insurance of the State of Wisconsin: the regulating body responsible for cracking down on bad insurance agents.

Let’s run it down, shall we?

Cold-calling a Medicare insurance customer, uninvited? $25,000 fine. Per person, if he’s called others.

Enrolling her on an outbound call, willfully signing her up into an unsuitable plan, and abusing OEP? Forfeiture of license, along with twice the value of any money they hoped to gain by doing this, plus a $5,000 fine and up to three years in prison. 

That’s three counts of it, mind you, so up to six times the money he tried to make, a $15,000 fine, and nine years in prison, and probably being banned from insurance work in the United States for life.

If he’s done it to one innocent old woman, he’s probably done it to others. I will never know the fallout from the case, but knowing the tools at the Commissioner’s fingertips, I’m reasonably confident I got a swindler his comeuppance.

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