CareGuard

CareGuard is a professional administration service offered by Ametros. It sets up a bank account for an injured party's settlement funds and acts as the custodian of these funds and the third-party administrator responsible for managing all healthcare expenses.

How Does CareGuard Work?

CareGuard manages everything for the injured party, providing seamless coordination and payment of medical bills. It also handles any necessary reporting to Medicare, ensuring a smooth process for fund management.

CareGuard vs. Amethyst

The CareGuard service differs from Ametros' self-administration service, Amethyst, in that the funds are placed into a custodial account. This account is fully managed on behalf of the injured party, providing a higher level of assistance and control.

After you settle your case with Ametros' CareGuard service, our Care Advocate team will guide you through the onboarding process. We will set up your account, explain how it works, and gather necessary medical information, such as your doctor and pharmacy details.

Setting Up Your CareGuard Account

Our team will contact your doctors and pharmacies to inform them about your partnership with CareGuard, ensuring they can bill us directly. You'll receive a welcome package, including your CareGuard card, in the mail. This card allows you to access medical services without a copay since all bills get directed to CareGuard. 

How CareGuard Manages Your Medical Bills 

CareGuard's role includes reviewing your medical bills for accuracy and applying discounts to reduce them whenever possible, before paying them from your account. This ensures that all transactions are handled smoothly and without financial strain on your part. 

Complying with Medicare Set-Aside 

If you have a Medicare Set-Aside (MSA), CareGuard will manage all necessary reporting to Medicare. This guarantees your compliance with federal regulations and protects your existing benefits. 

Conclusion: Understanding CareGuard's Comprehensive Service 

For any complicated inquiries or further information on Medicare Set-Aside or CareGuard's services, it's recommended to refer to official guides or reach out to our support team. 

When you become a CareGuard member, our team ensures your doctors, providers, and pharmacies are informed about billing procedures for CareGuard.

Welcome Packet Information

Your CareGuard welcome packet includes essential information in case you visit a new provider. This allows you to inform them about CareGuard if our team has not contacted them yet.

What If I See a New Provider?

If you start seeing a new doctor or provider, simply present the information from your welcome packet. This ensures they know how to bill CareGuard correctly.

For more details, don't hesitate to reach out to us for assistance with transitioning your healthcare providers to the CareGuard billing system.

You are the primary individual with access to your CareGuard account. If you wish, you can designate someone else to access your account. This option gives you flexibility and control over who views or manages your information.

CareGuard Representatives

CareGuard representatives are granted access for the purpose of assisting you. This can involve compiling your reporting or aiding you through our dedicated Care Advocate Team. Our representatives maintain strict security measures to ensure your information's confidentiality.

Rigorous Security Protocols

At CareGuard, your identity and information security are of the utmost importance. We implement rigorous security protocols to protect your account, ensuring that all access is both secure and authorized.

For more detailed information or to clarify any questions, you may refer to our full FAQ or contact our support team directly.

Using your CareGuard card is simple and straightforward. Just present it at the check-in when visiting a doctor or pharmacy, and your bills will automatically be processed by our Care Advocate team. The CareGuard card functions similarly to a traditional insurance card. It’s designed for easy use, ensuring you have a hassle-free experience at medical facilities.

Benefits of Using the CareGuard Card

There are no co-pays required when using your CareGuard card. Once the bill is received, we will apply any network savings and handle the payment on your behalf.

Understanding the Care Process

For additional information on how our Care Advocate team operates and what to expect after your bill is processed, refer to the cardholder guidelines provided during your enrollment.

By following these steps, you ensure that your medical bills are managed efficiently with minimal effort on your part.

The CareGuard card is not a debit card; it functions similarly to a traditional insurance card. It is used primarily to inform doctors and pharmacies that bills should be sent directly to CareGuard, rather than for direct withdrawals or purchases.

How to Use the CareGuard Card

The card is designed to streamline medical billing, allowing healthcare providers to send bills directly to CareGuard. This ensures that your medical settlement funds are utilized according to the settlement terms.

Accessing Your Medical Funds

It's important to note that you cannot access or withdraw money directly from your CareGuard account on demand. The account is structured to hold your medical funds as specified in your settlement agreement, ensuring they are available for their intended purpose.

