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A call center agent. (Image: bbernard/Shutterstock)

Life Health > Health Insurance > Medicare Planning

End Call If a Medicare User Refuses Recording: Officials to Agents

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What You Need to Know

  • Medicare plan regulators say 80% of sales call recordings they reviewed contained incomplete or inaccurate information.
  • The Centers for Medicare and Medicaid Services released new third-party marketing organization call recording rules this summer.
  • The new rules apply to captive agents and traditional independent agents, not just to big call centers.

Medicare plan agents and brokers should give up on telephone calls or online calls with any consumers who refuse to let the calls be recorded, according to guidance posted last week.

Officials at the Centers for Medicare and Medicaid Services, the agency that oversees the Medicare Advantage and Medicare Part D prescription drug plan programs, gave that advice in a batch of answers to frequently asked questions about the new CMS “third-party marketing organization” rules.

The new TPMO rules apply to all call centers, independent agents, captive agents and others involved with helping consumers sign up for Medicare Advantage or Medicare drug coverage.

One plan issuer told CMS, “We have received multiple questions from agents who want to know what they should do when a beneficiary is refusing to have the call recorded, but still want to enroll in our plan.”

“There are no exceptions to this requirement,” CMS officials say in the answer to that question. “If a beneficiary declines to be recorded, the call must end.”

What It Means

The new call recording rules will have a direct effect on any clients who buy Medicare plan coverage over the phone.

Because so many people buy Medicare plans over the phone, the new call recording rules could have big, indirect effects on how regulators, lawmakers and businesses think about recording calls — like the existing bank transaction call recording rules.

The History

Two years ago, the Medicare plan market went through what looked like a gold rush.

National marketing organizations raced to put Medicare plan ads on television and to set up giant Medicare plan sales call centers.

Traditional agents and brokers suggested that many of the ads were misleading.

Some consumers asked Medicare for help with changing plans, arguing that call center reps had given them incorrect information about their original plans.

CMS officials say they reviewed call center sales call recordings created based on old recording rules, and found that 80% contained incomplete or incorrect information.

“Examples included beneficiaries being told that if their medication was not on the formulary, the doctor could tell the plan and the plan would simply add it; or incorrectly stating that ‘nothing would change’ when beneficiaries asked if their current health coverage would stay the same,” officials say.

CMS responded to drafting and implementing TPMO rules.

TPMOs with limited plan menus must offer consumers the following disclaimer:

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all of your options.

CMS already required Medicare Advantage plan sellers to record sales transactions completed over the phone.

CMS moved to require all TPMOs, including plan administrators and lead-generation firms, to record all calls from Medicare plan shoppers and enrollees.

The recording requirements took effect Oct. 1. The requirements apply to any coverage that will take effect on or after Jan. 1, 2023.

CMS Answers

Here are some of the topics CMS officials discuss in the new TPMO guidance.

The TMPO definition: “The definition of TPMO includes all organizations and individuals, including independent agents and brokers, who are compensated to perform lead generation, marketing, sales, and enrollment related functions as a part of the chain of enrollment,” officials say. “TPMOs may be a first-tier, downstream or related entity.”

The acronym for “first-tier, downstream or related entity” is FDR.

Officials note that CMS is treating all agents and brokers the same.

“Smaller agents and brokers are not exempt from any requirement based on size,” officials say. “CMS does not believe it is appropriate, or even possible, for the purpose of applying regulatory requirements, to distinguish between independent agents who work for a ‘large call center’ versus those agents who do not, as many of these ‘independent’ agents are associated with an FMO [field marketing organization], which may employ hundreds or thousands of agents. And those FMOs may have contracts with both clearinghouses/lead generators as well as independent agents.”

Which calls? A plan now must ensure that all TPMO calls with enrollees, “even calls that are outside the scope of the chain of enrollment,” are recorded.

The recording requirement applies both to inbound and outbound calls.

Storage: A plan and the TPMO may not have to worry about actually storing the recordings of calls about administrative matters, such as updating ID cards. “If, however, such a call becomes a sales call at any point (e.g., if the beneficiary begins asking about products), then the recording of the call would need to be retained,” officials say.

When a call recording must be stored, it must be retained for at least 10 years.

Call recording and retention responsibility: “CMS holds plans responsible for making sure that the recordings of calls between TPMOs and beneficiaries are recorded and that the recordings are maintained,” officials say. “Plans and TPMOs should arrange for recording and storage of the recordings.”

Some agents and brokers have told CMS that they are not set up to record calls with consumers.

CMS officials say the requirement to record telephonic enrollments has been in place for some time.

“If a TPMO engages in telephonic enrollment, they would have been required, under existing policy, to record calls with beneficiaries prior to the implementation of this regulatory requirement,” officials say. “As such, we would expect TPMOs to leverage their existing process for recording telephonic enrollments when recording all calls with beneficiaries.”

Smaller producers should ask the plans they represent for help with recording and maintaining calls, officials add.

Face-to-face meetings: Officials note that the new recording requirements do not apply to in-person interactions.

Broker Reactions

Companies like Senior Market Sales and Integrity Marketing Group are now offering call recording help to affiliated agents.

Chapter, a web broker that says it offers consumers help with buying all available Medicare plans, through the website, is questioning whether CMS is requiring TPMOs to give consumers enough information, and whether some TPMOs make it clear enough that they offer only a few high-commission plans.

“Misleading advertisements often promise a lot — even home-delivered meals — for little to no cost, while leaving out key details about the plan, such as the price of co-pays and whether one’s doctors will still be in-network,” Chapter says. “Brokers often use these tactics to push plans that are too expensive and do not cover enough health care costs.”

(Image: bbernard/Shutterstock)


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