Professional administration is usually synonymous with higher dollar medical settlements that include consistent future medical care for the injured individual. But what about the lower dollar allocations? Whether it is a Medical Cost Projection (MCP) or a Medicare Set Aside (MSA) that doesn’t meet the threshold for review, there are still many benefits to leveraging support through administration.
Coordination of Benefits
Coordination of benefits is crucial when it comes to a medical settlement, regardless of the size, in order to ensure future benefits are protected. A question we hear frequently from individuals post-settlement is “What treatment should I use my medical settlement funds for and when should I use my own health plan to pay?” An administrator ensures that medical settlement funds (MSAs in particular) are spent according to the Centers for Medicare and Medicaid Services’ (CMS) guidelines, and there is no interruption to the injured individual’s treatment.
Annual Reporting Compliance
Ametros’ role as a best-in-class administrator is to help individuals manage their future medical treatment and give them access to discounts after settling a workers’ compensation or liability claim. If they have an MSA, Ametros’ professional administration service, CareGuard, completes any required reporting to CMS keeping them compliant with CMS’ guidelines.
If an injured individual plans on using Medicare coverage in the future, it is critical to ensure proper reporting to CMS regardless of the amount of the MSA, as improper reporting of funds could result in Medicare denying paying for treatments.
Professional Administration Savings
Regardless of the type of future medical allocation, every injured individual wants access to discounts on treatments and prescriptions to extend the life of their funds.
The exhibit below is an example of two cases that are both currently being professionally administered. Both cases are for lower back injuries with regular pain management treatment and semi-frequent physician visits. The only difference in these two allocations is the amount included for prescriptions. As you can see, the number of medications is the same, but the actual prescriptions and their cost are the only delta when evaluating the two cases. The actual treatment and details of the MSAs are very similar, so the role of the administrator is crucial in both scenarios.
Irrespective of the size of the case, professional administrators can secure potential discounts on both the treatment and pharmacy costs for each of these members, making their experience hassle free and prolonging the life of their settlement funds, regardless of the size.
Case Example
|
MSA #1 |
MSA #2 |
|
|
Total MSA Amount |
$23,415 |
$178,648 |
|
Treatment Allocation |
$13,195 |
$18,425 |
|
Rx Allocation |
$10,220 |
$160,223 |
|
Ametros Pricing for Rx |
$7,230 |
$117,120 |
|
Life Expectancy |
13 Years |
13 Years |
|
Medications Included in MSA |
Pregabalin, Gabapentin, Oxycodone |
Oxycontin, Gabapentin, Trazadone |
Self-Administration Support
For individuals who insist on retaining their MSA funds in their own bank account Ametros has a self- administration tool that can help. Amethyst is a health card links to a member’s existing bank account, and works like a traditional insurance card. This enables members that want to self-administer with access to savings, on average 21%*, on their prescriptions. The Amethyst portal provides insight into spending trends and savings amounts, and helps members prepare their own reports for their Medicare Set Aside. No matter the size of the MSA, Amethyst can help individuals save money and remain compliant with CMS guidelines.
In an unpredictable healthcare marketplace, Ametros is rapidly adapting to constant changes to help support our members in their continuation of care. Over the years, Ametros has developed innovative technology to support any size medical allocation and provide savings, support, and security for any post settlement situation.
