Find Out More About CareAssist with Our New Video!

CareAssist Video

Are you self-administering your Medicare Set Aside? 

CareAssist is an innovative self-administration and financial management tool that allows members to achieve prescription medication savings from their settlement, while assisting with Medicare compliance for their MSA.

CareAssist’s online portal reduces your administrative hassle with:

  • MSA reporting templates & interactive charts for tracking
  • 24/7 support from our Care Advocates
  • Tools to organize your data for Medicare Set Aside compliance, accompanied by a guide on how to complete and submit your annual reporting for Medicare

CareAssist maximizes settlements by providing members with cash discounts on medications through its prescription savings program. CareAssist’s prescription discount card is accepted at over 65,000 pharmacies nationwide.

CareAssist also provides access to an online portal that can be used on your computer or mobile phone, enabling you to keep track of all your MSA-covered expenses in a simple and easy-to-use platform.

CareAssist Card

Get started today!

  • CareAssist is FREE to use
  • Contact our CareAssist team at 877.275.7415 or at careassistinfo@ametroscards.com to schedule a personal consultation
  • Visit our website at www.careassistsystem.com

CareQuote: Real Pricing for Better Settlements

Colorful caplets on smartphone screen with Rx form, isolated on white background.

A central challenge to closing open medical claims is the lack of transparency into the future cost of healthcare.  Adjusters, attorneys and injured individuals have lacked a reliable source when predicting how much future treatments will cost. Variability in the estimates of healthcare costs can make settlements hard to reach.  All parties at the settlement table deserve to work with a company that will provide true, transparent quotes on the pricing that the injured individual will actually pay after they settle.  This information facilitates a more productive negotiation and provides reassurance to the injured individual that their needs will be met.

At Ametros, our CareQuote service provides that information; it allows parties to go into their negotiations well-grounded with the knowledge of what settlement amount is acceptable for future medical care.

medical-money

There is no doubt that in preparing a case for settlement, both sides will want to negotiate the items that should or should not be included in the medical allotment.  This process is necessary, but it can be supplemented by knowing what things actually cost.  What if the item you’re arguing over will only cost $80,000 instead of $800,000?  Perhaps your priorities and negotiating tactics would change considerably!

Ametros’ new CareQuote service shows a precise look at the actual price the injured individual will pay after they settle and become a member on the Ametros platform.  At Ametros, thousands of injured individuals, our members, are using our networks to make healthcare purchases with their Medicare Set Aside (MSA) accounts or with the cash allocated for their other medical care (non-MSA monies).  In order to save our members money, we at Ametros have established group purchasing networks that provide discounts on doctor visits, drug purchases and equipment purchases.  On average, Ametros’ administration services provide pricing that is 30-40% below the pricing in most MSA projections or life care plans.

For example, a recent CareQuote Ametros constructed showed that with Ametros’ discounted pricing, it was possible to provide the level of care that a life care plan estimated to be $7.7 million on a liability case for just $6.6 million.  The structured broker handling the case presented the CareQuote (below) at the negotiation.  By showing Ametros’ discounted price, he showed there was negotiating room for the parties to reach a compromise. The parties split the difference on the savings, ultimately settling for $7.15 million.  The result was the injured individual and their attorney were confident there were enough funds and the carrier was able to settle at an approved authority level. It was a creative approach to bridging the gap between the defense and plaintiff side and creating an end result that helped both sides reach an acceptable settlement.

In another case, a plaintiff attorney recently used the CareQuote below to understand part of her bottom line in her settlement negotiation.  The defense was offering $1M in non-MSA funds on a worker’s compensation claim.  The demand was $2M.  The attorney asked us to generate a CareQuote to see, with the treatments she and her client wanted to secure from the settlement, what was a realistic amount.  The CareQuote showed that with Ametros’ savings, $800k would be sufficient.  The case was settled for $1.8 million and the attorney shared with her client that he had $1 million dollars of cushion beyond what his expected medical costs would be!

