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  1. #1
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    Sep 2013
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    Default Once Your MSA Goes to the Cms How Long to Hear Back from Them

    My case is in Florida, my MSA came in at $100,000. and it was sent into the CMS.
    Can anyone tell about how long it takes to here back from them.
    The MSA is for Lower Back fusion surgery. Just wondering that is enough to cover the surgery if I get it later on.

    Thanks Flash

  2. #2
    Join Date
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    831 East Morehead St., Ste 355, Charlotte, NC 28202
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    Default Re: Once Your MSA Goes to the Cms How Long to Hear Back from Them

    It may take several months. It does not matter if that is enough money to cover your surgery, if you have Medicare. Medicare will pay for it after the money in the MSA is used up, so long as you manage it/use it properly.

    There is a company on the East Coast that will manage that MSA for you for free or very little cost to you, if you want that. It is called "Ametros" and it is based in Burlington, Massachusetts. I met with their reps recently to learn about what they do, and I am going to refer a couple of my clients to them for management of self-administered MSAs to take that burden off the clients.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney and Board Certified Specialist in NC Workers' Compensation Law

  3. #3
    Join Date
    Oct 1971
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    5,082

    Default Re: Once Your MSA Goes to the Cms How Long to Hear Back from Them

    There is a company on the East Coast that will manage that MSA for you for free or very little cost to you,
    There are several companies that offer to manage MSA's, Ametros is a good one.
    At the settlement, the claimant can choose to self administer or have it professionally administered on their behalf.

    How Ametros works with MSAs
    https://www.ametroscards.com/medicar...iAAEgK2lPD_BwE

    This issue needs to be addressed at the settlement to save the claimant the cost of having the MSA managed professionally if they so choose.
    If the claimant chooses to have the MSA managed professionally, the cost, if any should be included in the settlement.
    If the claimant chooses to self administer and then hires a professional later, he may get stuck with the cost.

    WCMSA Self-Administration
    A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a portion of a Workers’ Compensation (WC) settlement “set aside” for all future work-injury-related medical expenses that are covered and would normally be paid by Medicare. The goal of creating a WCMSA is to set aside money from the settlement to cover those injury-related medical expenses.
    You may choose to self-administer your CMS-approved WCMSA or have it professionally administered on your behalf.
    https://www.cms.gov/Medicare/Coordin...istration.html

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  4. #4
    Join Date
    Sep 2013
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    38

    Default Re: Once Your MSA Goes to the Cms How Long to Hear Back from Them

    Thank you for the fast replies,

    "It may take several months. It does not matter if that is enough money to cover your surgery, if you have Medicare. Medicare will pay for it after the money in the MSA is used up, so long as you manage it/use it properly."


    If the MSA gets used up on my back surgery will Medicare cover 100% the remaining bill from the surgeon or only 80% and I would be required to pay a 20% co-pay/ delectable?

    If that is so, should I try to get W/C (Sedgwick) Insurance company to add non-medicare covered cost to my settlement amount?

    Its been a long five years to get to this point I do not want to blow it or mess up here at end.

    Thanks Flash.

  5. #5
    Join Date
    Oct 1971
    Posts
    5,082

    Default Re: Once Your MSA Goes to the Cms How Long to Hear Back from Them

    Phoenix Flash
    If the MSA gets used up on my back surgery will Medicare cover 100% the remaining bill from the surgeon or only 80% and I would be required to pay a 20% co-pay/ delectable?

    If that is so, should I try to get W/C (Sedgwick) Insurance company to add non-medicare covered cost to my settlement amount?
    They won't do it, you'll get stuck with the 20% - this is just one reason I'm against these Set Aside arrangements.
    If you believe you'll be needing future surgeries or extensive care - don't settle.
    No one should settle until their condition has stabilized to the point where they'll need no more than future maintenance care.

    In my opinion, it should be mandatory that the carriers set up and maintain these WCMSA's - this is to their advantage, not the claimants.
    These arrangements save carriers billions in future medical at the tax payers expense, they should at least be responsible for the cost of maintaining them.

    Do you have a lawyer?
    If not consult one before proceeding further, this is too complicated for a layperson to handle.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  6. #6
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,766

    Default Re: Once Your MSA Goes to the Cms How Long to Hear Back from Them

    The Medicare deductible and co-pay money can be included in your settlement evaluation. Also include any related meds you might need that would not be paid by Medicare anyway, such as physical therapy. But including these things in your evaluation workup of your case does not mean that the insurance company will pay for a single dime of it. That still has to be negotiated.

    If you don't have a good workers' comp lawyer helping you with this, you need one.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney and Board Certified Specialist in NC Workers' Compensation Law

  7. #7
    Join Date
    Sep 2013
    Posts
    38

    Default Re: Once Your MSA Goes to the Cms How Long to Hear Back from Them

    Thanks guys for your response to my questions. Yes a have a good lawyer.

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