Check Medicare Advantage sales calls for their disclaimers

Fields

• Who sells on the call (the plan itself, or a broker or agency for several plans)
• Sales call transcript with speaker labels

Questions

1. Is this a call where the agent discusses, offers or enrolls the caller in a Medicare plan? Yes / No

   Count calls where a Medicare Advantage or drug plan, or its benefits, is discussed, offered or enrolled in, whether or not the caller enrolls. Yes: The agent discusses, offers or enrolls the caller in a Medicare plan. No: The call is only about service, a claim, a bill or an existing plan, with no plan offered. The disclosure questions then have nothing to check.

2. Is the caller told that the call is recorded? Yes / No

   Read the transcript. A recorded announcement quoted in the transcript counts. Yes: The caller is told the call is recorded. No: Nothing in the call tells the caller it is recorded.

3. Does the agent give the third-party marketing organization disclaimer, and before discussing any benefit? Choice

   Read the seller field and the disclaimer item in the context. The full disclaimer says how many organizations and products the agent represents and points the caller to Medicare.gov or 1-800-MEDICARE. Judge the order in which things are said in the transcript. Pick one option.

   • Given before any benefit The seller is a third-party marketing organization and the agent gives the full disclaimer before discussing any plan benefit.
   • Given after benefits were discussed The agent gives the full disclaimer, but only after discussing at least one plan benefit.
   • Part of the disclaimer missing The agent gives only part of the disclaimer, for example without the numbers or without pointing to Medicare.gov or 1-800-MEDICARE.
   • Not given The seller is a third-party marketing organization and the agent never gives the disclaimer.
   • Plan's own agent The seller field says the agent works for the plan itself, so this disclaimer is not required. Code treats this apart from a disclaimer given.

4. Does the agent confirm which kinds of product the caller agreed to discuss, before discussing any plan or benefit? Yes / No

   Use the scope of appointment item in the context. Order matters: the confirmation must come before the agent describes any plan or benefit. Yes: The agent confirms the kinds of product the caller agreed to discuss, before describing any plan or benefit. No: The agent never confirms the scope, or confirms it only after describing a plan or benefit.

5. Does the agent market a product outside the scope the caller agreed, or a non-health product? Yes / No

   Use the scope of appointment item in the context. If no scope was agreed, count any kind of product beyond the one the caller called or was called about. Yes: The agent markets at least one product outside the agreed scope, or a non-health product such as an annuity or life insurance. No: The agent markets only products within the agreed scope.

6. Before any enrollment, does the agent discuss the caller's doctors, pharmacy, drugs, costs and health needs, as the rules list them? Choice

   Use the needs discussion item in the context: primary care doctor and specialists and whether they are in network, pharmacy, prescription drugs and their coverage and cost, costs of care, premiums, benefits, and specific health care needs. A topic the caller raises that the agent brushes aside is not discussed. Pick one option.

   • All topics discussed An enrollment is taken or attempted, and the agent discusses every topic on the list before it.
   • Some topics missed An enrollment is taken or attempted, and the agent discusses some topics but skips or brushes aside at least one.
   • No needs discussion An enrollment is taken or attempted with no discussion of the caller's needs.
   • No enrollment in the call No enrollment is taken or attempted in the call.

7. Does the agent review the Pre-Enrollment Checklist with the caller before completing a phone enrollment? Choice

   Use the Pre-Enrollment Checklist item in the context. Saying that paperwork will come in the mail is not a review. Pick one option.

   • Reviewed before enrollment The agent goes through the checklist's contents with the caller before the enrollment is completed.
   • Not reviewed An enrollment is completed or submitted in the call without the checklist being reviewed, or it is reviewed only afterwards.
   • No enrollment in the call No enrollment is completed or submitted in the call.

8. Does the agent tell the caller where to find the Summary of Benefits before completing a phone enrollment? Choice

   Use the Summary of Benefits item in the context. Pick one option.

   • Told before enrollment The agent tells the caller where the Summary of Benefits can be found, or sends it, before the enrollment is completed.
   • Not told An enrollment is completed or submitted without the caller being told where to find the Summary of Benefits, or told only afterwards.
   • No enrollment in the call No enrollment is completed or submitted in the call.

9. Does the agent make a claim the rules forbid, or one likely to mislead the caller? Yes / No

   Use the never item in the context. Count claims to be from, to work for, or to be endorsed by Medicare, CMS or the government, including a yes to "Is this Medicare?"; "free" used in a misleading way; suggesting the plan is a Medicare supplement; and statements about benefits, costs, doctors, drugs or current coverage that the call gives no ground for. A dodge that leaves the caller believing something false counts. Yes: The agent makes at least one such claim. No: The agent makes no such claim.

10. Does the agent push the caller to decide now or brush aside their questions? Yes / No

    Use the no pressure item in the context. Count false urgency, such as plans or benefits running out; repeating the pitch after the caller says no or asks for time; and brushing aside or talking over their questions. Yes: The agent does at least one of these. No: The agent lets the caller decide at their own pace and answers their questions.

11. Does the caller say they do not understand what they are agreeing to? Yes / No

    Go only by what the caller says, never by age, accent, fluency or tone of voice. Count a caller saying they do not understand, did not know they were enrolling, thought the call was about something else, want to stop, want someone else to help them decide, or have trouble with memory or understanding. Yes: The caller says at least one of these. No: The caller says nothing of the kind.

12. How does the caller answer when asked to agree to the enrollment? Choice

    Judge the final answer to the enrollment. Go by what the person says about who they are; whether they are the beneficiary or an authorized representative is checked by code. Pick one option.

    • Clear yes The caller agrees to enroll in the plan as described, without doubts or conditions.
    • Hesitant yes The caller agrees but voices doubts, conditions or reluctance, for example "I suppose so".
    • Agreed by someone else The person who agrees says they are not the person the plan is for, such as a relative.
    • No agreement The caller declines, asks for time to think, or the call ends before they agree.
    • No enrollment offered The agent does not ask the caller to enroll in the call.

13. What should a person do with this sales call before the enrollment goes through? Choice

    Judge the call as a whole against the rules in the context. The answer is a suggestion for a person; it does not hold or cancel any enrollment. Pick one option.

    • Proceed Every required item is given in order, the caller agrees clearly, and nothing misleading or pressured is said.
    • Verification call first A required item is missing or late, or the agreement is hesitant, and nothing misleading or pressured is said. A call to the beneficiary can fill the gap.
    • Compliance review first The agent makes a forbidden or misleading claim, uses pressure, markets outside the scope, someone other than the beneficiary agrees, or the caller says they do not understand. A person reviews the call before the enrollment goes through.
    • Not a sales call No Medicare plan is discussed or offered in the call.

Lens columns

is_sales_call, is_sales_call_probability, recording_notice_given, recording_notice_given_probability, tpmo_disclaimer, tpmo_disclaimer_probability, scope_confirmed, scope_confirmed_probability, outside_scope_product, outside_scope_product_probability, needs_topics, needs_topics_probability, pre_enrollment_checklist, pre_enrollment_checklist_probability, summary_of_benefits, summary_of_benefits_probability, prohibited_claim, prohibited_claim_probability, pressure_used, pressure_used_probability, caller_confused, caller_confused_probability, enrollment_outcome, enrollment_outcome_probability, next_step, next_step_probability