ADJUSTED

Financing for Medicare with Andrea Mills

June 27, 2022 Berkley Industrial Comp Season 3 Episode 39
ADJUSTED
Financing for Medicare with Andrea Mills
Show Notes Transcript

In this episode, ADJUSTED welcomes Andrea Mills Senior Vice President of Account Management at Ametros. Andrea discusses the benefits of using a custodial account when financing for Medicare.

Season 3 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Matt Yehling, Directory of Claims at Midwest Employers Casualty.

Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com

Greg Hamlin:

Hello, everybody and welcome to adjusted. I'm your host Greg Hamlin coming at you from Sweet Home Alabama, where the skies are so blue and Berkeley Industrial Comp and with me as my co-host for the day. Matt Yehling, Director of claims at MEC did get your name right, finally, Matt?

Matthew Yehling:

You got it right. This is Matthew Yaling. I'm in St. Louis, Missouri, along the banks of the Big Muddy Mississippi and I am the director of Midwest employers casualty. So I'm looking forward to this interview.

Greg Hamlin:

So Matt, I finally it took me like a year I think I finally got your name, right. But what I remember every time is just if I think yay. And then Matt, and I'm good, Matt. Yayling. So I'm there now. With us is our special guest for the day. Andrea Mills, Senior Vice President of account management at Ametros. Andrea, if you you could say hi to everybody.

Andrea Mills:

Thanks for having me.

Greg Hamlin:

And Andrea, where are you out of?

Andrea Mills:

I'm in Tampa, Florida.

Greg Hamlin:

Okay, the Sunshine State?

Andrea Mills:

Yes.

Greg Hamlin:

I actually have my son is on a trip to Universal Studios right now. So he is doing that for show choir. So seems like there's always a reason for them to go to Florida.

Andrea Mills:

Yes, I love that for them.

Greg Hamlin:

Well, we're glad to have you here today. The topic we're tackling today is Medicare set aside custodial accounts. So I know the tension is high, as everybody is excited to learn about this topic. But I felt like it's really important to understand all the things that are out there. And I think there are a lot of people who probably don't know what your company does for injured workers and carriers. And before we get too far into that, though, I wanted to start with a little bit about you. How did you end up in the insurance industry? I'm sure this was a goal you had since you were a child.

Andrea Mills:

Very much so. So randomly, I have a degree in music. I sing my background. So sorry. Yes. So it is interesting that I have landed in this insurance world, but I worked at a couple different insurance agencies through high school just kind of had some connections through it in my hometown. So I did that. And then after college, I worked for a case management company out of Baltimore, did that for a couple years, and then was recruited over to more of the ancillary space, did that for about nine years, ran a product line and a business unit, and then came over to Ametros because I thought what they were doing was really exciting. A lot of different people, you get to work with a different side of the claim. Everything I used to do is pre-settlement. Now my life is post-settlement. And it's really interesting.

Greg Hamlin:

That's awesome. So soprano or alto?

Andrea Mills:

Soprano.

Greg Hamlin:

All right, well, I went to Indiana University, and they have arguably the top music school in the country. So I always enjoyed, where I would park I'd walk by I'm wasn't a music student, but I'd walked by and I could always hear, you know, different instruments or opera singers, all kinds of stuff coming out the windows. So it's kind of fun.

Andrea Mills:

We just went to visit my college in February, and we took the kids. And I just love walking through the music building and the practice rooms, and you get to hear so many different things and people working on different songs. And it just was a cool experience.

Matthew Yehling:

Greg, if you ever need to add a intro or or an outro for the the vocalist for the podcast, maybe you should call.

Greg Hamlin:

That'd be great. Well, we're glad to have you here with us today. For those who don't know anything about Ametros. Can you tell us a little bit about your company?

Andrea Mills:

Sure. So our mission is protecting and empowering the future of medical care. And we really want to support injured parties, whether that's an injured worker or an injured individual on a liability case after settlement after they've received those medical funds being a resource and an advocate for them. Because if you think about what you all are doing today, pre-settlement, you probably have nurse case managers, they have one of your delightful team members assisting them. And then once the case settles, all of those resources go away and they're managing their health care on their own. They're trying to navigate the healthcare system, they're trying to maybe navigate maybe their family member assisting them. And some of that gets a little dicey. So our program is there to help the injured party from an advocacy standpoint, but also from a bill perspective. So helping them maximize their dollars by obtaining savings for them and negotiating bills for them. And then that way, the dollar lasts a little bit longer for them. If something unexpected comes up there. You know, there could be a cushion within the account to help pay for those unexpected medical costs that may pop up. So you know at the end of the day, you all are assisting them pre settlement and we really want to be that resource and advocacy for them after settlement.

