This section of the notice describes how information about you, including personally identifiable information and medical information, may be used and disclosed, and how you get access to this information.
Ametros collects personal information, such as your first / last name, Social Security Number (SSN), Date of Birth (DOB), your workers’ compensation / liability insurance claim and settlement information, including but not limited to settlement documents, as well as healthcare and provider information in order to provide services to you.
Ametros Use & Disclosure
When you sign-up for Ametros services, including professional administration services via CareGuard™, Ametros typically uses your personal information, including health information in the following ways.
|Establish a Bank Account||We can use personal information, including your Social Security Number (SSN) and Date of Birth (DOB), to establish a bank account in your name at a financial institution of Ametros’ choosing. This bank account will be where the funds from your Medicare Set Aside (MSA) / medical cost projection are deposited.||Example: Ametros establishes an interest-bearing account at a financial institution of Ametros’ choosing to place your MSA funds.|
|Provide Services||We can use and share your personal and healthcare information to provide services that you signed-up for.||Example: We use health information about you to administer your MSA.|
|Process Bills & Reimbursement for Healthcare Expenses||We can use and share your personal and healthcare information to communicate with providers and Ametros network partners to process bills and provide for reimbursement for covered healthcare / medical expenses.||Example: A provider bills Ametros for services related to your work injury and Ametros reviews the bill and provides information to its network partners to process your bill and ensure your provider is paid from your account.|
|Comply with Medicare Compliance Obligations||There may be compliance obligations associated with the administration of your account. We can share your personal and health information, insurance claim / settlement information and documentation, with Medicare and other governmental agencies or contractors to ensure compliance with your account.||Example: We use your health information about you to report annually to Medicare or when your account exhausts / depletes.|
|Coordinating Benefits with Other Coverage||We can use and share your personal and healthcare information to communicate with other insurance plans, including Medicare Part C/D plans, Medicaid, group health plans, or other sources of coverage.||Example: You may have a Medicare Advantage Plan that provides benefits and needs to determine whether it is the primary payer. Ametros may share personal, healthcare and/or insurance information with this plan to assist in coordinating benefits.|
|Coordinating with payment sources and other financial institutions||We can use and share your personal information to communicate with payment sources or financial institutions such as life / annuity companies and/or structured settlement companies and their representatives.||Example: You may have your account funded by annuity and the annual payment is late. Ametros may contact this company to ensure you receive funding in your account.|
How else can we share your health information?
|Comply with the law||We will share information about you if state or federal laws require it, including with the Centers for Medicare & Medicaid Services (CMS).|
|Respond to legal actions||We can share information about you in response to a court or administrative order, or in response to a subpoena.|
As it relates to your health information, you have certain rights. This portion of the notice explains your rights and some of our responsibilities to assist you.
|Obtain an electronic or paper copy of your record||Ametros provides access to monthly statements via an online portal: https://portal.careguard.com/#/login for you to access your records. Upon request, Ametros will also provide a written copy or summary of your record.|
|Ask us to correct your record||You can ask us to correct personal or health information about you if you believe it is incorrect or incomplete. We may deny this request, but we’ll inform you if we do and why.|
|Ask us to limit what we use or share||You can ask us not to use or share certain personal or health information. However, we are not required to agree to your request and may deny it if it affects our ability to provide services.|
|Choose someone to act on your behalf||If you have provided valid copy of a power of attorney designation or if someone is your legal guardian, that person can exercise your rights and make choices relating to your account and the services Ametros provides to you.|
|Sharing information for marketing purposes||Ametros will never share your information for marketing purposes unless you give us written permission. Permission is typically granted in writing in the CareGuard agreement when you sign-up for services. You can revoke this permission if you have provided it in the past by sending an e-mail to firstname.lastname@example.org|
|Request to have your information deleted||If you would like to have Ametros delete your personal information, please contact us at email@example.com or 877-620-2221|
We take the handling of your information very seriously and we will make best efforts to maintain the privacy and security of your personally identifiable information.
Changes to the Terms of this Notice
Ametros can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on our website.