When to Contact Care Advocate Team

For any questions about deposits or specific withdrawals from your CareGuard account, you should contact our Care Advocate team. They can provide detailed information and assistance tailored to your individual situation.

By understanding the specific functionality of the CareGuard card, you can effectively manage your medical funds and adhere to the agreements set in your settlement.

You cannot withdraw money from your CareGuard account on demand. The account contains your medical funds from your settlement and is established per your settlement agreement's terms.

Conditions for Withdrawing Funds

In certain situations, you may be allowed to withdraw funds from your CareGuard account. However, specific conditions must be met, as outlined in your settlement agreement.

When Withdrawals Are Not Permitted

There are instances where withdrawing funds from your CareGuard account is not allowed. It is crucial to understand these restrictions to manage your account effectively.

Contact Care Advocate Team for Assistance

To learn more about possible deposits or withdrawals from your CareGuard account, it is best to contact our Care Advocate team. They can provide detailed guidance tailored to your settlement terms.

For further and detailed information, or if you have questions, please reach out to our support team.

When your MSA funds are exhausted, we will inform both you and Medicare of the depletion. It's important to continue having your healthcare providers bill CareGuard for your treatment during this time.

Billing After MSA Exhaustion

Even after your MSA funds run out, your providers should still send their bills to CareGuard. They will receive an Explanation of Benefits (EOB) showing a denial, which instructs them to bill your secondary insurance. Ensure your providers have your secondary insurance information to proceed with billing.

Role of Secondary Insurance

Your secondary insurance plays a crucial role once your MSA account is depleted. You must provide this information to your provider if it hasn’t already been done.

Annuity and Replenishment of Funds

If you have an annuity, MSA funds will be replenished periodically. Once replenished, your MSA account will resume covering expenses as the primary payor.

Additional Considerations

Be aware that per CMS guidelines, CareGuard cannot reimburse for copays or deductibles. For more detailed guidance, please refer to the CMS documentation on handling Medicare Set-Aside funds.

Switching doctors or pharmacies using CareGuard is simple and unrestricted. You can choose any doctor or pharmacy without limitations.

Steps to Change Your Doctor

To switch your doctor or pharmacy, please contact us directly. Our Care Advocate team will then ensure that CareGuard is set up as the payor in their system for your medical bills, making your visit seamless and hassle-free.

Does My New Doctor Have to Be in Network?

No, your new healthcare provider does not need to be within our network. You have complete freedom to select any doctor or pharmacy. Our Care Advocate team is available to assist you in finding suitable options.

If you require any help in this process or in finding new healthcare providers, don't hesitate to call us. Our team is dedicated to ensuring you have the support and information you need. For detailed information and further assistance, feel free to reach out to our Care Advocate team.

When you need to change your medications, it's important to update your treatment plan. Simply call us at 877-620-2221 to provide the new details. We'll update our records to reflect any changes.

Updating Your Medicare Set-Aside

If you're managing a Medicare Set-Aside (MSA), we'll ensure you understand which new medications are eligible for payment within your MSA. Keeping your MSA updated is crucial for proper fund allocation and coverage.

Need Further Assistance?

For any questions regarding MSA medication updates, contact us for guidance. It's essential to keep your records current to ensure coverage.

Additional Information

For further details on managing medication changes within your Medicare Set-Aside, and to understand more about eligibility, feel free to reach out to us. We are here to support you in navigating these updates effectively.

In the unlikely event that Ametros goes out of business, your CareGuard account remains secure. The account is established under your name and Social Security Number or Tax Identification Number, ensuring personal ownership and protection.

Protection of Your Funds

Each CareGuard account operates as an independent bank account, fully insured by the FDIC. This insurance guarantees that the funds within the account are safeguarded and not considered a business asset of Ametros.

Continuity in Account Security

Should Ametros become insolvent, your account's setup and insurance ensure its ongoing protection. This structure is designed to maintain your financial security, regardless of any changes in the status of Ametros.

For more specific details about CareGuard accounts and their structure, feel free to reach out to Ametros directly or consult with a financial advisor for personalized guidance.

If you've incurred any covered out-of-pocket expenses due to your injury, you can be reimbursed by simply submitting a receipt.

Submitting Receipts for Reimbursement

Receipts can be submitted through your CareGuard member portal. Alternatively, you also have the options to fax or mail them for review.