Matthew Yehling:

I was just gonna add to the conversation here. I Obviously, we're talking about Medicare set asides. And you know, we throw out the word custodial accounts, and administered accounts versus not administered accounts, I think already, but maybe back up and say Just briefly, like, I know we've on prior podcast talking about MSA is but just at a 30,000 foot view, what an MSA is supposed to do as a part of this settlement?

Andrea Mills:

Sure. So you know, from a professional administration standpoint, or custodial account, really where that came from was as the insurance carrier or as an employer, you will have to make sure that you're not becoming a burden to Medicare. So you are doing a Medicare set aside, that's taking into consideration what the future costs would be, and you know, of the Medicare covered items that are related to the injury so that Medicare won't become the burden. So we're here to assist that person who is the recipient of a Medicare set aside or, you know, funds that are non Medicare related to make sure that we're taking care of their reporting to Medicare annually, there's a lot of rules and regulations about setting up the funds and a separate interest bearing account that can't be co-mingled with other funds. And you have to only pay for what is Medicare covered and related to the injury out of your Medicare set aside account?

Greg Hamlin:

I appreciate you pointing that out. Because you know, we were talking about this within our department. And we have some adjusters that maybe have been in industry one to three years, and this is all new stuff to them. And in fact, we left one of these meetings, and then afterwards, several of them like sent me messages saying, Hey, I don't think I fully understand this. So I think sometimes eyes can glaze over a little bit when we start talking about Medicare. And compliance is really important that we do things the right way, and that we follow the rules that are in place so that we're taking into account Medicare's interests. And I think where it can get difficult, is if you take an injured worker who is not familiar with all these things, how are they supposed to know that they're being taken care of. And I mean, I don't know if I'm qualified, if you gave me Greg Hamlin and said, Here's$30,000, for your lifetime, medical, or $100,000, I don't know that I know how to correctly account for the bills I'm paying for to show Medicare, I'm using that money for that. So I can only imagine what some of our injured workers how confusing it can be talk to us a little bit about custodial accounts and where that fits into all of this.

Andrea Mills:

Sure. So think about you preparing for a settlement. And you know, you've gotten this Medicare set aside, maybe it's $50,000, maybe it's$150,000. And it's for this person's future medical care. And you've been working, you know, with that person for probably seven to nine years. That's the average age of the claim when it comes over to ametros. And you're about to give this person kind of a windfall of money for their future medical, and they're going to be the least likely person to be able to do the annual reporting to Medicare, take those bills and call that provider and say, Hey, provider, you're supposed to be billing me at the Florida fee schedule, or the North Carolina fee schedule, or the various state fee schedules throughout the country, as well, as you know, I don't know if I should have paid for this portion of the visit, because that was related to, you know, my general health care versus, you know, my knee or ankle injury. So you're going to set that person up for kind of immediate failure in a way because they're not going to be able to advocate for themselves in a way that reduces their bills and helps maximize the savings, as well. As you know, sometimes providers make mistakes on the bills. And a big portion of what we do that we probably don't talk about enough is just the bill review function of making sure that what's billed is appropriate, the appropriate codes are being used. And just sheer savings from that perspective is a benefit to the injured party after settlement that they probably don't even know that they were supposed to be looking for asking for.

Matthew Yehling:

to Medicare, but we don't want to shift the burden for all this to the injured employee either, right. So I think you guys fill a nice kind of gap in that to solve that problem for an injured employee. You know, I'm from St. Louis, Missouri, is the "show me" state. Everyone always wants to know, like, how is this benefit an injured employee? From their perspective? You know, and you talked a little bit through that, but how do you guys help explain that to an injured employee?