Example of CareGuard Prescription Savings

CareQuote is a unique service because Ametros shares the true pricing of its discounted networks that are available post-settlement.  If the case settles and the individual elects to use CareGuard, the injured individual knows that the prices provided are the true price that CareGuard’s current members are receiving via its platform for the exact drugs, equipment and treatments needed.  That is a far cry from the vague ranges most life care plans provide – ranges for services and items that are quoted from random sources and that no one is even sure the injured individual will be able to secure. In many situations, CareQuote should be used in conjunction with life care plans and other medical projection reports (MSA or non-MSA). While the life care plan and medical reports provide the treatment required, CareQuote can be utilized to provide more transparency into the cost of the treatment.

With CareQuote, if the injured individual joins CareGuard, they will have access to the exact vendors that were in the quote so they can rest assured that the pricing is accurate. Currently, CareQuote is accessible by contacting our team at carequote@ametroscards.com. However in early 2017, many more advanced tools and features including an online portal will be released. Give CareQuote a try today for free to see what the medical care you are negotiating would actually cost on the CareGuard platform.

For more information on CareQuote or CareGuard, visit www.ametroscards.com, call 877-275-7415, or email us at carequote@ametroscards.com.

Ametros Announces Release of New Service, CareQuote

carequote

Contact: Porter Leslie                                                                                                                FOR IMMEDIATE RELEASE
Phone: 339-223-9857
Email: pleslie@ametrosfinancial.com
Website: http://www.ametroscards.com

AMETROS ANNOUNCES RELEASE OF NEW SERVICE, CAREQUOTE

CareQuote Custom Services Available Now, with Advanced Features Launching in Early 2017!

October 31, 2016

WILMINGTON, Mass. — Ametros Financial Corporation (“Ametros”), the leader in providing professional administration of Medicare Set-Asides (MSAs) and other non-MSA medical custodial accounts through its patented CareGuard product, has announced the release of a new service, CareQuote.

CareQuote provides customized post-settlement pricing for home healthcare, skilled facility, and durable medical equipment services to injured parties. The dedicated CareQuote team will quickly price these services, ensuring that parties at the settlement table have visibility into the discounted pricing of these services after settlement through Ametros’ medical networks. CareQuote’s services are available now by contacting the team at 877-905-7322 or carequote@ametroscards.com. Ametros will launch advanced tools and automated features of CareQuote in early 2016.

CareQuote is the first and only service of its kind that provides transparency into a range of medical services prior to settlement, and allows parties to a settlement to lock-in pricing on home health care and skilled facility services for multiple years after settlement.  The result not only provides transparency into the injured party’s future medical costs, but also allows all parties to the settlement to view the true cost of these treatments and services as they prepare to negotiate settlements. CareQuote can be utilized in all personal injury cases, including workers’ compensation and liability cases, to bridge the gap to settlement for both the defense and plaintiff, as well as be an effective tool for mediators.

“At Ametros, our goal is to maximize savings for our members and provide the best care possible,” says Ametros’ CEO Marques Torbert. “The opportunity  further this goal while introducing a more comprehensive solution in the medical management industry is exciting for us and our clients.”

About Ametros Financial

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make savvy decisions on how to spend their funds. Ametros’ team works closely with patients, insurers, employers, attorneys, medical providers and Medicare to create a seamless experience for their clients. Their depth of expertise in the Medicare Set Aside, property and casualty insurance, healthcare, legal, financial and software industries positions them to offer the best solutions in the marketplace. Their flagship product, CareGuard, is revolutionizing the way funds from insurance claim settlements are administered after settlement, for Medicare Set Aside accounts and any other medical allocation. Ametros is backed by Clarion Capital Partners, LLC, a New York based private equity firm. For more information, visit http://www.ametroscards.com.

Amethyst: The Settlement Saver

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Jordan Pfeiffer wasn’t sure what to do. He’d fallen from a roof while on the job 4 years ago and sustained a significant spinal injury. His life had changed dramatically and so had his finances. Today he was seated uncomfortably in a mediation room with his attorney and a couple of strangers from the insurance company trying to figure out what was the best option for him when it came to his pending insurance claim.

