Member

If you would like to go paperless and avoid fees related to administrative and postage costs, please follow the steps below.

• Login to your online account
• Go to ‘My Profile’ in the top right corner
• Under your profile settings, click the 'Edit' box in the top right corner
• Select the checkbox that says, ‘You’ve chosen online statements only’
• Click 'Save' in the top right corner
• Please finish setting up your account by clicking the validation link sent to your email

If you don’t have an online account, setting one up is easy. Please go to portal.careguard.com/#/login and choose to register to create a new account. You can also reset your password here.

For information on registering for your online CareGuard account, please see: How do I sign up for the CareGuard Member Portal?

Thank you for helping us in our mission to go paperless!

If your patient has a Worker’s Compensation injury, we will pay according to your state Worker’s Compensation Fee Schedule.  Additionally, if we are part of any mutual PPO networks, we will honor your PPO contracted rate.

Our networks include Coventry, Rockport, TRPN, Prime, and CorVel.

Ametros is partnered with WCEDI who will distribute the payment to you. You will receive a Virtual Credit Card that can be processed through your credit card terminal. For any questions regarding VCC, please call 631-648-6020.

No, CareGuard members are not bound by timely filing limits; however, we highly recommend billing in a timely manner as we cannot guarantee that a member’s settlement funds will not be exhausted at any given time.

We do not require prior authorization for any procedures, however, CareGuard is only able to pay for claims that are related to the member’s injury and Medicare compliant.  Additionally, a member is not guaranteed to have funds to cover a procedure just because they have coverage (please see what to do if you receive a funds exhausted EOR) We always recommend obtaining authorization from secondary insurance as back up and encourage you to speak with your patient about their fund status if you have any concerns.  CareGuard is unable to provide any fund amount to you directly.

Please be advised, CareGuard only provides prior authorizations for relatedness, compliancy, and fund availability.  We do not perform prior authorizations based on medical necessity.

Submitting a receipt for reimbursement related to your injury requires specific documentation. The receipt must be an itemized invoice on the provider or service letterhead, including their name, address, phone, and Tax ID number. It must list the date of service (DOS), item description (procedure code), and cost.

Methods for Submitting Your Receipt

You have several options for submitting your receipt:

• Mail:  Send it to Ametros Financial, PO Box 827, Burlington, MA 01803.
• Email:  Forward it to support@careguard.com.
• Fax:  Our fax number is 877-443-9344.
• Online Portal:  Upload through portal.careguard.com for the quickest processing. 

Requirements for Reimbursement

Please ensure all proper documentation is included, and note that we reimburse only for services related to the injury and covered by Medicare. Note that co-pays are not eligible for Medicare coverage.

Important Details 

Remember, receipts must meet all requirements to ensure prompt processing and avoid delays. For further guidance, consider contacting our support team via email or telephone. 

Medicare does not cover several medical items and services, especially for those with a Medicare Set Aside. Below is a list of common exclusions:

Vision Hardware Exclusion

Typically, Medicare does not cover vision hardware such as eyeglasses or contacts. Exceptions apply post-cataract surgery or for prosthetic eyes if related to an injury. For more information, see Medicare Eyeglasses and Contact Lenses Coverage.

Dental Care Limitations

Most dental care and procedures are not covered by Medicare. For additional details, see Medicare Dental Services Coverage.

International Service Restrictions

Medicare does not provide coverage for medical services received outside of the United States or while traveling abroad. More information is available at Medicare Coverage While Traveling.

Medical Supplies and Surgical Dressings

Medicare does not cover general gauze or bandages unless they are used for wound care. Learn more about coverage specifics at Medicare Medical Supplies and Surgical Dressing Services.

Medical Marijuana and CBD Products

Medicare does not cover medical marijuana or CBD products as the FDA has not approved medical marijuana for any condition. It is considered illegal at the federal level. Additional information can be found on the FDA and Cannabis Research.

For a comprehensive understanding of items and services not covered by Medicare, consider reviewing the Medicare resources and guidelines. This will ensure clarity on what can be expected in terms of coverage under your plan.