Andrea Mills:

Yeah, that's a great question. So oftentimes, when we're invited to mediations, or informal settlement conferences, or just to speak to the injured party, we welcome and love the opportunity to speak with that injured party, because we think we can articulate our message and our value to them better than if it came through, you know, someone else trying to say, hey, we want to give you your money, but we also want you to have it administered by this other company, whom you don't know So when we get a chance to speak to them and speak with them one on one and talk to them about, like, What were their goals for settlement? What were the things that they're most worried about settling their claim? You know, is it the future medical care? Is it that they want to make sure they keep being able to go to the pharmacy that they like to go to monthly? Because they love their pharmacist or what have you, you know, we try to uncover those opportunities, and then let them know what portions of our program kind of fit their needs at that time? Do they prefer continuing to get mail order for their prescriptions? You know, do they really like their doctor? Can they stay with that doctor, it's important to have all those conversations with the injured party so that they can truly understand what support we're going to be providing them as well as the savings portion of it, and the access to the networks. You know, we kind of try to liken ourselves when we're talking to the injured party to an insurance carrier, like their group health insurance, because we give them the care guard card, because we're paying bills on their behalf, you have to, you know, explain it to them in a way that they would understand it normally, because settlement and Medicare set asides and all these phrases that they've never really had to deal with and work through before are coming at them. And so you need to take the time to explain it, and show them, you know, the value of it. And if it also takes them speaking with one of our member care advocates that work in our home office to, you know, help with the continuum of care and the transfer of care. You know, we welcome that opportunity as well.

Greg Hamlin:

I think that's great. And you hinted at this a little bit, but I wanted to explore it a little further. So my wife, I've mentioned this earlier, we just had our sixth child. And so I got the hospital bill just recently. And that's always fun. Or they say like, and these aren't the exact numbers, but I want to say it was a C section so, it was expensive. And I remember looking at thinking Oh, $80,000. So we were billed, let's say$80,000. And then my carrier, my health insurance paid 12,000, because they reduced it from$80,000 to whatever. And then there was the you pay part that's after that. But I remember thinking, oh my gosh, like this bill was reduced because of all their networks down to a very low amount. And I think everybody's seen that who has health insurance. So when you're going from workers' comp, or we're pairing all your bills to now you're responsible for paying for your own bills with this money, that's been set aside? How do you guys do that? As far as networks go? Are you similar to that, like what you would see on the healthcare side as far as having a PPO or networks that are going to reduce the bill costs?

Andrea Mills:

Yeah, so we're very similar to a managed care organization, but after settlement, so we tap into PPO networks, we have a PPO mosaic. So the initial cut is a reduction to fee schedule, because MSAs are written based on that state's fee schedule. So fee schedule is applied. And then the different PPO networks that we work with would step in next for reductions. But it's interesting, too, that you mentioned that, Greg, we were just talking about kind of medical bills in general, as a lay person. And if you are underinsured, or you don't have insurance, you know, people don't know that you can call and try to negotiate bills on your own behalf. People don't know that you can do that. And we were talking about that yesterday, because one of our co-workers, family members got a really expensive bill. And she was like, call them and talk to them about it. She was like, you can do that. And she's like, you absolutely can do that. And anyone can do that. So you know, that's just a special note that anyone could go negotiate your health care bills,

Greg Hamlin:

You're gonna get me on a tangent. But yeah, that's one of my pain points, you know, when they were talking about having affordable health care is until consumers understand what they're paying for and know how to pay for it. It can't be afford- it makes it really difficult to be affordable. Because if I don't know, and I feel like people who are seeing exactly what you said, many of these people are highly educated people, they still don't understand how this complex system works, which I think is one more reason to get you involved in one of these situations, Matt, anything you want to add to that?

Matthew Yehling:

I would just you're backing up a little too on the whole process. So obviously, you mentioned that the average referral you guys are getting is nine years. And that's assuming nine years from the date of the injury to the injured employee had that caused the work injury. And just a clarifying point, the medical we're talking about is medical, all related to the original work injury, and what PMS would prescribe as the meeting for future care for the rest of their life. So I think we have, you know, Greg and I, and you assume that just for folks listening, right, that the future medical we're talking about is not all their future medical care for the rest of their lives, right. So this MSA is going to, you know, wrap it up of the care related to that treatment. So I'm a carrier, right? Why should I use you guys and why should I Why should I pursue it a professionally administered account versus writing over a lump sum And, or annuitized in some money and throwing that at an injured employee.