What Expenses are Eligible?

To ensure a smooth reimbursement process, make sure the expenses are directly related to your injury and are covered under your CareGuard policy.

Need More Information?

For further details on how to submit receipts or what qualifies as a covered expense, refer to your CareGuard member portal or contact their support.

Ametros is staffed with a fantastic Care Advocate Team that are available to you 24/7, by email, phone or online chat. They are there to be your support system for questions, concerns, and to help coordinate your care.

When a Workers' Compensation or liability settlement involves a Medicare Set-Aside (MSA), there are often specific terms in the settlement agreement about who will inherit the remaining medical settlement funds upon the death of the injured party.

Settlement Agreement Terms

Typically, the settlement agreement clearly outlines the beneficiary or beneficiaries who are entitled to any remaining MSA funds. Both the plaintiff and defense parties can negotiate these terms and stipulate how these funds should be distributed.

Beneficiary Designation

If a beneficiary is named in the settlement agreement, the funds are disbursed accordingly upon the account holder's passing. If no beneficiary is listed, the funds will generally pass to the account holder’s estate or follow the stipulations of their will.

No Beneficiary? What's Next?

In instances where no beneficiary is appointed, nor an estate plan or will exists, the account holder can designate a beneficiary with Ametros by completing a beneficiary form. This action ensures a clear path for disbursement.

Priority of Instructions

The executed settlement agreement's instructions have the highest authority and will always take priority in determining how funds are distributed. In all cases, Ametros does not charge an account closing fee or keep any remaining funds in the account.

Further Details and Assistance

For additional clarity on the process of MSA fund distribution upon death, reviewing the executed settlement agreement is crucial, as well as consulting with legal counsel if necessary. If you need to update your beneficiary information, consider reaching out to Ametros for guidance.

You have the flexibility to treat with any doctor or pharmacy of your choice when using CareGuard. They do not need to be part of our network for you to access CareGuard services and potentially benefit from discounts on healthcare expenses.

Choosing a Doctor or Pharmacy

With CareGuard, you aren't restricted to a specific network. This allows you to select healthcare providers that best suit your personal needs.

Benefits of Using CareGuard Network Providers

While it's not mandatory to use CareGuard’s network providers, many members opt to do so to maximize savings on every visit. Using network providers often results in significant cost reductions.

Final Details and Savings Potential

To fully understand the savings opportunities with CareGuard, consider reviewing your healthcare plans and options. If more information is needed, refer to our detailed guidance included with CareGuard's resources.

With your CareGuard membership, you're free from utilization reviews. This means that most of the time, as long as your treatment is related to your Medicare Set Aside (MSA) claim and is covered by Medicare, it will be taken care of. In some cases, there are no restrictions on your covered treatment's scope, leaving your treatment plan primarily between you and your doctor.

How CareGuard Membership Affects Treatment

With CareGuard, the focus is on granting autonomy in your treatment choices, letting you bypass typical utilization reviews that might otherwise limit your care.

Covered Treatments and Expenses

Your treatment expenses are generally covered if they relate to your original claim and meet Medicare's coverage criteria.

Are There Any Limitations on Covered Treatments?

In certain situations, your CareGuard membership might offer a treatment plan without limitations, supporting a wide range of covered options.

Unused funds at the end of the year will not go to waste. Instead, they will remain in your account and automatically roll over into the next year.

How Do Unused Funds Roll Over?

When you have remaining funds, these are carried forward, allowing you to continue utilizing them in the future. There is no penalty for not using all of your funds within the current year.

Is There a Limit on Rollover Funds?

There is typically no limit to the amount that can roll over, but it can vary depending on specific account terms. It’s important to review your account details or contact your account provider for specifics about rollover limits or restrictions.

Need More Information?

For more detailed information on unused funds and account specifics, you may want to consult the official guidelines provided by your account service or reach out to customer support for tailored guidance.

After settling your case, the carrier or employer no longer has any input into your treatment decisions.

Post-Settlement Treatment Management

Once a settlement is reached, you gain the autonomy to manage your treatment without influence from your employer or insurance carrier. It's important to consult with your healthcare provider to ensure you are receiving appropriate care tailored to your needs.

Why Is Employer Input Not Permitted?

