Settling a workers’ compensation or liability claim without proper planning can be agonizing and complicated. What’s more, life post-settlement can become the stuff of nightmares – unless injured parties have thoroughly addressed the many moving parts involved.
Professional administration is a valuable way to prepare for claim settlements and, more importantly, ensure injured parties can feel comfortable that their needs will be easily managed afterward.
Injured parties and their representatives have increasingly turned to professional administrators to help handle Medicare Set-Asides. But what many people don’t realize is the multitude of additional aspects involved in post-settlement medical care. Experienced, highly qualified professional administrators can tackle any medical account issues the injured party may experience.
Changes Following Settlement
Injured parties who are offered and agree to a workers’ compensation or liability claim settlement may feel like they have just won the lottery. Unfortunately, this situation often turns around quickly, leaving the injured party with no money to pay for medical – or any other – bills.
Reaching a settlement can be a freeing feeling for injured parties. Where they might have been limited to the medical providers they could see, the treatments they were allowed to receive, and the timing of medical services, settlement ends those restrictions. But other changes may not be expected – or welcomed. For example, medical bills that had been paid with no out-of-pocket money are suddenly the responsibility of the injured person, and often at much higher prices than expected. Nurse case managers, claims adjusters, attorneys and others involved in the injured party’s care are suddenly out of the picture, leaving the injured party to navigate the healthcare world alone. The services offered by reputable professional administrators can alleviate these stressors.
Saving Money
Among the biggest concerns among injured parties who want to settle their claims is running out of money too soon. Paying out of pocket – or in this case, paying out of settlement money – is scary. Instead of the negotiated discounts paid by insurance companies, the injured party must pay retail, unless he has the assistance of a qualified professional administrator.
Professional administrators with vast industry connections have access to large discounts on everything from medical treatments and procedures to pharmaceuticals and durable medical equipment. Injured parties can take advantage of these deep savings, helping to preserve their money that much longer. It is not uncommon for professional administrators to save their members up to 62-percent on provider bills and 28-percent on other healthcare treatments.
An injured party who’s paying $100 for a doctor visit may instead only have to pay $40. That can add up to tremendous savings for an injured party who has frequent medical provider visits.
In addition to access to discounted medical services, some professional administrators will go the extra mile and actually locate the lowest priced provider or treatment. For example, medications are typically available through multiple pharmacies and manufacturers. Highly quality professional administrators will research and find the least expensive available.
In addition to finding the best prices, professional administrators can also ensure the injured party is paying appropriately. Are the medical bills properly coded for the treatments received? And, in addition to the discounts available, is the overall pricing in accordance with the jurisdiction’s applicable fee schedule? These are among the hurdles professional administrators overcome.
The Hassle Factor
Paying the medical bills is only a part of the process. Many other issues are involved in medical care. Handling medical billing, for example, can be trying for someone who is undergoing multiple medical treatments. Professional administrators can set up fiduciary systems which greatly simplify the process.
‘Medical Cost Projections’ offer an easy process for the injured party post-settlement. A Medical Cost Projection (MCP), also referred to as a ‘non-qualified medical expense account, generally consists of funds allocated for future medical expenses. While somewhat similar to Medicare Set-asides, these pay for treatments and services that are not covered by Medicare, such as incontinence supplies. And, unlike MSAs, Medicare does not step in to pay if these funds are exhausted. That is why it is more important than even to make sure the settlement funds last.
Some professional administrators will establish an interest-bearing account with the future medical funds set up for the injured party. After making the appropriate arrangements with physicians and pharmacies, the professional administrator will provide a card for the injured party to use for all medical services. By simply presenting the card at the time of medical treatment, the injured party is ensured that all medical bills will be sent to the professional administrator for payment out of the MCA account. Injured parties can track action on their accounts by going into an online portal.
Coordinated Benefits
Coordinating benefits is another challenge that injured parties often run into, if, for example, they have other federal and/or state benefits. Done incorrectly, those additional benefits can be put in jeopardy. The situation may call for a special needs trust (SNT).
Injured parties who have Medicaid or Supplemental Security Income may be well served by having a SNT. The well-versed professional administrator can establish these to protect the injured party’s benefits.
Whether the trust is established to protect public benefits now or in the future, delineating beneficiaries upon death, or spendthrift protection, knowing when a trust should be used and which trust option is most appropriate can be a tremendous advantage to the injured party.
Putting funds into the SNT allows the disabled beneficiary to preserve their needs-based benefits, while still having the trustee utilizing funds to improve their overall quality of life. Typically, funds meant for medical care are designated in the settlement by a Medicare Set-Aside, Medical Cost Projection, or Life Care Plan report.
Life Care Plans
Injured parties who have settled their workers’ compensation or liability claims can best protect their limited funds by having a plan that spells out where and how the money will be spent. Life care plans fulfill this need by penning a strategy for the current and future needs of injured parties with catastrophic injuries or chronic healthcare conditions.
These specifically address tactics for such things as evaluations, therapies, diagnostic testing, durable medical equipment, medications, transportation, home and/or auto modifications and vocational services.
The professional administrator develops the plan by meeting with the injured party and his family members, and reviewing medical records and any other related documentation. A variety of experts are brought in to help create the plan, such as rehabilitation professionals, nurses, occupational and physical therapists, physicians, psychologists and others.
Conclusion
Going it alone post-settlement may be the best option for some injured parties. For others, it can be fraught with hurdles. Professional administrators can be a tremendous advantage for those looking to preserve their settlement money and enjoy their lives without having the stress of having to navigate the healthcare system.