Jordan needed the money; the weekly checks he received were just enough to get by. He also wanted to visit his own doctors and to try some alternative therapies he’d been recommended but that the insurance company had denied.

Settlement Gavel

Jordan and his attorney were very concerned about his ongoing medical needs.  The insurance company had put a number on the expected costs, but how could he trust it was enough and who would help him coordinate everything? He was worried about running out of money and needed to complete complicated reports to Medicare. Jordan didn’t want to settle without feeling comfortable that he would be taken care of in the long-run.

The settlement was at an impasse when the mediator recommended a healthcare savings card called Amethyst. He explained that Amethyst would allow Jordan to keep his settlement funds in his own bank account, while providing him with discounts on his medications and doctor bills. Upon reading further on Amethyst’s website, www.amethystcard.com, Jordan discovered that the service also provides him with a support team to help him create his annual Medicare reports, and nifty graphing tools for him to track his spending and savings.

Jordan wanted to learn more, so he and his attorney reached out and spoke with Tina, one of Amethyst’s care advocates.  She confirmed that Amethyst would help Jordan save money, making his settlement last longer, and keep him organized for reporting to Medicare, while allowing him complete control of his settlement funds.  Jordan’s attorney sent Tina a list of the treatments and medications included in Jordan’s settlement offer.  Tina quickly showed Jordan the discounted pricing he would achieve through Amethyst.  He would save almost 50% on the medication pricing he had in his settlement offer (see chart below).   Relieved and excited at the savings, Jordan had Tina walk him through the 5-minute sign-up process and he was ready to go with his Amethyst card.

After setting up his Amethyst account, Jordan felt confident knowing he had the necessary support to get the medical treatments he needed and to maximize his settlement dollars. He and his attorney were able to reach an agreement with the insurance company to settle his entire claim. All of the parties involved were thrilled to reach an agreement.

Do you have a story like Jordan’s?  Share your experience in our comments section.  Or, if you know someone who could benefit from learning more about Amethyst, reach out to us anytime at:  877-275-7415 or am-info@amethystcard.com.

Amethyst Savings Example

*This graph is representative of pricing at the time the case was settled, current pricing may differ.

About Amethyst

Amethyst’s health card links to a member’s existing bank account, and works like a traditional insurance card, allowing a member to access on average 21% savings on their prescriptions. The Amethyst portal provides insight into spending trends and savings amounts, and helps members prepare reports for their Medicare Set-Aside. To find out more about Amethyst or to sign up, visit www.amethystcard.com or call 877-275-7415.

**To protect the privacy of our members, names and identifying details have been changed.

Ametros Announces the Launch of New Websites and Introduces Two New Breakthrough Products!

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Ametros announces the launch of new websites and introduces two new breakthrough products, Amethyst and CareAssist.

At Ametros, we recognize that each settlement is unique and that each injured individual approaches the challenge of managing their healthcare needs differently.  Our CareGuard service is the leading professional administration service for both medical allocations and Medicare Set Asides (MSA’s) after settlement, but it is just the beginning.  We are pushing the bounds of innovation by introducing two new products designed to help not just injured individuals, but any individual with managing their out-of-pocket healthcare costs.

PRODUCT COMPARISON

We are confident that Amethyst will revolutionize how individuals save on their out-of-pocket healthcare expenses, while CareAssist will provide a solid foundation for tracking and reporting, particularly for self-administered MSA’s.  With these two additional offerings, we are confident we now offer holistic solutions for anyone considering settling their insurance claim, or those folks that are just faced with expenses that fall outside of their insurance coverage.

Visit our webpages to learn more. AmetrosCards.com  We will follow up in the weeks ahead with more information on both Amethyst and CareAssist and perspectives on how they can be helpful for you and your clients.

