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.


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.  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

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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)

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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, call 1-877-905-7322 or email Porter Leslie at

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, call 1-877-905-7322 or email Porter Leslie at

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

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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, call 1-877-905-7322 or email Porter Leslie at

Freedom from 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:



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, call 1-877-905-7322 or email Porter Leslie at

Get a Grip on Non-Medicare Covered Costs

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Would you buy a house if you didn’t know its price or the ongoing cost of your mortgage? It seems like a ridiculous question, but many claimants are asked to make decisions of the same magnitude on the non- Medicare covered portion of their settlements with little to no reliable information.

Most of the time, claimants don’t know the current cost of their medical treatment nor the future expected increases. While a Medicare Set Aside may provide a vote of confidence to the claimant for the MSA portion of their settlement, given Medicare approves the amount, the costs that would not be covered by Medicare (also known as “non-qualified costs”) can be particularly daunting.

Many adjusters try to avoid addressing the issue of non-Medicare covered items altogether in a settlement, but often times it is a necessary component of the offer and a very contentious one. Estimating the pricing on big-ticket items, such as facility costs, custodial care service and home health care can be extremely difficult and often result in many cases never reaching settlement.  Working with a hands-on professional administration company, like CareGuard, you can gain transparency into real- world pricing for these items and reach a definitive number for the costs.

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What are some of the most significant non-Medicare covered expenses?

  • Long Term Skilled Nursing Facilities
  • Home health aides and custodial care services
  • Home modifications
  • Certain creams, gels & compounds (Lidocaine, Voltaren, )
  • Transportation
  • Medical supplies sold over the counter
  • DME bathroom supplies
  • Services like acupuncture, gym memberships, home IV therapy

There is no exact science for how to appropriately cost out these expenses for a settlement.  Many adjusters are trained to look at the past two years’ cost and then project out the future costs based on the claimant’s life expectancy. The issue with this method, as many applicant attorneys will be quick to point out, is that the carrier has sophisticated cost containment systems in place to reduce what it pays on its bills. The true expense can be dramatically higher after settlement when the claimant is no longer covered by the payer’s systems and instead faces these costs alone, paying retail prices with cash.

Other adjusters rely on MSA vendors to put together a “non-qualified” projection for these costs. It is worthwhile to examine the basis of these projections, given that, unlike MSA’s, there is no specific guideline across the industry that the vendor must follow so the figures can vary significantly.

In contrast to methods above, with a professional administration provider you can often discover the exact cost that the claimant will incur after settlement for these expenses.   Professional administration companies can go out and secure pricing for some of the largest cost-drivers, and often minimize or at least lock-in inflation risks. For example, at Careguard, we have locked-in rates for claimants at specific facilities for long periods of time: 10 to 15 years, or for the rest of their life. In other instances, we have been able to secure rates for home health treatment, depending on the type of care and requirements of the claimant.  In addition, many professional administration companies have pharmacy networks that drive discounts on the creams, gels, and medications that are non-qualified.

CareGuard Case Study: California Facility Costs

 An attorney introduced a case to CareGuard which was not going to settle due to disagreements over non-Medicare covered costs. The claimant was in a long term skilled nursing facility in California. He and his family were interested in settling, but hesitant about the ongoing expense of the care and medical cost inflation.  CareGuard took the following steps to help move the case forward:article data

In this case, CareGuard was able to negotiate a rate with the facility that was about $54 a day below what the carrier had been paying.  This reduced rate over 17 years generated a significant savings that allowed the carrier and claimant to find a middle ground and to settle the case.article ideaaaaaa

Non-Medicare covered expenses will continue to become more significant components of settlements. Reports indicate that home health attendant costs have risen between 1-2% over the past 5 years, nursing facility costs have risen approximately 4% per year, and that in last year alone, rates for adult day care rose almost 6% nationwide.* There is also enormous price inflation and variance in the cost of the prescriptions.  These challenges are not going away anytime soon. As the parties to a settlement try to come to a resolution, knowing and using real-world pricing through a platform such as CareGuard can help bridge the gap.

Don’t let the discrepancy in estimates of non-Medicare costs become a huge sticking point in your negotiations. Instead, introduce visibility into the cost and let a professional administrator like CareGuard help get everyone on the same page so the claimant can feel confident that they’ve made an informed choice when they settle their case.

