Every fall, a hospital system and a Medicare Advantage carrier go public with a contract fight, and agents' phones light up. One recent example, reported by the Sarasota Herald-Tribune, had a deadline after AEP ends. Clients have to choose before they know how it turns out.
I'm Justin Brock. Brock has helped agents serve 250,000+ Medicare beneficiaries. For how to handle the client call, read Network Fights: How Agents Should Handle Hospital Contract Disputes During AEP on justinbrock.com. Here is what your upline should do.
The key point your upline should reinforce
A network change is not a plan termination. When a plan ends or leaves a service area, federal guaranteed issue Medigap rights generally apply. When a hospital leaves a network, the plan still exists, so that same right usually does not. Agents who mix these up promise clients things they cannot deliver.
What good support looks like
- Fast alerts. When a dispute becomes public in your market, you should hear from your upline with the facts and the deadlines.
- Both paths ready. Tools to show a plan that includes the hospital and, where the client qualifies, Original Medicare with Medigap and Part D side by side.
- GI and underwriting guidance. Help confirming whether a client actually has a guaranteed issue right, and what underwriting looks like if not. See our piece on Medigap underwriting support.
- Client language. Calm, honest wording for "nobody knows yet."
- Follow-up reminders. A way to flag affected clients and call back when the news breaks.
Questions to ask an upline
- How do you alert agents to network disputes in their markets?
- Who helps me confirm guaranteed issue situations?
- Do you provide talk tracks for network change conversations?
How Brock helps
Brock covers market changes in weekly live webinars and gives agents tools to compare options and track follow-ups. Our free Objection Manual on the justinbrock.com free resources page includes language for these conversations.
Want backup for the next network fight? Book a call with the Brock team.
Frequently asked questions
Does a hospital leaving a Medicare Advantage network give clients guaranteed issue Medigap rights?
Usually not. A network change alone generally is not a plan termination, so it usually does not create the federal guaranteed issue right that a plan ending would. Check the client's situation and state rules before promising a supplement without health questions.
How should agents handle clients worried about a hospital dispute?
Do not predict the outcome. Explain what is known, show both paths side by side, check guaranteed issue rights before promising anything, ask what matters most to the client and schedule a follow-up for when the contract news breaks.
What should my upline do when a network dispute hits my market?
A good upline sends prompt updates with the facts and deadlines, provides tools to compare options, helps confirm guaranteed issue situations, offers client-facing language and helps you track affected clients for follow-up.
Are Original Medicare and Medigap members affected by network disputes?
Generally no. Original Medicare does not use plan networks, so a contract dispute between a hospital and a Medicare Advantage carrier typically affects only that carrier's MA members. Confirm the hospital accepts Medicare and check any news reports for details.