New Ametros Amethyst Video

Amethyst screenshot
The Amethyst Healthcard links to your existing bank account and helps you maximize all of your care-related payments, but you are always in complete control of your funds!

 

With Amethyst you have the ability to sync your bank account to our transaction and claims management platform. Amethyst is designed to allow you to retain complete control of your funds, while ensuring a seemless process for both the member and facility providing services.
The Amethyst platform functions very similarly to clearing house, by managing transactions, funds and ensuring funds are available to support charges in question.

Top 10 MSA Self-Admin Mistakes to Avoid (Part III)

medicare toll

Why you should consider having your MSA Professionally Administered

 

We’re rounding out our three-part series on frequent mistakes injured individuals make when they self-administer their MSA.  In our second post [Part II], we focused on complications that arise with billing and the use of the funds over the medium to long-term.  In our first post [turn into a link], we pointed out some of the most basic and costly mistakes made.  Finally, today we’ll point out a few straightforward accidents that can have a big impact.

  1. Commingling your MSA funds with other accounts or investments.
  • Medicare requires that you place your funds in a separate interest-bearing bank account. A professional administrator will make sure are funds are set up appropriately so that every cent is accounted for and reported.

Often times, injured individuals skip the step of establishing a dedicated bank account for their MSA funds.  This may not seem like a big deal at first, but as the account is used for other expenses, it can be quite a challenge to separate out the items and produce reporting for Medicare.  In addition, depositing your MSA funds into a personal checking account that you also use for shopping, etc. means you may very well spend the money incorrectly by accident.

Likewise, while Medicare has not given specific guidance on placing MSA funds into investment vehicles, the safe play is to keep your funds in a standard checking or savings account.  We believe you a playing with fire if you put your funds into the market.  The issue is that most folks in the industry believe that Medicare will not accept that your MSA is smaller because you invested poorly.  Medicare views the MSA as a safeguard against having to use its funds, so it seems fair that Medicare would not look kindly upon injured individuals gambling with the money in the stock market.

At Careguard, each of our members gets a separate interest bearing saving account and we do not pool or invest your funds so that all the tracking is clean and your money is in the safest accounts available.

  1. Failing to notify Medicare properly when funds exhaust or replenish (if you have an annuity).
  • A professional administrator verifies you’ve reported exhaustion properly and also receives annuity checks and will report when your account is replenished. This way the hassle of keeping Medicare up-to-date is taken care of.

Medicare really becomes your pen pal when you get an MSA. They want to hear from you every time your MSA funds run out and every time you get another annuity check.   If you miss a beat, they will not be prepared to cover your healthcare if you have exhausted your funds and show up for a treatment.

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Medicare’s self-administration guide has a letter template for every time your funds run out and another letter template for every time your funds are replenished.  Some injured invididuals find themselves running out of MSA funds every year.  This means they need to send a letter twice a year to Medicare (not counting the annual reporting).  They also are often required to call Medicare to make sure they received the letter and are prepared to help cover costs when they go in for their next visit.  This is a lot of coordination and can be really exhausting for some injured individuals.  CareGuard takes care of all this seamlessly.

Even the most astute injured individuals sometimes get confused on what triggers the exhaustion and replenishment letters.  The math on exhaustion is important – it’s when your total account balance runs out. A frequent confusion of MSA holders that have annuities is whether they technically “exhausted” their funds because they spent more than their annuity check for that year. This is a mistake.

Let’s take an example. You have $25k in your MSA account. You receive a $10k annuity check this year. You spend $15k on MSA-related medical expenses. There is $20k left in your account at the end of the year. You do not need to report you exhausted your funds.

You only need to report exhaustion to Medicare when your aggregate account balance reaches zero. In other words, in the example above, if instead of $15k in expenses, you had $45k of expenses, then your total account balance would be zero and then you would be required notify CMS that you’ve exhausted your funds.

  1. Failing to report your MSA spending to Medicare annually.
  • Medicare expects to hear from you on the anniversary of your injury, every year for the rest of your life. The only exception is if you have notified Medicare that you have no funds remaining and not future annuity checks. As long as you have MSA funds or annuity payments expected, Medicare looks for your report. A professional administrator will ensure you never miss a report.