Andrea Mills:

Yeah, I think from a carriers perspective or self insured employers perspective, you know, you want to do right by this injured worker that you've probably been with for nine years that you've worked closely with, or maybe they were one of your ex employees, you want to do the right thing for them, you want to set them up for success. And you also want to make sure that they have resources, you know, available to them after settlement, you know, that goes for the plaintiff attorney as well, you want to make sure you're setting your client up for the best possible outcome after settlement. And by doing that is setting them up with a professional administrator so that they can have care advocates available to them, they are, you know, getting that annual reporting to CMS completed and getting the access to discounts that they wouldn't otherwise get access to, if they were going to self administer their MSA. And I also think it's added protection for the carrier and the self insured employer that CMS knows that you set them up with professional administration. And they're not going to come knock on your door. If that person exhausts or goes and buys. You know, everyone always in the industry says go buy the boat, you know, I'm just going to say go buy Louis Vuitons or Botox or things that you shouldn't buy with your settlement money, because that's probably what I would do.

Greg Hamlin:

I think it's just human nature. Right?

Matthew Yehling:

And going back to an earlier point, I had a call I would I would work for a TPA and settle the claim within MSA. And about three months after the settlement, I had a call from actually a plaintiff attorney, and he said, Hey, we got this bill, and just curious who's supposed to pay it? And they said, well, it's after the date of the settlement. You know, this should all be outlined in the settlement language. And there's the MSA language and Medicare language. And he's like, Well, it's, you know, whatever, I forgot the amount, but I don't recall. He said, Well, it's this amount. He was looking for direction. I'm like, I'm sorry. Like, we can't help you with this. But he was, and I'm not disparaging and hopefully, but he didn't know, you know how to best represent his client in that example. And it's pretty interesting situation. So I kind of referred him back to the language in the settlement and kind of sent him back on his way. But there's a lot of misinformation a lot of information that people don't know about, like Greg even alluded to the the frequency of, of this as an excess carrier nearly every claim we've resolved as an MSA. So I'm a little more comfortable talking about it. But there's, you know, there's changes being made all the time in this in this world and the whole process with TMS and probably have a whole other podcast on and some of that stuff. So when might I guess you're talking about the different product offerings? You guys have too. Because I know it's not we're talking about mshs and custodial accounts or administrative costs. What are the other product offerings that Ametros have, for their clients and carriers?

Andrea Mills:

Sure. So our our flagship product is our full professional administration service, which is called Care Guard. And you can go to Careguard.com, or Ametros.com. And check out Care Guard. And then our self administration assistance program is called Amethyst, and that is someone wants access to discounts, but they want to hold the money in their own, you know, Bank of America bank account or truest or something, they want to keep that money so they can have access to it at all times, they may also run into using that money for some things that they shouldn't. So Amethyst is really for someone who may have a smaller settlement that just wants access to discounts when they get a couple of prescriptions a year. But Care Guard would be that full professional administration service that provides the most savings for the person and compliance from a Medicare standpoint to make sure that only Medicare covered items related to the injury are paid out of the account. They do have access to view it we have online, an online portal, we have a mobile app, so they could you know, check the balance of their accounts at any time see what bills have been paid out of it. So it's a really good ease of use function for the injured party after settlement. And then we do have some banking products. So if you think about settling and giving someone a large indemnity check, not often do folks have their own checking account that they could take that and deposit it into. So we do have some banking products to bridge that gap. If someone is unbanked in which we have found in the settlement process happens.

Greg Hamlin:

Excellent points. Here's a question. I've got Andrea. So if I've got an injured worker who part of the whole reason that they want to settle their claim is they're tired of having to deal with us in the fact that they don't want to go through utilization review and have someone tell them they can't get that shot for their knee, or their doctors ordered a medication and the carrier is not approving it and it's related, but like the carrier's been difficult to deal with. Are they going to experience those same things? I mean, I could see from their perspective, they're thinking, Okay, well, now I don't have to deal with Matt's team or Greg's team. But now I've got to deal with Andrea's team, and they're going to be the ones that are going to be telling me no. What world do you guys play in that in them selecting their own care when it comes to their custodial account?

Andrea Mills:

Yeah, that's a fantastic question. So we do not restrict care. We don't restrict providers that they can go to we don't restrict which pharmacies they can go to. If they have a traditional Medicare set aside, the guardrails are Medicare covered and related to the injury. We are also not doctors. So if we get a bill for something that appears to be unrelated, we will call that provider and say, you know, first question is Did you mean to bill us for this is this, you know, related to the injury and Medicare covered? And they may say, oh, no, that was a mistake, we'll bill you know, secondary insurance for that or that was supposed to be on their primary insurance our bad, we'll fix it. Or if it's, you know, something related to body creep, or someone's gait has changed because of the injury to their leg. As long as we get confirmation and infirm, in a letter from the provider's office saying this is related, then it can go through the accounts. So we're not here to restrict someone's care or, you know, manage it so that they can't possibly get treatment for something that is related as a secondary cause.

