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  1. #1
    Join Date
    Aug 2013
    Location
    California
    Posts
    23

    Default MSA Self Administer or Professional Administrator

    My workers compensation claim was made in the State of: CA I am getting close to finalizing settlement after many years. I will have a MSA in place. I have to decide if I will self administrate the account, or if I will have it dealt with by Ametros. The cost of the administration is being handled by defense, but I want to know what the pros/cons of using an administrator would be. My concern is that the self administration is going to be difficult to keep up with. Thanks for your input

  2. #2
    Join Date
    Oct 1971
    Posts
    5,289

    Default Re: MSA Self Administer or Professional Administrator

    The cost of the administration is being handled by defense,
    That's not the norm, if they're willing to pay grab it.
    Administering those MSA's are above the average person - it takes a lot of time and knowledge

    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.

  3. #3
    Join Date
    May 2010
    Posts
    657

    Default Re: MSA Self Administer or Professional Administrator

    Tony is probably right...But.I control mine and thats what my attorneys fought for, as its common place they do what they can to screw you and hold funds back for stupid reasons....This is what I was told by my team....I control the account and the money in it...And I spend it on things Medicare wont cover.

  4. #4
    Join Date
    Oct 1971
    Posts
    5,289

    Default Re: MSA Self Administer or Professional Administrator

    airdale
    I spend it on things Medicare won't cover.
    You better be careful, that money is meant to protect Medicare's interest and can only be spent on cost associated with Medicare and your work related injury.
    This is exactly why it's best to let a professional administer the fund instead of trying it on your own.

    Can I spend my Medicare Set Aside money?
    “Once your WCMSA account is set up, you can ONLY use it to pay for medical treatment or prescription drugs related to your WC claim, and ONLY if the expense is for a treatment or prescription Medicare would cover. This is true even if you are not yet a Medicare beneficiary (not yet enrolled in Medicare).”

    Funds from an MSA cannot be utilized for anything other than treatment related to an underlying injury otherwise covered by Medicare. If the funds are spent on other things, there may be issues with respect to Medicare coverage.
    https://ametros.com/faqs/medicare-se...are%20coverage.

    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.

  5. #5
    Join Date
    Jun 2022
    Posts
    25

    Default Re: MSA Self Administer or Professional Administrator

    I was just reading through the FAQ on the site above. When it says it only covers treatment that would have been covered by medicare, does this mean we have to use a medicare approved treatment center. Just curious as there are a lot of physicians /therapists these days who don't take insurance at all and we submit ourselves. Especially those who are concierge. And I have seen physical therapists who do not accept medicare. Would these rules make it so we have to see just those who medicare would accept. I am not even sure if medicare pays for physical therapy or massage therapy.

  6. #6
    Join Date
    Oct 1971
    Posts
    5,289

    Default Re: MSA Self Administer or Professional Administrator

    jerry68
    When it says it only covers treatment that would have been covered by medicare, does this mean we have to use a medicare approved treatment center.
    No, it means it covers anything that Medicare would approve. Many providers don't accept Medicare because they can't afford the cut in payments - Medicare has their own schedule of payments and discounts, they don't pay the full amount.
    As long as it's associated with your work injury and a Medicare approved treatment you'll be fine, you can go to any provider you want.

    I am not even sure if medicare pays for physical therapy or massage therapy.
    I believe they do as long it relieves or improves your condition - Medicare has a schedule of what they approve.
    Here's some info below.

    What Medicare covers
    https://www.medicare.gov/what-medicare-covers

    This is why it's better to have a professional handle an MSA - it's very complicated and time consuming.

    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.

  7. #7
    Join Date
    Jun 2022
    Posts
    25

    Default Re: MSA Self Administer or Professional Administrator

    Quote Quoting tony View Post
    jerry68 no, it means it covers anything that medicare would approve. Many providers don't accept medicare because they can't afford the cut in payments - medicare has their own schedule of payments and discounts, they don't pay the full amount.
    As long as it's associated with your work injury and a medicare approved treatment you'll be fine, you can go to any provider you want.

    I believe they do as long it relieves or improves your condition - medicare has a schedule of what they approve.
    Here's some info below.

    What medicare covers
    https://www.medicare.gov/what-medicare-covers

    this is why it's better to have a professional handle an msa - it's very complicated and time consuming.

    Tony

    thank you so much!!!

  8. #8
    Join Date
    May 2010
    Posts
    657

    Default Re: MSA Self Administer or Professional Administrator

    As Tony said its very tricky.....Early on after I moved Medicare would deny payment and say it was work related to my accident. I now use my official settlement papers to show the 4 codes that are not covered. Seeing we have only one medical group out here I havent been questioned in many years...3 of my codes are for psychiatric problems and another for organic headaches....It was set up as a structure settlement thats pays yearly...I have been doing well on many levels and that money is growing in an account that is ONLY used for those things.

  9. #9
    Join Date
    Jun 2022
    Posts
    25

    Default Re: MSA Self Administer or Professional Administrator

    Quote Quoting airdale View Post
    As Tony said its very tricky.....Early on after I moved Medicare would deny payment and say it was work related to my accident. I now use my official settlement papers to show the 4 codes that are not covered. Seeing we have only one medical group out here I havent been questioned in many years...3 of my codes are for psychiatric problems and another for organic headaches....It was set up as a structure settlement thats pays yearly...I have been doing well on many levels and that money is growing in an account that is ONLY used for those things.
    Thank you for this information as well......one of my injuries is my eyes/vision/blurry and the doctors said I can possibly lose the vision in one due to lack of treatment. After seeing your post I will ask for all of the codes pertaining to my vision and make sure Medicare knows those are only for WC insurance coverage. I hope I am not getting out of this crappy system too early!! But with the codes given to Medicare, like you have done, it should be ok. Thanks!!!!

  10. #10
    Join Date
    Oct 1971
    Posts
    5,289

    Default Re: MSA Self Administer or Professional Administrator

    I will ask for all of the codes pertaining to my vision and make sure Medicare knows those are only for WC insurance coverage.
    Again, you guys better be careful.
    That MSA is for "medical treatment or prescription drugs related to your WC claim, and ONLY if the expense is for a treatment or prescription Medicare would cover."

    Medicare and WC coverage aren't the same and - Medicare doesn't cover the same things as private insurance, which is what WC insurance coverage. is.
    Medicare doesn't cover private insurance codes - airdale even said "I spend it on things Medicare won't cover."
    Just because he's gotten away with it for a few years doesn't mean he won't have problems in the future.
    Or he may be getting lucky and Medicare has similar codes that the comp carrier has.

    Medicare is not bound by the same coverage codes as the comp carrier.

    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.

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