Last but not least, we end with the most essential requirement of the MSA.  The annual reporting to Medicare is the fundamental requirement that MSA holders need to fulfill to ensure their Medicare benefits are protected.  Unfortunately, many injured individuals forget the date of their settlement and file their reports late or not at all.  At CareGuard, we’ve seen Medicare accept reporting that is late, but it usually takes multiple phone calls and often times the injured individual is left waiting for approval for a medical treatment or prescription that Medicare needs to help cover.

The real challenge that some injured individuals face is, after a couple years of missing reporting, they don’t even know where to begin.  At CareGuard, we sometimes work with MSA-holders that have gaps in their reporting.  We do our best to clean up any old files they have and get them to Medicare and then we fulfill the reporting requirements from then on out to be able to show to Medicare that they are doing the right thing to get on track.

This concludes our series on MSA mistakes to avoid.  We hope you found some helpful information in these posts for you, your client, your family member, etc. with an MSA account.

At CareGuard, we’re constantly encountering new issues with MSA accounts and adapting our systems and team to address them to take the burden off of the shoulders of the injured individual.  After all, folks with MSAs have been through enough; they shouldn’t have to deal with the daily stress of Medicare compliance.  That’s what we’re here for!

For more information on professional administration or CareGuard’s services in particular, please visit http://www.careguard.com, call 1-877-905-7322 or email Porter Leslie at pleslie@ametrosfinancial.com.

Top 10 MSA Self-Admin Mistakes to Avoid (Part II)

Medicare Maze

Why you should consider having your MSA Professionally Administered

 

We’re back with part two of our three-part series on mistakes to avoid when administering your MSA.  In our last post [Part I], we focused on the top three near-term, most costly mistakes we see.

Today, we turn our focus to a number of issues that can occur in the usage of the funds over time that can cause major reporting problems.  There are quite a bit of details to pay attention to in the process of using your MSA funds to secure the care you deserve.  Our team identified several issues that over the medium to long-term will likely result in your MSA reporting being inaccurate and your Medicare benefits in jeopardy.

  1. Believing that Medicare will play some part in managing the billing of your MSA
  • Medicare does not receive your bills and verify information. A professional administrator will do this for you, but if you are self-administrating it is your responsibility. Medicare only sees what you’ve sent in as your annual report.

Many injured individuals we speak to wrongly think that their medical bills after settlement will go directly to Medicare and that the MSA is set up only to pay their copays or deductibles.  This is a dangerous misunderstanding, because it means that you may be trying to bill Medicare for the injury and Medicare will most likely reject paying for it.  It also means you may be underestimating the cost of your treatments.

Medicare couple confused RESIZEddddddd Instead, remember that as long as you have funds in your MSA you are responsible for collecting the bills and paying for them in full.  Medicare will rely on your annual reporting to see that you did the right thing.

To clarify how you will pay for bills with your MSA, let’s look at an example. For the average person, let’s say a procedure would cost $100 total, both at the Medicare reimbursal rate and workers compensation fee schedule (to simplify things). The average Medicare beneficiary would contribute a $20 dollar copay to the cost and Medicare would cover the remaining $80. An MSA account holder, on the other hand, will need to pay the full $100 out of their MSA funds. Only once their MSA is exhausted, do they contribute just the copays alongside Medicare like any other Medicare beneficiary would.

  1. Using your MSA funds to pay for medical expenses that are unrelated to your injury or not Medicare-covered
  • A professional administrator verifies that each medical expense is Medicare eligible and will go the extra mile with you and your doctors to document relatedness.

 Many injured individuals view their MSA as a pool of funds that they can use for their medical care in general, or at least for any type of expense that arises from their injury.  In reality, Medicare’s guidelines are very specific.  Medicare requires that you only use the MSA funds to pay for the entire cost of medical treatments that are A) related to your injury and B) would be covered under Medicare.  At CareGuard, our team receives constant questions about whether medical treatments meet both requirements.

