October 21, 2017 • Education

How Do You Coordinate Your Benefits?

doctor signing paperwork

Ametros’ Benefits Advisory Team works with settlements, cases, and members on how to coordinate and preserve federal, state, and local benefits. Many times it can be confusing to coordinate who pays for what treatment. Our new full-service Benefits Advisory Team strives to simplify benefits for injured parties and their families.

The case study shown below shows how we helped Harold coordinate and understand how to preserve his benefits while receiving multiple different medical funds from his accident. We were able to work with him and his family to coordinate the best possible solutions for his situation.  

Confusion About Benefits:

An attorney reached out to our Benefits Advisory team prior to settlement looking for advice that could help their client, Harold*. The situation was complex and Harold’s family needed a clear explanation of what life would be like after settlement, what funds would pay for which treatments, and what the total cost of settlement would be.

Harold was in a unique situation where he was receiving both a workers’ compensation and a liability settlement stemming from the same accident. He was now a quadriplegic due to his accident, and would need complex medical care for the rest of his life. The settlement was expected to be in the multi-million-dollar range, most of which would reside in a special needs trust to preserve government benefits. The rest would be included in a $529,379.10 Medicare Set-Aside and a monthly lifetime annuity.

Harold had applied for and was granted Social Security Disability (SSDI), but was not yet Medicare-eligible, which occurs on the 30th month of SSDI. He was only in his 20’s when his accident occurred and was still currently under the medical insurance of his parental guardian and Medicaid. Because of his accident, Harold now had significant healthcare coordination needs including skilled nursing, custom mobility, transportation and home modifications to accommodate disabled access and living.

Ametros' Benefits Advisory

Ametros was able to simplify the interactions between Medicaid, the insurance from the parental guardian, and the future care under Medicare for Harold and his family. Often, the Coordination of Benefits can be complex and not well explained by carriers and healthcare providers alike.

Ametros determined and explained who was the primary, secondary and payors of last resort for Harold’s case. For the non-Medicaid covered items, Ametros was able to coordinate a discount purchase of the custom mobility wheelchair Harold needed with our group buying power resulting in saving Harold $3,000 off of the original price.

Additionally, Ametros coordinated the quotes and purchases of the mobility equipped vehicle and home modifications. We were also able to reprice the skilled nursing facility bills by professionally administering the Harold’s MSA fund, resulting in further out of pocket cost savings for his family.

Explanation of Benefits

In the end, we were able to coordinate and explain Harold’s benefits, offer savings on some of the expenses, and make complex medical care coordination much easier for Harold and his family. Harold was intrigued by our professional administration service, CareGuard, and how we could manage his medical funds for him. Harold explained to us how happy he is with the CareGuard service:

“I am so thankful that I came across Ametros and their CareGuard service when I did. It is so helpful to know that I always have the support I need from them. I know that none of my benefits will be jeopardized because my medical funds are being managed properly by them.”

Want to find out how Ametros can help you coordinate your benefits?

Learn More About Our Benefits Advisory

* To protect the privacy of our members, names and identifying details have been changed.

Reach out to our team!