ONGOING HELP FOR THE INJURED WORKER: Before settling a claim, an injured worker usually has nurse case managers, adjusters, and other resources to assist them with their claim. Once the case settles, those personal resources go away, and the injured worker is left to manage their healthcare on their own. Unless they have experience with all the details, such as state fee schedules for medical bills, bill negotiation, and annual reporting to Medicare for their Medicare Set Aside (MSA), they are being set up for failure. Ametros can assist injured workers by offering MSA Custodial Accounts, Bill Review Services, and Annual Reporting to Medicare. Ametros advocates for injured workers post-settlement so they can have peace of mind and have their MSA dollars go further.

WHAT IS A MEDICARE SET ASIDE (MSA)? A Medicare Set Aside is a future medical allocation related to the worker’s compensation injury. When an adjuster is reviewing for settlement of a claim, they need to consider the future costs of the Medicare-covered items related to the injury so that Medicare will not become burdened with the cost. For example, a Medicare beneficiary has a broken foot and may need future medical care for his foot post-settlement. Before settlement of the claim, the insurer would need to review the medical records and determine what amount should be set aside in an interest-bearing account to pay for the future medical treatment of the injured worker’s foot. Medicare requires annual reporting, and there are a lot of rules and regulations.

AMETROS MAKES A DIFFICULT PROCESS EASY:  Navigating the MSA account rules can be daunting. When an injured worker has their MSA Account administered by Careguard (Ametros’ Flagship Product), it is a full professional administration service. Careguard will negotiate discounts on bills, perform bill review services to ensure the provider is charging correctly and according to the state fee schedule, report annually to Medicare, and give the injured worker a CareGuard Card to give to their provider for any bills. The injured worker will not receive bills related to their MSA; CareGuard will receive every bill and pay them on behalf of the injured worker. The injured worker can download the Careguard app and check the balance in their account at any time. 

AMETROS OFFERS SELF-ADMINISTER PRODUCTS: Ametros has a self-administration assistance program called Amethyst. This program is for someone who wants access to discounts but wishes to put their MSA money in a self-administered account. Amethyst is an excellent option for someone who may have a smaller settlement and needs a few prescriptions per year or very minimal care. 

CARE IS NOT RESTRICTED: The main reason that injured workers want to settle their case is that they no longer want to go through Utilization Reviews and get approval for medications and treatment. When their MSA is administered with Ametros, they do not restrict care. They don’t restrict providers or pharmacies that they can go to. If a bill is received, and they are unsure if it’s related to the injury, they will clarify the issue with the provider’s office. Once the provider’s office confirms it is associated with the injury, they will pay the doctor’s bill through the MSA account. The injured worker stays in control and chooses who they want to see for treatment. 

AMETROS LOVES MEETING WITH INJURED WORKERS:  They are often invited to mediations and informal settlement conferences to articulate their message to the injured worker and see their settlement goals. They want to know their future medical needs or some of the biggest concerns an injured worker may have about settling their claim. They want them to understand what support they can provide to them, as well as the savings and access to the provider networks. They want to build trust with the injured worker and show them how to make the process seamless and stress-free post-settlement. For further information, please go to www.ametros.com.