First, it’s important to have your doctor verify that medical treatments are causally related to your injury, and to keep their notes on file.  Injuries to one body part can affect other areas of the body and often individuals with MSAs do not recognize the relatedness and document properly how and why they spent their funds on certain treatments. For instance, a knee injury may trigger a hip problem that requires hip surgery. When it’s related to your injury and Medicare would cover it, it should be paid for with the MSA.  It’s best to document this so that if Medicare questions you, you have all the records handy.  Also, if you fail to use your MSA funds for a procedure that is related, you run the risk of Medicare denying it.

Next, it’s equally as important to verify that Medicare would cover for the expense.  Often times, injured individuals are caught off guard that expenses like transportation, long-term care facilities, many compound creams, and over-the-counter products are not covered by Medicare.  Many folks who self-administer try to rely on the Medicare & You guide to see if they can determine what is covered, but often times, it’s a challenge to get specific feedback on the exact expense in question.  At CareGuard, we’re verifying thousands of bills per month automatically so there is no ambiguity and more importantly, no hassle for you to do the research.

  1. Using your MSA funds to pay for copays, deductibles, premiums or administrative fees.
  • Copays, premiums and administrative fees are not allowable uses of your MSA funds. A professional administrator ensures that all payments out of your MSA are for eligible costs and will block any such expenses.

Medicare guidelines dictate that the MSA funds are not to be used for any co-pays, deductibles, premiums, or any administrative fees.  It’s important to note as well that if you have an annuitized MSA, then you may think that once your MSA funds arrive, you can use them to pay a backlogged bills for deductibles or copays related to your injury that you received from Medicare or your health plan.  Medicare does not permit this either.

Some injured individuals purchase Medicare supplement plans to fortify any coverage gaps they may run into if their MSA funds exhaust.  While this can often be a very good idea, Medicare does not allow you to use our MSA funds to pay the premiums for Medicare supplement plans, nor the premiums for any other plan (including Medicare Part B, C or D).

Medicare also does not allow use of the MSA funds to pay investment advisors or any other administrative service.  At CareGuard, our administration fee for professional administration always comes from funds that are separate and apart from the MSA funds.

  1. Failure to coordinate with providers and pharmacists on which items to bill your MSA vs. your Medicare or private insurance plan. Staff at most pharmacy and provider offices has never heard of an MSA so there is often confusion about directing bills to be paid by the MSA or insurance plan.
  • A professional administrator works hand-in-hand with your providers to ensure bills are routed and paid properly; they also catch and correct any bills that were misdirected.

As an individual self-administering your MSA, you are responsible for making sure you pay each bill properly with your MSA funds or route unrelated bills to your Medicare or insurance plan.  It may sound simple, but often times, you will visit the pharmacy to pick up some medications that should be covered by your MSA and other medications that should go to your health insurance or Medicare.  The same can happen with doctor visits.  The same physician may be treating you for your injury and also for other ailments.  It’s important to be very specific with your healthcare providers and their staff to make sure they are separating out the bills.

At CareGuard, we often see doctors’ offices or pharmacies incorrectly route bills to Medicare or insurance plans.  These bills need to be reversed and paid for out of the MSA funds.  On the other hand, we reroute bills that come in for payment out of the MSA that should go to the insurance plan.  If you are self-administering, this bill administration tracking can be a huge hassle; it’s also a challenge to request that your insurance plan reverse bills or to try to secure a refund from your doctor if bills are routed improperly in a timely manner.  At CareGuard, we routinely resolve billing issues so you don’t have to waste your time.

That’s it for today!  We’ll be back in a couple of weeks with part three of our three-part series. For more information on professional administration or CareGuard’s services in particular, please visit http://www.careguard.com, call 1-877-905-7322 or email Porter Leslie at pleslie@ametrosfinancial.com.

