HealthSpring is encouraging agents to follow the steps below to help reduce member complaints and create a better member experience.
One of HealthSpring’s primary goals is to help members make informed healthcare decisions and enroll in coverage that best meets their needs. When members understand their options and have clear expectations about their coverage, they are less likely to encounter issues that result in complaints. Proactively addressing concerns can also strengthen member loyalty and contribute to higher Medicare Star Ratings.
Agents play an important role in achieving this goal. The following best practices can help improve the member experience and reduce the likelihood of complaints:*
- Conduct a thorough needs assessment to understand each client’s healthcare needs, provider relationships, prescription requirements, and expectations before discussing plan options.
- Make sure clients understand how a plan change could affect their current coverage, including potential changes to providers, networks, benefits, costs, and existing Medicare Advantage or employer-sponsored coverage.
- When enrolling a client in a HealthSpring Alliance Medicare (HMO) plan, available in Arizona, Maryland, and Texas, make sure the client understands that it is a narrow-network plan and is comfortable receiving care exclusively from participating network providers.
- Verify provider participation using approved provider lookup tools. Agents should review each client’s complete care team—not only the primary care provider—and avoid assigning nurse practitioners or specialists on the member application.
- Share HealthSpring’s online provider lookup tool and new-member customer service line in case a client needs help finding a new provider after enrollment.
- Present benefits accurately and completely, including applicable limitations, requirements, and disclosures. Discussions should focus on the plan’s overall value rather than a single, highly promoted benefit.
- Use additional care when explaining benefits that commonly generate questions or complaints, including OTC, Flex, grocery, dental, and Part B Giveback benefits. Client expectations should align with the plan’s actual coverage.
- Take an educator-first approach to enrollment and confirm the client’s understanding throughout the conversation. Clients may be hearing the information for the first time and could need additional explanation and discussion before fully understanding their options.
- Use a consultative approach and allow the client to drive the enrollment decision, ensuring the client feels comfortable, engaged, and confident in the selected plan.
- Address client concerns directly instead of avoiding difficult conversations. Objections can be used as opportunities to educate clients and help them make informed decisions.
- Obtain the client’s consent to enroll and provide a confirmation number for the member’s enrollment case.
- Record all marketing, sales, and enrollment calls, including the audio portion of calls conducted through web-based technology.
- Ask for assistance when questions arise. Agents should use available support resources rather than make assumptions about benefits, provider participation, or coverage details.
These actions are not an all-inclusive list of applicable requirements.
Most importantly, agents should not proceed with enrollment until the client is ready. Many complaints can be prevented through thoughtful conversations, clear expectations, and a consultative approach to the enrollment process.
Reminder: Required CTM Response Times
HealthSpring recently implemented new expectations for timely responses to Centers for Medicare & Medicaid Services Complaint Tracking Module requests. These requirements are intended to strengthen compliance and prevent response delays.
The new requirements became effective July 1, 2026, and may affect agent commissions.
Agents should review the guidance provided in this message. It includes information about:
- Required response times for CTM requests
- How to track CTMs in Salesforce
- The potential effect on commissions if an agent does not provide a timely response
The information on this website is for agent use only and not intended for the general public. If you have questions about this post, please call 800.562.7733 or email nf_sales@neishloss.com.