Following a settlement, the legal and financial responsibilities shift, removing the carrier or employer from any decisions regarding your treatment. This change is designed to focus your care on medical necessity rather than financial considerations.

What Should I Do After the Settlement?

• Consult Your Doctor: Regularly discuss your ongoing needs with your healthcare providers.
• Understand Your Benefits: Familiarize yourself with any coverage or benefits you have after settlement, such as Medicare or private insurance.

Understanding the landscape of your medical treatment post-settlement empowers you to take charge of your health decisions without external interference.

If the yearly funds in your Medicare Set Aside (MSA) account run out, Ametros will assist in coordinating with any secondary insurance or payment options you may have, such as Medicare coverage.

How Secondary Insurance Works

Typically, your secondary insurance will cover the remaining balance of your bills. For individuals with a Medicare Set Aside, Medicare becomes the secondary payer. Note that when using secondary insurance, you are still responsible for any deductibles and copays, either personally or through the insurance.

Role of Annuity in MSA

If you have a Medicare Set Aside and an annuity, once your account is replenished, CareGuard will resume its role as the primary payer with your MSA funds.

Managing MSA Fund Shortages

For detailed guidance on handling situations when your MSA funds run out, consult Ametros for assistance with secondary insurance options. If you have further questions, exploring MSA management strategies can be helpful. For more information, check out our Medicare Set-Aside resources.

Ametros can negotiate treatment and service prices by running bills through our network to reprice them to the appropriate fee schedule or apply network discounts. If a provider is within our network, we often deliver additional savings beyond the usual and customary prices. 

How Much Can You Save with Ametros? 

Through Ametros’ discount networks, members can save an estimated 62% on provider visits and approximately 28% on prescriptions. Our team meticulously reviews every bill to identify possible savings, ensuring your funds last longer. 

What Happens with Large Bills or Out-of-Network Providers? 

For significant bills or services with providers not in our network, CareGuard’s team actively attempts to negotiate discounts, striving to reduce costs for our members. 

More Details on Ametros Negotiation and Savings 

Ametros enhances members' saving potential by incorporating network discounts and diligently reviewing each bill for further savings. For complex pricing scenarios or larger bills, the team negotiates directly with providers to secure favorable terms. 

If you wish to understand more about how Ametros manages bill negotiations and pricing strategies, please contact our support team

With your CareGuard membership, you're free from utilization reviews. This means that most of the time, as long as your treatment is related to your Medicare Set-Aside (MSA) claim and is covered by Medicare, it will be taken care of. In some cases, there are no restrictions on your covered treatment's scope, leaving your treatment plan primarily between you and your doctor.

How CareGuard Membership Affects Treatment

With CareGuard, the focus is on granting autonomy in your treatment choices, letting you bypass typical utilization reviews that might otherwise limit your care.

Covered Treatments and Expenses

Your treatment expenses are generally covered if they relate to your original claim and meet Medicare's coverage criteria.

Are There Any Limitations on Covered Treatments?

In certain situations, your CareGuard membership might offer a treatment plan without limitations, supporting a wide range of covered options.

When a member's CareGuard account earns interest, that interest is subject to federal taxes, similar to any other bank account interest. If the account earns more than $10.00 in interest, the member will receive a 1099-INT form.

 Using MSA Funds for Tax Payments

Members with a Medicare Set Aside (MSA) account have the option to use these funds to cover taxes on the interest earned by their CareGuard account, as permitted by Medicare guidelines.

 Details on Taxation and Reporting

It’s important to note that federal taxation applies to the interest earned on any account, including CareGuard accounts. The 1099-INT form will reflect the amount of interest earned and helps ensure accurate tax reporting.

For more complex inquiries or specific guidance on managing your CareGuard account and handling taxes, it is recommended to consult the appropriate reference materials or a tax professional.

As a CareGuard member, you always have full visibility into your account activity and savings with your CareGuard Member Portal.

Set Up Your Online Account in 5 Simple Steps

• Go to https://portal.careguard.com/#/login.
• Click 'Register'
• Complete the registration form by filling out your name, email, membership ID #, and then choose a password
  • Please reference you membership ID# on the back of your CareGuard card during registration
• Click ‘Register’ on the registration form 
• Please finish setting up your account by clicking the validation link sent to your email