Top 10 MSA Self-Admin Mistakes to Avoid (Part I)

stop overpaying

Why you should consider having your MSA Professionally Administered

 

There is one correct way to administer your MSA (Medicare Set-Aside); but there are plenty of ways to screw it up!  Mistakes in managing your MSA can have a huge impact because they may result in you running out of money quicker than you expected or in Medicare denying to cover your medical benefits.

Let us clear up some misunderstandings for you, your client, your family member, etc so you can make an informed decision about how to best manage your funds and avoid the most common mistakes that are made in self-administering an MSA.  We have compiled the top 10 MSA administration mistakes we most commonly see from the most costly in the near-term to the most impactful in the long-run.  Today, we’ll go over part one of a three-part series of posts and cover the top three mistakes we encounter in the first year or so of self-administration:

  1. Overpaying! When you self-administer your MSA you are paying retail prices on drugs, doctors’ visits, procedures and medical equipment instead of the much lower fee schedule.
  • A professional administrator will make sure you save your money by only paying fee schedule or below.

 In most states, an injured worker is required to pay the state fee schedule for their treatments even after settlement. However, providers do not know how to bill you at the fee schedule rates.  Their billing department rarely knows that you have had a worker’s compensation settlement nor do they know Medicare’s guidelines for billing.  If you do not calculate the fee schedule for each of your treatments and demand to be billed accurately, you will be overpaying!  In short, paying anything other than fee schedule is a huge waste of your MSA money!

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At CareGuard, we find that on average the fee schedule is 55 percent below what doctors actually bill at retail prices. Why pay $100 for a doctor visit when you legally should pay $45? Or in other words, why reduce your $100,000 MSA settlement to $45,000 dollars?  A professional administrator like CareGuard automatically ensures you pay fee schedule on all your expenses, and often times even less.

The double impact of paying retail prices is that Medicare may review your reporting and determine that you spent through your money too quickly because you overpaid on your bills.     Medicare could then deny to provide your medical benefits until you make up the difference on what you overpaid!  In other words, you may have to use your personal funds to pay the amounts you overpaid with your MSA funds again.

  1. Assuming that when your funds run out, Medicare or your private insurance will automatically cover 100% of your healthcare costs.
  • This is not the case. You will be responsible for copays and deductibles. By keeping your expenses to a minimum a professional administrator makes it far less likely you will run out and face these expenses.   

The settlement process has a lot of moving parts. Often times, we find that injured workers are told that when their MSA funds exhaust Medicare or private insurance will kick in and take care of everything. This is a huge misunderstanding.

First, you need to be actually enrolled in Medicare or private insurance and paying your premiums!  If you did not enroll, you do not have coverage for anything but emergencies.  If you are enrolled in a plan, when your funds run out, your insurance/Medicare will begin picking up the bills, but you will still need to contribute copays!  In other words, once your MSA funds run out, your medical expenses are not 100% covered.  Typically, you are expected to contribute around 20% of your medical costs.

This is why it’s important to have a professional administrator ensuring you do not overpay on your medical expenses, so that you never have to use personal funds to cover copays and deductibles once your MSA funds are gone.

  1. Failure to enroll in Medicare or personal insurance altogether. Many injured individuals assume that having an MSA means they are setup on Medicare automatically.
  • You need to enroll in a Medicare or private insurance plan to have coverage if your funds run out. A professional administrator will guide you through the plans that are required or a good fit for your situation.

Regardless of your settlement, as mentioned above, you need to be enrolled in Medicare or a private insurance plan and paying your premiums so that they know to cover you as a beneficiary for any and all of your healthcare needs. Medicare has an open enrollment period from October 15th to December 7th and most private plans have an open enrollment period from November 1st – January 31st. You also may be able to take advantage of a special enrollment period – check with Medicare or your plan to see if you’re eligible.

