Recently, Ametros' CEO, Marques Torbert, presented at the IAIABC Annual Convention in Virginia. He discussed the challenges that injured workers face when entering life after settlement, and how to manage these challenges with resources that are now available. Marques was featured in an article on WorkersCompensation.com about how his presentation brings light to the fact that there are services to reduce the cost of healthcare once an injured worker settles his or her workers' compensation case.
The Medical Billing Shell Game and the Insufficient MSA
While his presentation was related to broader challenges injured workers confront when managing their MSA funds, it was the potential pricing disparity that truly stood out. When an employer or carrier calculates the money needed to adequately fund an MSA for an injured workers future medical care, they use as a basis the current and expected costs of medical services and pharmaceuticals. These costs are all based on the network discounts currently received for the care they have provided the worker to date. But when the injured worker is “out of the system” and on their own, they are often out of the network, and therefore subject to billing at the much higher retail prices proffered by the medical community. The upshot, of course, is the medically unsophisticated injured worker who cannot negotiate better deals is much more likely to burn through their MSA at an accelerated rate – and the MSA will not be sufficient to protect Medicare or the worker in the future.
As Torbert pointed out, professionally administered plans could offer the same network protections that were available to the carrier and employer. There are other benefits as well. He made an excellent point that the injured worker, who has been widely assisted during the management of their care, is suddenly left on their own with no support network once their case is settled. They are left to navigate the waters on their own. The fact that, despite good intentions, the lifeboat they've been provided may run out of provisions before they safely reach the shoreline should be a major concern.