CareGuard Reimbursement Policy Terms and Conditions

Applicable to Healthcare Providers Submitting Claims to CareGuard

1. By accepting payment, you, the provider (“you”), have reviewed and accept the terms and conditions in this CareGuard Reimbursement Policy Terms and Conditions (“Policy”), available at www.ametros.com/billing.  If you do not agree with the payment rates reflected on the EOR or any of the associated CareGuard Reimbursement Policy Terms and Conditions, you must return payment you received associated with the claim within thirty (30) calendar days of receipt of payment and contact CareGuard to dispute or clarify any issues associated with the claim.
2. We highly recommend electronic bill submission to our Payer ID 20572 to streamline your claim payment. If you must submit via paper, our mailing address is PO Box 25977 Tampa, FL 33622.
3. Ametros Financial Corporation d/b/a CareGuard (“CareGuard”) is a professional administrator of Medicare Set Aside accounts and/or future medical funds for individuals who choose to become CareGuard Members. CareGuard acts as an agent on behalf of its Members to reimburse providers for healthcare treatment associated with a Member’s underlying bodily injury claim, including those where an MSA was established as part of the settlement with an insurer of a prior workers’ compensation or general liability claim. s. CareGuard is not an insurance plan, insurance provider, commercial payer, or prescription drug plan.  
4. If reimbursement is associated with a workers’ compensation Medicare Set Aside (“MSA”) account, CareGuard pays claims in accordance with applicable policy guidance provided by the Centers for Medicare & Medicaid Services (“CMS”). Reimbursement is not guaranteed and is subject to: a) availability of funds in the MSA account; b) relatedness of treatment to the underlying workers’ compensation or bodily injury claim; c) timely submission of the invoice/claim to CareGuard (within twelve (12) months from the date of service); and d) whether the item/service/treatment is covered/ allowable by Medicare.  Payment is made at the rates reflected on the EOR. Reimbursement by CareGuard may not be the same as the rates used to estimate services when the MSA was created.  Reimbursement by CareGuard may take place at a rate below a provider’s original billed charges. CareGuard may reimburse for services below any state workers’ compensation fee schedule because the Member’s workers’ compensation claim has been resolved prior to implementing the Member’s MSA.  If you would like information about reimbursement amount associated with a claim prior to rendering the services, please contact our Provider Service Team at 978-276-4972 or at claims@careguard.com.
5. If reimbursement is associated with a medical cost projection, liability set aside, or other future medical account that is not associated with a traditional workers’ compensation MSA, discounts will be applied and reimbursement may take place at the Medicare fee schedule rate or at a discounted network rate below the usual and customary costs, in efforts to extend the Member’s funds. If you would like information about reimbursement amount associated with a claim prior to rendering the services, please contact our Provider Service Team at 978-276-4972 or at claims@careguard.com. Depending on the type of future medical account, payment may be subject to: a) availability of funds in the Member’s account; b) relatedness of treatment to the underlying injury claim; c) timely submission of the invoice/ bill to CareGuard (within twelve (12) months from the date of service); and d) whether the item/ service/ treatment is permissible for reimbursement per the terms of the Member Agreement.
6. Absent a written agreement, signed by both you or your authorized representative and an authorized representative of CareGuard, you recognize and agree there is no negotiated fee schedule in place for your services, and there is no agreement or obligation between you and CareGuard beyond the terms and conditions contained in this Policy.
7. By accepting payment, you agree to not seek additional payment from CareGuard, its Member(s), or third-parties, beyond what is reflected in the Explanation of Review  (EOR).
8. You accept payment as payment in full for the services rendered in the itemized EOR, regardless of your standard or usual billed charges.
9. You agree you will not seek any further billing, collection or balance billing from the Member with regard to any services that you billed to the Member’s CareGuard account.
10. DISPUTE RESOLUTION, MEDIATION. You agree that you will attempt in good faith to resolve any claim, dispute, or controversy arising from or relating to healthcare services billed to CareGuard, against CareGuard, and/or pursuant to this Policy through mediation administered by the American Arbitration Association under its Commercial Mediation Procedures. Mediation will occur exclusively on an individual basis only, and not in any form of class, group, collective or on behalf of the general public or other Ametros Members. Mediation under this Policy is a condition precedent to seeking arbitration.
11. DISPUTE RESOLUTION, ARBITRATION. IF, AFTER A GOOD FAITH ATTEMPT, YOU AND CAREGUARD REACH AN IMPASSE AT MEDIATION THEN ANY CLAIM, DISPUTE OR CONTROVERSY, INCLUDING WHETHER SAID CLAIM, DISPUTE, OR CONTROVERSY IS ARBITRABLE, UNDER OR IN ANY WAY RELATED TO HEALTHCARE SERVICES BILLED TO CAREGUARD, AGAINST CAREGUARD, AND/OR PURSUANT TO THIS POLICY, SHALL BE RESOLVED EXCLUSIVELY THROUGH BINDING ARBITRATION BEFORE A SINGLE ARBITRATOR IN ACCORDANCE WITH APPLICABLE COMMERCIAL ARBITRATION RULES OF THE AMERICAN ARBITRATION ASSOCIATION. THIS AGREEMENT TO ARBITRATE SHALL BE GOVERNED BY THE FEDERAL ARBITRATION ACT (FAA) (9 U.S.C. § 1 et. seq.) TO THE EXCLUSION OF ANY STATE LAW INCONSISTENT WITH THE FAA. ANY AND ALL SUCH DISPUTES OR CLAIMS WILL BE RESOLVED THROUGH ARBITRATION ON AN INDIVIDUAL BASIS ONLY, AND NOT IN ANY FORM OF CLASS, GROUP, COLLECTIVE OR ON BEHALF OF THE GENERAL PUBLIC OR OTHER AMETROS MEMBERS. BY ACCEPTING PAYMENT THROUGH CAREGUARD, YOU EXPRESSLY WAIVE ALL RIGHTS TO ASSERT ANY CLAIMS AGAINST CAREGUARD IN ANY VENUE, ARBITRATION FORUM OR COURT AS A REPRESENTATIVE OR MEMBER IN ANY CLASS, REPRESENTATIVE ACTION OR ON BEHALF OF THE GENERAL PUBLIC OR OTHER AMETROS MEMBERS. ADDITIONALLY, YOU EXPRESSLY DISCLAIM ANY RIGHT TO RECOVER ATTORNEYS’ FEES OR ANY OTHER COSTS ASSOCIATED WITH PURSUING A CLASS, REPRESENTATIVE, OR COLLECTIVE ACTION. THIS IS A LEGALLY BINDING PART OF THIS POLICY THAT AFFECTS YOUR RIGHT TO RESOLVE A DISPUTE BEFORE A COURT OF COMPETENT JURISDICTION.
12. Beyond what is reflected as reimbursement in the EOR, CareGuard’s maximum total liability to you for any acts or omissions under this Policy shall not exceed $1,000.00.
13. We reserve the right to modify or update this Policy at any time and at our sole discretion. Any changes will become effective immediately upon posting the revised version of the Policy on our website or otherwise making it available to you. It is your responsibility to review the most current version of this Policy, which will be available upon request or accessible at www.ametros.com/billing.
14. For questions about any claim payment or the information contained in this Policy, please contact the Provider Service Team: (978) 276-4972 or claims@careguard.com

July, 2025