While Medicare Part A (emergency visits) does not require enrollment, Part B (regular doctor visits), C (private Medicare plans) and D (prescription drugs) all have monthly premiums you must pay and require that you actively elect to enroll. If you do not enroll in a plan, when your MSA funds exhaust, you will have to pay your healthcare costs out-of-pocket. By the way, you are legally required to have insurance so if you do not enroll you may also have to pay a fine when tax season comes around.

At CareGuard, we work closely with each injured individual when they come onto our platform to make sure they get themselves a plan to be covered for any potential costs once their MSA exhausts.  One extra insurance protection that many of members ask about is Medicare Supplement plans.  These supplement plans kick in to cover many copays and the costs of extended hospital visits.  CareGuard works with a partner to provide guidance on all Medicare plans as well as supplement plans to make the question of coverage easy to the injured individual.

We hope this post helps you, your clients or your family be aware of the top three mistakes we see injured individuals make in the first year of self-administering their MSA.  Ametros’ premier product, CareGuard provides professional administration of the MSA and will help you avoid all of these mistakes and make the process easy.  Ametros also offers a self-administration service, called CareAssist that provides support to folks that still want to self-administer.

Next week we’ll continue with mistakes number 4-7.

For more information on professional administration or CareGuard’s services in particular, please visit http://www.careguard.com, call 1-877-905-7322 or email Porter Leslie at pleslie@ametrosfinancial.com.

Freedom from Utilization Review

Pro-Active-Utilization-Review

“I’ve gone to hell and back fighting the denials,” Sarah, an injured nurse living in rural California, recently related to me. * Sarah was injured in 1992 and, after one back surgery, has had her second back surgery denied for the last eight years. At age 73, she tells me how she and her husband must drive two hours to the closest doctor in her workers compensation carrier’s medical provider network to get a checkup. She says her attorney, after settling the lost wages portion of her claim, has long since given up fighting for her to get the second surgery that her own doctor says would greatly benefit her condition.

Stories like Sarah’s are well known at CareGuard, where we help injured individuals get the healthcare they need after they’ve settled their case. At CareGuard, we understand the
workers compensation system has rules and guidelines to make sure that the treatment
being delivered is fair and appropriate. However, as a professional administrator of
medical funds post-settlement, we specialize in making life easy for the injured
individuals; we give them full control to choose the doctors they prefer and we help them
save money along the way. ur photoMost importantly, with CareGuard, the injured individual is no longer subject to the utilization review process. The injured individual has the freedom to treat the way they want with the support in place to help them after settlement, which in many instances leads to more settlements of future medical.

Many injured individuals, like Sarah, feel trapped and neglected by the workers compensation system. They are contacting their adjusters, doctors and attorneys so much to get the medical care they need that they have little time to consider if settling their case and having the help of a professional administrator may be a better option.

Settling their case and working with a professional administrator allows the injured individual to be totally free from workers compensation utilization review; they become the decision-maker with 24/7 support, systems and online tools to make sure their experience is as convenient as possible so they can just focus on feeling better.

Below is a glimpse of the key differences between an open, pre-settlement claim and a settled claim with the professional administration of the medical funds CareGuard provides:

CHART

 

Settling the case and working with a professional administrator offers injured workers freedom from the bureaucracy of the workers compensation system and, with CareGuard’s cost savings, we maximize the chance that their settlement funds will last beyond their lifetime and even be left over in their account for their family or estate when they pass away.

After speaking with Sarah and her husband at length, she decided to become a CareGuard member. She recently had successful back surgery and is now seeing her own doctors as she progresses through physical therapy. CareGuard was able to save her 47 percent off of the billed charges for her surgery so she has substantial funds remaining for future checkups.

“Your team removed a huge stress off me and my husband’s shoulders,” she told with me last week.  She went on to share that she is feeling much better and is hopeful that as she continues to improve she won’t need to use her settlement money and can leave most of it behind for her three grandchildren.

*Sarah’s name and location are altered for purposes of this story.

For more information on professional administration or CareGuard’s services in particular, please visit http://www.careguard.com, call 1-877-905-7322 or email Porter Leslie at pleslie@ametrosfinancial.com.