To go paperless and avoid a $3 fee per paper statement:
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.
You have several options for submitting your receipt:
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.
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:
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.
Most dental care and procedures are not covered by Medicare. For additional details, see Medicare Dental Services Coverage.
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.
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.
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.
Massage Therapy
Massage therapy is not covered by Medicare, even when prescribed for pain management or rehabilitation. Some private insurance plans may offer coverage for massage therapy, but benefits vary widely. Please check with your provider for details.
