Know When Professional Administration Is Appropriate
Your legal team has worked hard to get your client a fair settlement. Don’t let those efforts go to waste. If any of the following statements or scenarios sound familiar, you should recommend your client get Opal right away.
I was advised that when my settlement is final and I open my Medicare set-aside account, I need to fee schedule my doctor and hospital bills. I do not know what a fee schedule is.
Professional Administration is recommended when a claimant is not familiar with workers’ compensation
fee scheduling.
Is this claimant capable of properly managing payments and complying with CMS administration guidelines?
My English is not very good and I do not understand what I am supposed to do with the money I was told I would receive for the Medicare set-aside account or what the CMS letter means.
Professional Administration is recommended when a claimant is unable to read or write English.
Is this claimant capable of properly managing payments and complying with CMS administration guidelines?
I have no idea what Medicare does and does not pay for. I thought Medicare paid for everything that my workers’ compensation carrier is paying for.
Professional Administration is recommended when a claimant is not familiar with Medicare-allowable and non-allowable expenses.
Is this claimant willing and able to comply with the CMS instruction that MSA funds may only be used to
pay for injury related medical services that would normally be paid by Medicare?
My injury was very severe and I have a lot of physical limitations. I will still need a lot of medical treatment after my settlement is final and know I will not be physically able to research fees or keep the paperwork and bills organized.
Professional Administration is recommended when a claimant has serious or complicated medical conditions.
Is this claimant capable of properly managing payments and complying with CMS administration guidelines?
I am a Medicare beneficiary. I think that once my settlement is final I am supposed to use my Medicare setaside funds to pay for co-pays for my doctor visits, prescriptions and supplies that Medicare will not pay for.
Professional Administration is recommended when a claimant is not familiar with Medicare-allowable and non-allowable expenses.
Is this claimant capable of properly managing payments and complying with CMS administration guidelines?
My settlement is final. The funds are just sitting in an account. I need that money for personal outstanding bills now.
Professional Administration is recommended when a claimant’s family or social dynamics place MSA funds at risk.
Is this claimant capable and willing to properly manage payments and comply with CMS administration
guidelines?
I am covered under my spouses insurance. I do not need to open the Medicare set-aside account when my settlement is final.
Professional Administration is recommended when a claimant is not familiar with CMS requirements.
Is this claimant capable of and willing to comply with CMS administration guidelines?
I am not yet a Medicare beneficiary and do not have any alternate insurance. Once I settle, I am afraid that I might pay too much for my prescriptions and medical treatment because I do not know how to negotiate with my providers.
Professional Administration is recommended when a claimant is not familiar with fee scheduling.
Is this claimant capable of managing payments and complying with CMS administration guidelines?
I did not finish school and do not read very well. I do not understand my settlement documents very well and I do not know nor remember what I am supposed to do about my medical bills after my settlement is final.
Professional Administration is recommended when a claimant has a lower education level.
Is this claimant capable of managing payments and complying with CMS administration guidelines?
After my settlement is final and I open the Medicare set-aside account, my understanding is that when my doctors ask me to pay for treatment at the time of the visit, I just write a check from my MSA account and pay them for whatever they ask for.
Professional Administration is recommended when a claimant is not familiar with fee scheduling and Medicare coverage guidelines.
Is this claimant capable of managing payments and complying with CMS administration guidelines?