For more information on professional administration or CareGuard’s services in particular, please visit, call 1-877-905-7322 or email Porter Leslie at


Genworth 2015 Cost of Care Survey


A New Tool for Settling Open Medical Claims: Professional Administration

gavelThe almighty dollar is often just one component of a successful workers compensation settlement.  Savvy negotiators recognize that they have several tools at their disposal when it comes to bridging the gap between the payer’s offer and the plaintiff’s demand, many of which dictate how and when the settlement dollars can be used.

On both sides of the negotiating table, many are adept at minimizing or maximizing the medical cost projection or the amount that goes into a Medicare Set Aside (MSA).  Many in the industry also understand how a structured settlement (annuity) can unlock value and allow for the pacing of stable income for the claimant.

Now, a small but growing number in the industry are beginning to understand how offering professional administration (PA) of the claimant’s future medical funds can help facilitate a settlement.  PA provides the claimant with a dedicated support team after they settle their case, along with technology to ensure they save money when they actually spend their settlement dollars on healthcare purchases.

What settlement issues can you use PA to address? 

The most often cited concerns of injured workers when they face the prospect of settling are regarding 1) access to their medical treatment and 2) how long it takes to get a response from their adjuster, attorneys or the board as they go through settlement process.  Examples of these concerns are easily found by reading the comments directly from injured workers in a survey conducted by the New York Worker’s Compensation Board.1  Issues like “denied treatment” and “delayed processes” are at the core of nearly every complaint.  PA is effective in addressing these concerns because PA services do not restrict the claimant’s access to medical treatment via utilization review or a MPN; on the other hand, they facilitate it by providing more options of providers and expanded choices for treatment of their medical condition.  In addition, many PA services have call centers that offer ongoing support to their clients, the injured worker.  CareGuard, for instance, offers 24/7 coverage to its members and prospective members to answer any questions they may have as they navigate the complex healthcare maze after settlement.

Through the life of their claim, many injured workers simply lose trust in the attorneys, judges or system in general.  This is often because the settlement process sets the parties up at a table for purposes of a one-time transaction, but then each group walks their own separate way.  There is sparing research done on injured workers’ attitudes toward settling their case, but a survey in Minnesota in 2013 scratched the surface of what a daunting undertaking settling is for the injured individual.2  The study found that about one third (1/3) of injured workers did not fully understand their settlement.  Further, it revealed that around three quarters (3/4) of injured workers did NOT believe they achieved a “fair” settlement.  The sample used were folks who actually overcame their concerns and settled regardless of the negative sentiment the process evoked.  Many claimants do not have the courage to push forward with settlement and instead decide to leave their future medical claim, if not their entire claim, open.

PA can be a valuable tool, whether for adjusters, defense attorneys or plaintiff attorneys alike to inject trust and solutions into a contentious situation.  By engaging a PA company, a team becomes available to address the claimant’s concerns about their future medical treatment.  It also introduces a party to the settlement negotiation whose interests are aligned with the claimant’s since the PA provider will be the only party continuing to provide ongoing service to the claimant after settlement. This can give the claimant much needed peace of mind that it has a partner looking out for their best interests, and it is this peace of mind that helps reluctant claimants see that settling could in fact be their best decision. PA services give claimants comfort and confidence that life after settlement can be a rewarding and hassle free experience.

How can you leverage PA in a settlement?

To leverage PA effectively, negotiators on either side of the table should introduce the service early on in the process and clearly explain its benefits to the claimant.  Often times it’s useful to connect the PA provider directly with the claimant and/or their attorney so that a relationship is established and the service is well understood.  After all, the agreement between the PA provider and the claimant will exist for years beyond the settlement; it’s better to begin that relationship early on rather than try to throw it in last minute.

The PA provider can serve as a neutral party that helps explain to the claimant what they can expect after settlement.  Some PA providers, like CareGuard, can go further to provide cost analyses of what treatments will cost on their platform and demos of how their service works.  PA providers understand that they do not get paid until the case settles, so they are a source of information and guidance toward settlement for all parties involved.

