...And How Do You Know If It’s a Good Fit?
Settling a workers’ compensation or liability case can be stressful and confusing. After settlement, many injured parties find themselves without the proper resources to manage their medical care, the funds they received, and any required reporting to the government. Many parties don’t know when to create medical custodial accounts or when professional administration is a good fit. We help answer the most common questions about medical custodial accounts, including how and when to involve a professional administrator:
What would be the benefit to the injured party of setting up a medical custodial account and using professional administration vs going at it alone?
Professional administration services were created so the injured party can access significant savings on their ongoing treatments and prescriptions after settlement while having a resource to provide support. In the case of a Medicare Set Aside (“MSA”), the professional administrator is a resource to help handle all of the tedious compliance and reporting responsibilities to the federal government that come along with the funding of an MSA.
Administrators provide an average savings of 62% on provider bills, and around 30% on all other healthcare expenses. If the injured party were to manage their medical funds on their own, they would not have access to network discounts, and would pay full price for treatments. They would also have no guidance or resource to help answer any questions they may have.
In the case of an MSA, the injured party would have to rely on the WCMSA Reference Guide to complete all required reporting, including keeping track of every expense made out of the MSA fund. This reporting can be complicated, and if not completed properly, could jeopardize the injured party’s future Medicare benefits.
When should you reach out to an administrator for help?
It’s common for injured parties, their attorneys, adjusters and/or structured settlement brokers to reach out early on during settlement discussions to involve an administrator. Experts at the administrator can help explain how the injured party will secure medical treatments and save money after the case settles. They can also address concerns about Medicare compliance if the injured party has an MSA.
Sometimes, parties to a settlement will be very up-to-speed on the benefits of administration and will involve the administrator around the time of mediation or negotiation. While this often works as well, typically experts recommend the earlier the better so that all parties are in sync and there is ample time to answer question.
Can a person who has already settled their workers' compensation or liability case create a Medical Custodial Account?
Ideally, the best time to involve a professional administrator is early on, but, if the injured party has already settled their workers’ compensation or liability case, they can still set up a Medical Custodial Account and use a professional administrator to manage their Medicare set aside (MSA) or medical settlement. All they need is a copy of the settlement documents, medical allocation or MSA, and their invoices and receipts for any purchases made from the account thus far. From there, the administrator can properly setup the account and, if it is an MSA, they can begin compiling the reporting for the Centers for Medicare and Medicaid Services (CMS).
Professional administrators can also work with MSA holders that have gaps in their reporting. They will do their best to clean up any old files they have and get them to Medicare. Then they fulfill all reporting requirements moving forward to show Medicare that the injured party is taking the right steps to get back on track.
Does it matter how long ago the case was settled?
It doesn’t matter how long the case has been settled for, injured parties can work with a professional administration to create a Medical Custodial Account any time to receive support and savings when managing their future medical funds. Professional administrators have helped handle situations where injured parties had settled their case, and even several years later became overwhelmed by the required reporting to CMS and managing payments for their treatments. Administrators have helped these injured parties become members, and helped relieve the burden of reporting, while providing them with savings to extend the life of their medical funds.
How can an injured party who has settled their case gauge whether a Medical Custodial Account would be a good fit for them?
Professional administrators can help injured parties in a variety of situations. A Medical Custodial Account might be a good option if the injured party:
- Is afraid their settlement money for future medical treatments will run out
- Has Medicare Set Aside reporting concerns
- Wants help managing all of their medical bills and assessing their treatment options
- Wants to pay less than full price for their medical care
If the injured party would like to remain in control of their funds while still receiving savings and support, self-administration tools allow them to keep the funds in their own bank account, while helping them compile any necessary reporting. If the injured party doesn’t want the hassle of managing their funds, professional administration services set up the Medical Custodial Account in the injured party’s name, and help facilitate all treatments and prescriptions, provide savings, and complete any required reporting.
How would the injured party reach out to inquire further about services?
Administration can help alleviate many concerns and fears that injured parties have about settling, while providing savings and support after settlement. Ametros offers many options and can work with all injured parties and their attorneys to find a solution that works best for them.
Our team is always more than happy to speak to injured parties to help determine what the best option is for them, and answer any questions they may have!