There are many positive reasons for an injured individual to settle their case, like having greater freedom with their care. But often, there is fear accompanied with settling. Oftentimes there are concerns with how their case will be managed once they lose heavily relied upon services including their attorney, claims adjuster, or nurse case manager. Many of the questions we hear often include:
- “Can you help me find a nearby provider?”
- “Can you help me secure equipment I may need?”
- “How will my money be managed to support my injury and keep me compliant with Medicare?”
Limited Control Over Care
Once an injured individual enters into the workers’ comp system, they typically don’t get to choose their own doctor or have decision-making power on what care they wish to pursue.
In the case of Sarah, she fractured a bone at work and later sustained chronic regional pain syndrome among other symptoms. Sarah felt that she had limited control over her healthcare, which caused distrust with the system overall. She was discouraged with not being able to see her own provider and even experienced delays with her medications due to prior authorization processes.
Sarah wanted to leave the system and settle her claim but she feared how she would manage her Medicare Set Aside after settlement. She was also afraid that using a professional administrator would be an extension of the workers’ compensation system and would still cause her to have limited control over her account.
Taking Comfort in Superior Customer Support
Once Sarah realized that settling may be the best option, her adjuster sent our team her case so we could explain our role and help ease her fears about managing her care. We explained the role we, as professional administrators, would have moving forward after settling.
Our team of Care Advocates played a critical role in making sure Sarah completely understood her options, and the benefits of using an administrator. We explained would not restrict her care, and how we could help her receive desired care on her terms.
After several calls with Sarah and her immediate family, our team was able to clarify concerns on how her medical funds would be managed to receive the treatment she wanted while receiving discounts to extend the lifetime of her funds. Our team also provided answers to questions regarding using her own doctor, prior authorization for medications, and dismissed concerns about experiencing delays with specific medications.
Sarah realized that she would have greater freedom and control with her care while using a professional administrator, and our team was able to assure her she would be taken care of once she settled.
By taking the time to make sure Sarah and her family felt thoroughly educated on how our services work to provide greater freedom with care, she felt more comfortable settling her case. She also took comfort in being able to make decisions with her care without having to worry about fulfilling administrative tasks like reporting to Medicare.
Finding Freedom with CareGuard
After receiving individualized support on her case, Sarah started using our professional administration service, CareGuard. She felt confident knowing our service would provide savings on treatment and medications, that she would be able to see her own doctor and would not have to deal with the hassle of reporting to Medicare. By choosing a professional administration service when she settled, she was able to focus her efforts on returning to health and felt she finally had greater control over her care.
Interested in Learning if Professional Administration is right for you?
2 Comments Posted on This Article:
you mention that you provide ” savings on treatment and medications” . How do you do this — do you negotiate with each particular provider and pharmacy. And if you do — are the reimbursement rates set at Medicare established rates?
Thank you for your question. Ametros makes all best reasonable efforts to ensure savings on treatment and medications. Potential savings are achieved in a variety of ways, depending on the spend category. Oftentimes, reimbursement rates are set at a pertinent workers’ compensation fee schedule when administering a Medicare Set Aside (MSA). In this instance, if a particular bill came in higher than at a related fee schedule amount, Ametros would attempt to reduce it to the applicable workers’ compensation fee schedule. Ametros also works to achieve potential savings through its pharmacy and medical network partnerships where, in many instances, we’ve secured negotiated rates lower than what someone may otherwise pay as a cash payer. This being said, we do not restrict any of our Members to Ametros’ network and they’re free to choose any provider or pharmacy of their choosing. Moreover, Ametros can’t guarantee specific pricing or savings on healthcare services. We’d be happy to further discuss with you and I’ll be sending you an e-mail directly.