Questions?  Contact Porter Leslie:


  1. New York State Worker’s Compensation Board Business Process Re-engineering “Comments from Injured Workers Survey,” 11/1/13 – 3/19/14.
  2. Minnesota Department of Labor & Industry “Workers’ Perspectives on Settlements and Hearings,” 2013.

A Better Reality Post-Settlement for Injured Workers

When is the last time you haggled with your doctor over pricing?

It’s certainly not a negotiation most Americans are prepared for or would even know how to approach. However, when it comes to workers compensation settlements, the system anticipates that after settlement injured workers can persuade their doctors to bill them fairly, according to their state’s fee schedule. In reality, the system is naive and injured workers are instead being unfairly stripped of their settlement funds because they are routinely overpaying for treatment.

Injured workers deserve better, and engaging a professional administration service, like CareGuard, provides them just that. CareGuard offers injured workers a sophisticated advocate and group-buying power to make sure they can navigate the healthcare system and get the lifetime of treatment they were promised in their settlement, with money to spare.

Each year, tens of thousands of injured workers decide to settle their cases. The vast
majority, over 95%, of these workers have no help when it comes to properly spending their funds on healthcare. picAfter settlement, the lion’s share of injured workers pay out-of-pocket for treatments related to their injury, relying upon their often limited knowledge of healthcare to figure out what treatments they should pay for with their funds. When they do decide use their funds to pay, they must navigate a complex maze of state fee schedule guidelines provided by the state to find the correct prices. In reality, it’s nearly impossible to comply with the guidelines without a computer application deciphering the numerous pages of schedules, CPT codes, rates, modifiers, and rules.

The end result is that, in most instances, when injured workers are left on their own after settlement, they fail to manage their care appropriately. They overpay for treatments and drugs, depleting their funds more rapidly than expected. They lose track of bills and fail to comply with regulations putting their Medicare and other benefits at risk. And even when they are aware they can negotiate, injured workers are left to haggle out pricing on their own, pitted against a complex and apathetic medical system. Keep in mind that most of these individuals have far more healthcare needs than the average person.

Professional administration services provide access to discounted drug, provider, and medical equipment pricing, as well as access to technology that provides a hassle-free experience with medical care, and support from a dedicated team of representatives and advocates to answer questions and help the injured worker navigate their medical care. With professional administration, there is no utilization review or the requirement to use a medical provider network (MPN); instead, injured workers can see any providerthey would like, giving them the freedom to get the care they need with the added support to help minimize administrative red tape.

The culmination of all these benefits is that professional administration helps alleviate injured worker’s concerns about settling their case. It is a tool that can help everyone at the settlement table prepare the claimant for post-settlement success and minimize any backlash or misunderstandings after settlement.

Professional administration is often overlooked due to a common misconception that is very expensive, costing tens of thousands of dollars. At CareGuard, our pricing is typically below $5,000 and can be even less for smaller cases. As a result of our low pricing and the high discounts we offer our members, we also find that, on average, we save the injured worker over five times the cost of our services each year.

The workers’ compensation system was built to protect injured workers. Significant work and resources are dedicated to ensuring the system runs well. However, the system was poorly designed to care for injured workers who have settled their case and exited the system. Professional administrators, like CareGuard, pick up where the system left off and ensure the injured workers a smooth transition to life post-settlement.


For more information on CareGuard’s services, please visit or call 1-877-905- 7322.

Ametros Financial Corporation (“Ametros”) provides cost containment and professional administration services for Medicare Set-Asides (MSAs), medical custodial accounts (non-MSA accounts), special needs trusts, and life care plans with the industry’s first automated, patented and affordable solution. Mixing simplicity and savings for the claimant with risk mitigation for all parties, Ametros’ CareGuard product facilitates settlements and its own growth as the nation’s premier professional administration company. Utilizing cutting-edge technology, continuous innovation, and world-class service, we enable those seeking medical care to live happier, healthier, and more productive lives. Our depth of expertise in the insurance and healthcare industries has positioned us to develop the best product in the marketplace f o r managing medical treatment, ensuring regulatory compliance, and solving complex billing and payment issues in the healthcare world.

Questions? Contact Porter Leslie –

Ametros Financial (CareGuard) –