Q: Who is Ametros and what is CareGuard?
CareGuard – Frequently Asked Questions
A: Ametros is a company that helps injured parties manage their medical funds after they settle their claim, as well as any individuals that are paying out-of-pocket for their healthcare. The Company was founded in 2010 and is the leader in settlement fund administration. Typically Ametros administers Medicare Set Aside funds, medical cost projection accounts, or any other future medical funds. CareGuard is Ametros' professional administration service. With CareGuard, the Company sets up a bank account for the injured party's settlement funds and acts as the custodian of the funds and the third party administrator paying for all healthcare expenses. The CareGuard service manages everything for the injured party, including the coordination and payment of medical bills as well as any necessary reporting to Medicare. This differs from Ametros' self-administration service Amethyst, because the funds are put into a custodial account that is fully managed on behalf of the injured party.
Q: What happens after I settle my case with Ametros’ CareGuard service?
A: Our Care Advocate team will reach out to begin the onboarding process. We will setup your account, explain how it works, and gather your doctor and pharmacy information. We reach out to your doctors and pharmacies to make sure they know you will be using CareGuard from now on and that they can bill CareGuard directly. A welcome package including your CareGuard card will be sent to you in the mail. Once you receive the card, you can take it to your doctor or pharmacy and you will not have a copay; all the bills will be directed to CareGuard. CareGuard will review them for accuracy, apply discounts to reduce them, and then pay on your behalf. If you have a Medicare Set Aside, CareGuard will file all your reporting to Medicare for you to make sure your benefits are protected.
Q: Who notifies my doctors/how do they find out about CareGuard?
A: When you become a CareGuard member, our team will find out all the doctors, providers and pharmacies you are seeing. We then will contact them to provide them with information on how to bill CareGuard for all future expenses. We also provide you with information explaining CareGuard in your welcome packet in case you go to a new provider and our team has not been notified to call ahead.
Q: Who has access to my CareGuard account?
A: Only you and CareGuard representatives have access to your account. Representatives have access in order to help you compile your reporting or assist you through our Care Advocate Team. We take your identity and information security very seriously and have rigorous security protocols to protect your account.
Q: How do I use my CareGuard card?
A: The CareGuard card acts as a traditional insurance card. When you go to the doctor or pharmacy, simply show your CareGuard card at check in, and bills will automatically be sent to our Care Advocate team. There are no co-pays with the CareGuard card, and, once we receive the bill we will provide any network savings, and then pay on your behalf.
Q: Is the CareGuard Card a debit card?
A: The CareGuard card functions like traditional insurance card and cannot be used like a debit card. The CareGuard card can only be used to notify doctors and pharmacies to send bill directly to CareGuard. You cannot withdraw money from your CareGuard account on demand. The account contains your medical funds from settlement and is established in accordance with the terms of your settlement agreement. To learn more about deposits or withdrawals from your CareGuard account contact our Care Advocate team.
Q: Can I withdraw funds from my CareGuard account?
A: You cannot withdraw money from your CareGuard account on demand. The account contains your medical funds from settlement and is established in accordance with the terms of your settlement agreement. In some situations, you can withdraw funds and, in others, it is not permitted. To learn more about possible deposits or withdrawals from your CareGuard account contact our Care Advocate team.
Q: What happens if I run out of money?
A: On average, less than 5% of CareGuard members exhaust their funds in a given year. Should your funds exhaust, we will notify your providers that the account has exhausted. If you have a Medicare Set Aside, we will notify Medicare and help ensure Medicare takes over as primary payer when your account is exhausted. If you have an annuity, once your funds are replenished we will coordinate with your providers to have your MSA account become the primary payor again. This coordination is crucial in the administration of an MSA and CareGuard removes the burden entirely from the injured party.
Q: What if I need a new doctor?
A: With CareGuard, you can see any doctor you would like, with no restrictions. If you need to switch doctors/pharmacies, we ask that you please give us a call. We will reach out to them and make sure CareGuard is setup in their system as the payor for your medical bills. That way, when you show up for your visit, you only have to mention CareGuard and everything will be ready to go. Please note, you can choose any doctor/pharmacy you want; they do not have to be within our network. Our Care Advocate team will help you find doctors or pharmacies. Just give us a call!
Q: What if I need to change medications?
