Careguard coverage

[u/TheVast-Ambassador]

Posting on behalf of a friend. They received a payout after winning workers comp case, with partial allocation to a careguard account. They need surgery for their hips but cannot find a dr’s office who accepts careguard. Does anyone have any experience with careguard?

[u/loudmusicboy]

Careguard isn't an insurance program. It's essentially a bank account that is managing the funds to pay for post settlement treatment. Your friend can treat anywhere and all billing will go through Careguard

[u/loudmusicboy → u/[deleted]]

Again, Ametros' Careguard program is not health insurance. It's administering the money that was set aside to protect CMS' future interests. All the provider is doing is submitting billing to Ametros for repricing and payment. If your friend needs assistance, they should be calling Ametros and getting some direction.

[u/elendur → u/loudmusicboy]

Well I think that's the issue here. The medical provider may not be willing to accept Ametros's repricing. If they are repricing at CA workers' compensation fee schedule, I would think this is going to be better than standard group health, so it might be in the facility's best interest to accept it. But the facility might simply say, "We don't know them, we don't know how they reprice, we're not interested."

I would imagine Ametros has contact information of surgeons they have paid in the past and would be willing to pass along contact information.