How Ametros Receives Payment
This section of the notice describes how Ametros receives payment in relation to administration services provided to you, the Member. Ametros professional administration services may include CareGuard® or Amethyst™. Additional information can be found at ametros.com and answers to Frequently Asked Questions can be found at: https://ametros.com/ametros-company-faqs/
Please be advised that this notice may be updated from time to time. Please visit https://ametros.com/Notice to view the most current notice.
There is a one-time fee for establishing the account. This fee is charged once the Member agrees to become an Ametros member and is a flat one-time charge regardless of the case value. This charge covers Ametros’ costs to establish the account and onboard the member onto our platform. Among other things, it covers Ametros’ time and potential travel for providing consultations (either telephonic or in-person), preparing and editing member agreements, gathering all the medical and settlement information, and properly setting up the account so Ametros can administer the ongoing needs of the member. The law does not regulate who pays this fee, but it is often paid for by the insurance carrier or employer. However, other times it is paid for by the member, the attorney or other parties.
Additionally, Ametros receives revenue from banking partners for placing deposits with them. Ametros ensures its members receive interest on their funds held in a CareGuard account. The current annual interest rate offered on a CareGuard account is 0.07%. The interest rate provided may change at any time. Ametros banking partners target offering an interest rate within 0.25% of the national average for a checking account as tracked and reported publicly by the Federal Deposit Insurance Corporation (FDIC). The FDIC is an agency created to provide insurance and coverage for banking deposits for U.S. depository institutions. After a case settles, the Members’ funds are placed in separate, interest-bearing checking accounts with Ametros’ banking partners. These funds are FDIC-insured up to $250,000 per account (this is the maximum national insured amount for any individual opening a bank account). The funds are not invested in the stock market or other securities that have risk. In return for bringing the banks these deposits, Ametros’ banking partners pay Ametros a recurring placement fee for the funds placed with them.
Ametros receives bills from healthcare providers, including but not limited to doctors and pharmacies (“providers”), related to treatment for injuries you incurred relative to your workers’ compensation or bodily injury claim/settlement. Ametros partners with third-party network providers, including bill review partners, clearinghouse services, pharmacy benefits managers (“PBMs”) and preferred payer organizations (“PPOs”) to facilitate payment and obtain potential savings. Collectively, these network providers are referred throughout this notice as “Ametros Network Partners.”
When Ametros Network Partners are able to obtain savings off the billed amount of a bill received from a provider, Ametros will receive a portion of the realized savings as payment. The revenue captured by Ametros is a portion of the difference between what you would have paid and the amount you saved below applicable thresholds outlined below. Below, in further detail, under each potential category of healthcare spend, Ametros outlines how it is compensated.
By default, every Member of Ametros’ administration services will be designated to utilize Ametros Network Partners. However, utilizing Ametros Network Partners is not a condition to being a Member of Ametros’ administration services and you may opt-out of using Ametros Network Partners for any reason at any time. Opt-out procedures are indicated below.
It is important to note, however, that if you opt-out of utilizing Ametros Network Partners, you will likely pay more than you otherwise would if you used Ametros Network Partners. If you choose to opt-out of Ametros Network Partners, you can opt-in again at any time during your membership.
Do you, the Member, pay a fee to use Ametros’ CareGuard Services?
No, once you are established as a Member, there is no ongoing fee you, the Member, are required to pay.
Do you, the Member, have to use a certain Provider?
No. You, as a contracted Member of Ametros administration services, are not obligated to use any particular provider.
Ametros Network Partners not Accepted at Every Provider
It is possible not all providers will accept Ametros Network Partners. Ametros provides reasonable efforts to assist you in being seen by providers.
How does Ametros provide the CareGuard service if it doesn’t charge a fee?
Ametros Network Partners negotiates discounts with providers through Ametros Network Providers, and, on average, passes most of the savings to you, the Member. Ametros retains some of those negotiated savings to provide our services. We do not charge an administrative fee so using CareGuard ensures both compliance with Medicare’s recordkeeping requirements as well as a providing a good financial benefit for the member.
