At Ametros, we’re best known for our Professional Administration service, CareGuard. CareGuard helps individuals manage their future medical treatment and access discounts after settling a workers’ compensation or liability claim. If they have a Medicare Set Aside (MSA), CareGuard completes any required reporting to the Centers for Medicare and Medicaid Services (CMS), keeping them compliant with CMS guidelines.
But our members and clients also have access to a suite of services that can help throughout the settlement process and well beyond the settlement for the injured individual. These services have a big impact on getting cases settled and providing injured individuals with the support they need after settlement, while helping to facilitate a more seamless settlement for all parties involved.
Often, when an injured individual settles their case, they have other government or needs-based benefits, including but not limited to Social Security and Disability Income (SSDI), Supplemental Security Income (SSI), Medicaid, Medigap, food stamps, or Medicare (Parts A, B, D, or Medicare Advantage Plans). Settlement can have an impact on these benefits and can be a significant hurdle to getting the case closed.
Ametros members receive free access to a dedicated and specialized team and resources to help navigate the impacts of settlement and to coordinate these benefits to ensure they are protected.This team is available free of charge prior to settlement and after settlement to the injured individuals that have joined our platform as they continue to receive ongoing support and help with navigating these complexities.
Injured individuals that settle with CareGuard have access to a team of Care Advocates to help them coordinate their care after settlement. This includes helping set doctor or specialist appointments or finding new providers or pharmacies. In fact, at Ametros we have a dedicated team to help our members find providers both prior to and after settlement.
Members with Ametros also have support in finding and purchasing Durable Medical Equipment (DME). This can include purchasing modified vehicles, adaptive equipment for current vehicles, and helping with home modifications. Members can call, email, or chat into our dedicated Member Care team with any questions at any time.
10% of American households do not have a primary checking account, and 20% are under banked, meaning they rely on payday lenders, check-cashing services, and pawn shops. When an injured individual settles their claim, this means 1 in 5 injured individuals might use one of these predatory check-cashing services, losing around 10% of their very important and valuable settlement funds. Sometimes banking issues can even prevent settlement. In response to these struggles, Ametros developed Ametros Checking and Savings Accounts for indemnity payments or funds paid for pain and suffering that are received in a settlement.
These free accounts can also be set up and coordinated with an injured individual’s structured settlement annuity payments and are specifically created for settlement funds. Ametros and our banking partners understand the nuances of settlements, so there are no minimum balances, no fees, and funds clear overnight, much faster than a traditional bank. Any settling individual can open an account, regardless of poor banking history, allowing all individuals access to the banking support that they need.
One potential issue that can arise after settlement is garnishment from creditors. When settling, injured individuals might not be thinking about how these funds may be impacted by divorce, child support payments, federal/state tax levy, or defaulted student loans. Medical funds from a settlement are to be used for future medical care, in accordance with Medicare Secondary Payer rules.
As an Ametros CareGuard member, individuals have our support to negate any garnishment attempt on the funds, as government agencies must directly interact with Ametros prior to any garnishment payment from the account and cannot access the account where the funds are being held without consultation with Ametros representatives.
If an injured individual settles a workers’ compensation or liability case with a future medical component, the responsibilities to CMS and trying to determine which bill should be paid for with the settlement funds can be overwhelming. As part of Ametros’ services, CareGuard members have access to our team’s support and payment coordination. We’ll ensure injury-related treatments are paid for from the medical funds, and that non-injury related treatments are paid for by Medicare or other insurance. Our members simply have to show their CareGuard card at their provider or pharmacy, and we’ll coordinate the rest, no hassles, no confusion.
After an individual settles an insurance claim, they may now have significant funds and resources they did not have previously. They may also be a vital part of their family or community’s future planning and might be considering how to best organize their affairs to take care of their family or estate. As an Ametros member, we can connect our members to partners that can help coordinate wills and estate planning. These experts are able to establish a personalized, secure plan, so our members can be confident that their family, beneficiaries or estate is protected and can focus on getting healthier and better.
Understanding the different parts and components of Medicare, including Part D Prescription Plans, Medicare Advantage Plans, and Medicare Supplemental Plans can be confusing and daunting. An injured individual may need to enroll in Medicare or one of its many plans but may not know exactly what they need. Ametros members have access to a team of experts to help them understand and navigate the options available to them, as well as help them enroll in these plans. This service is available to Ametros members free of charge either before or after settlement.
With CMS ramping up monitoring Medicare Set Aside accounts, occasionally injured individuals can run into issues after settlement with coverage denial or conditional payments by Medicare that occurred while the claim was open but that have spilled over into and complicated the post settlement world for the individual. Unraveling these issues post settlement can be complex and confusing for injured individuals and their attorneys. Ametros assists members in understanding and dissecting any issues they may encounter after settlement as it relates to conditional payment, coverage, or other payment issues, as part of their CareGuard membership.
With CareGuard, members have 24/7 access to chat virtually with a doctor through our telemedicine services. Members have unlimited access to a doctor for consultations related to their injury. These physicians can accept all emergency and non-emergency medical calls anytime, from anywhere. These services are particularly helpful if members are unable to see their primary care physicians, after hours or on weekends, or if they are traveling or on vacation. Members are able to get electronic prescriptions, and there is no fee for a consultation and referral to another doctor.
For individuals that settle with a Medicare Set-Aside, the CMS requires that MSA funds are spent on items that are Medicare-covered. For members that need non-Medicare covered treatment, Ametros offers both our Amethyst and CareGuard services for discounts on those items. There are thousands of individuals that settle their case without a formal MSA but still need help navigating the complex healthcare world and could benefit from Ametros’ access to medical discounts on their care.
Our goal is to provide our members with the resources and support that they need to make their lives simple after they settle, and we continue to evolve our services to reflect their needs. Managing a Medicare Set Aside is one piece of the larger puzzle. Ametros provides a myriad of services that can benefit the injured individual thereby resulting in a more seamless settlement process for all parties to the settlement. You can find out more about these services by getting in touch with our team here.