A: As time goes on, medication and treatment will change. Just give us a call at 877.275.7415 and we will update our records with the new information. If you have a Medicare Set Aside, we will help advise you on what medications are eligible for payment by your MSA.
Q: What happens if Ametros goes out of business?
A: Your CareGuard account is set up under your name and Social Security number or Tax Identification Number. Each account is a separate bank account with FDIC insurance. The funds in your account are never a business asset of Ametros. This ensures the your account will be always protected should Ametros ever become insolvent in the future.
Q: What do I do if I have any out-of-pocket expenses?
A: Any out-of-pocket expenses related to your injury can be reimbursed upon submission of a receipt. You can submit receipts for reimbursement through your CareGuard member portal or fax or mail them in for review.
Q: Who can I contact for more help?
A: 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.
Q: What happens if I pass away?
A: Ametros follows the terms established in your member agreement or settlement documents to determine where to send the remaining funds in your account when you pass away. If you assigned a beneficiary to your account, the funds will be distributed to them within six months after your passing. If your account was setup so that the remaining funds will revert back to the payor, Ametros will remit them back to the payor. If there is no indication of where to send the remaining funds, Ametros notifies the estate/probate entities involved so they can make a determination.
Ametros does not take any portion of the remaining funds as any form of payment; Ametros only directs the funds as instructed.
Q: Do I have to see a specific doctor?
A: You are able to treat with any doctor/pharmacy you’d like; they do not have to be a part of our network for you to to use CareGuard and potentially receive our discounts on healthcare expenses. While not required, many members choose to use CareGuard's network providers so that they can save more on every visit.
Q: Does Ametros dictate my treatment?
A: With your CareGuard membership, you are free from utilization review. Ametros does not dictate your treatment. This means you don’t have to worry about any treatments or medications being denied as long as they are Medicare covered expenses. Your treatment plan is at the discretion of you and your doctor.
Q: What happens if I don’t use all my funds in a given year?
A: Each year your remaining funds will remain in the account and roll into the next year.
Q: Does the carrier or employer have any input into any of my treatment?
A: After settling out your case, the carrier or employer does not have any input on your ongoing treatments.
Q: What happens if my bills exceed the amount in my account?
A: If the yearly funds run out, Ametros will help coordinate with any secondary form of insurance or payment you may have, including Medicare coverage. Typically, a member's secondary insurance will step in and pay for the remaining balance of your bills. For members with a Medicare Set Aside (MSA), that secondary insurance is Medicare coverage. When you use secondary insurance, including Medicare, you will still be responsible for any deductibles and copays through the secondary insurance. If you have an MSA and an annuity, once your account is replenished, CareGuard will become the primary payer again with your MSA funds.
Q: Will Ametros negotiate the treatment or service prices with providers?
A: We run bills through our network and reprice to the appropriate fee schedule or network discount. If the provider is within our network, we are often able to provide additional savings below the fee schedule or typical "usual and customary" price. On average, members about 62% on provider bills, and 28% on all other healthcare related expenses.
For large bills and with providers that are out of network, CareGuard's team will still attempt to negotiate discounts.
Q: Does Ametros have the authority to determine medical necessity?
A: No. Medical necessity is to be determined by a licensed medical professional. Ametros does not direct care nor determine necessity.
Q: Are members taxed on interest that the CareGuard account earns?
A: CareGuard establishes a bank account for the member that earns interest. Just like with any other bank account, the federal government taxes interest earned. The member will receive a 1099-INT if the account earns more than $10.00 in interest. Standard withholding is done on the account so that typically the tax on the interest has already been accounted for and the member just needs to include the form on their tax return. For members with a Medicare Set Aside, according to Medicare's guidelines, the funds in the MSA account can be used to pay for taxes on the interest earned by the account.
Q: Is marijuana covered?
A: Marijuana can be covered if you have a Medical Cost Projection (MCP) account and if you can get marijuana at a pharmacy, not a dispensary. If you have a Medicare Set Aside (MSA), then marijuana will not be covered because it is not a Medicare-covered expense and therefore not compliant with CMS’s guidelines.
Q: Why are my funds not immediately accessible?
A: Settlements can take time to be finalized. In some cases, we can be waiting for the insurance company to cut the final checks, as they typically have 30 days to do so, or the judges or the workers’ compensation board are in the approval stage of the documentation. Ametros follows up constantly to see when to expect the checks from settlement. We will typically have your funds within 30 days of settlement and we notify you once the checks have cleared.