Ability to Opt-Out of Ametros Network Partners
You, as a contracted Member of Ametros administration services, are not obligated to utilize Ametros Network Partners. You can opt-out at any time. To opt-out, you can call, toll-free: 877-415-6507, Monday through Friday, 9 a.m. – 5 p.m. Eastern or e-mail firstname.lastname@example.org. Ametros will process your request within 48 hours. During the pendency of opting-out, please note that any pending provider invoices may be processed through Ametros Network Partners. If this is the case, Ametros will make best efforts to re-process these provider bills.
If you opt-out of utilizing Ametros Network Partners, you will likely pay more than you otherwise would if you used Ametros Network Partners, and often you will pay the full amount billed by your provider. If you choose to opt-out of Ametros Network Partners, you can opt-in again at any time during your membership.
How Ametros Receives Payment Collateral to Healthcare Expenditure Savings
When you, a Member, have a bill for medical services processed by Ametros via one of Ametros Network Partners, if Ametros’ Network Partners is able to reduce the billed charge to either: 1) less than an applicable workers’ compensation fee schedule; or 2) less than the billed charge, in the event there is no applicable workers’ compensation fee schedule, Ametros will receive a portion of this savings as compensation.
In other words, Ametros receives payment in instances where a bill you received is discounted. A portion of savings is passed along to you, the Member, and the remainder is maintained as compensation to Ametros for services rendered. The portion of savings as compensation to Ametros will not be greater than the savings passed back to you, the Member. Of note, Ametros incurs any fee with its Network Partners to reduce a billed charge to an applicable workers’ compensation fee schedule.
When you, a Member, have an injury-related prescription, Ametros will work with your pharmacy to ensure that your payment is less than or equal to the Usual and Customary rate charged by the pharmacy. The Usual and Customary rate is a price set by the pharmacy and provided to Ametros that indicates the price that they would charge for the drug when there are no insurance plans or discounts available. When Ametros is able to provide pricing that is below the Usual and Customary rate, Ametros will receive a portion of that savings as compensation.
Disclaimer on Savings & Discounts
Ametros does not guarantee any level of discounts, savings or results relative to potential cost savings realized, including but not limited to prescription drugs, medical treatment, items and services. Ametros makes no warranties, promises, representations, or guarantees whatsoever about potential cost savings or the level of potential discounts obtained on any service or prescription payment. There are no assurances that prior successes or past results as to cost savings will be applicable to Member.
Any information or statements provided about savings or savings examples on the Website or in our marketing materials are only estimates. There is no guarantee that your account will perform as well as any of the examples. The materials on this website or in our marketing materials are presented for educational, general reference and informational purposes only. They are not intended to serve as legal or other advice. They are not intended to be a full and exhaustive explanation in any area and they should not be used to replace the advice of your own legal counsel. Nothing on the Website should be construed as legal advice. Ametros makes no representation or warranty that the content is accurate, complete or current for any specific or particular purpose or application.
If you rely upon any data, information or figures provided, you must accept the entire risk of not attaining any of the amounts or figures represented with regards to potential savings or discounts. There is no assurance that any prior successes or past results as to savings or discounts will apply, nor can any prior successes be used as an indication of your future success or results from any of the information, content, products, services or strategies. Any and all claims or representations as to savings are not to be considered as average savings, but rather a potential estimate.
Any and all forward-looking statements on this web site or in any of our marketing materials are intended to express our opinion of the savings potential that some people may achieve. THEY USE WORDS SUCH AS “ANTICIPATE,” “ESTIMATE,” “EXPECT,” “PROJECT,” “INTEND,” “PLAN,” “BELIEVE,” AND OTHER WORDS AND TERMS OF SIMILAR MEANING IN CONNECTION WITH A DESCRIPTION OF POTENTIAL SAVINGS OR FINANCIAL PERFORMANCE. ANY AND ALL FORWARD-LOOKING STATEMENTS HERE OR ON ANY OF OUR WEBSITES OR MATERIALS ARE INTENDED TO SOLEY EXPRESS OUR OPINION OF SAVINGS POTENTIAL AND DO NOT REPRESENT PROMISES, WARRANTIES OR GUARANTEES.
Changes to the Terms of this Notice
Ametros can change the terms of this notice. The new notice will be available upon request and on our website.