Greg Hamlin:

Excellent. So they're still in control. They're still managing their medical, which I think sometimes could get confusing. And I want to make sure we clarify that. And the other question I had is, we talk a lot about Medicare. Well, let's say the injured worker is 32 years old, and there's a settlement for their medical, and it doesn't we don't need to take into account Medicare's interest in this particular claim that doesn't meet their criteria, that guy's still working, not anywhere near Social Security age. Do you ever see those instances where a custodial account might still have value?

Andrea Mills:

Yeah, absolutely. So if I, well, there's a couple of different clients that do a couple different things. So even if the person is 30 years old, they're still getting potentially a future medical allocation that would account for Medicare covered items, or non Medicare covered items. So that's one instance of one, you know, client that we see kind of take a stronger approach to any age of the person making sure that they're taking Medicare's interest into account. There's other situations where maybe the person needs orthotics, or maybe they have home health care, or maybe they have something that's not related, or not Medicare covered, but related to the injury, and the carrier, or the employer is going to give them money for that. The benefit for having us administer the non Medicare covered items is again, the ease of use, they don't have to see the bills, they don't have to pay the bills, we're going to take care of all that for them. But just the access to the discounts that they would not otherwise get if they were going to do it on their own.

Matthew Yehling:

Yeah, and I know, I know, Greg has a final question for you. And just to expand on that a little bit, you know, we talked about and I see qualified, like a Medicare qualified expense, and then a non qualified expense, particularly on some of the larger, more serious injuries, where maybe it's you mentioned, orthotics or you know, sometimes it's attendant care. So, maybe just briefly hit on, like, you know, what you guys and what you see with that, and how that's beneficial for the injured employee and some of their family representatives to that, you know, if they're helping to manage a complicated medical claim?

Andrea Mills:

Yeah, so especially on those larger dollar claims, with the non Medicare covered items, we typically call that an MCP account and medical costs protection account, the biggest thing I see, and especially with the family members involved, and maybe this is because I came from the ancillary side first, and I understood how sometimes the home health care person becomes part of your family, and they're with the family constantly caring for that injured individual. It could be scary to settle your case, because you could think, Oh, am I going to, you know, not have this caregiver or these caregivers that have been kind of part of our family and integrated in with them? If we settle the case? Or do they use a different agency, like what's going to happen? You know, part of our program is to make sure that continuum of care continues, and that we can work with the same agencies that they're working with today, we can make sure that the same discounts and things that they were that you all were probably getting pre-settlement, extend after settlement so that the rates don't go up or things don't change. You know, we really worked to make sure all the communication happens pre settlement. So we set it up for success after settlement. And I just think the home health care thing is such a big proponent of that.

Matthew Yehling:

All right, thanks. I'm gonna tell Sean, that you're ready to be interviewed for his podcasts out there. So thanks for your time. And Greg gonna kick it back to you. And a final question.

Greg Hamlin:

Yeah, well, one of the things I'm trying to do this year, Andrew is I am on a mission and my mission is to put some good stuff out there. I felt like we've all been through a rough 2020 2021 Whether it's the pandemic or you know, I felt like polarized politics, all kinds of crazy things that we've had to see wars now. So my one The person mission is to put some good vibes in the universe to maybe counteract a little bit of that. And so what I'm doing this year is I'm asking the same question to our guests. And that is, if you don't mind, I would love for you to share a memory of a time you were truly happy. And what were you doing? And who were you with? So I,

Andrea Mills:

When you ask me that question, or, you know, initially, so that's what we're going to discuss, I immediately thought about our Thanksgiving vacation that we just took last November, because it was kind of well in Florida, we don't have a ton of rules. But it was a little bit, you know, outside of the pandemic, and things like that. We went to a resort in the keys was all of us together, you know, my husband and my two kids. And I really felt like we were unplugged. Like there was just not a lot of other things to do besides be together. And I loved that. And then I also read a book, which if you're a busy mom out there, or just a busy parent, it's really hard to read books when you have small children. It is I read a book the whole week, I finished that book. And then we were all together as a family. And I just loved every minute of that vacation.

Greg Hamlin:

That was awesome.

Matthew Yehling:

Are you going to share with us the title of the book, hopefully?

Andrea Mills:

Well, it was a book by a comedian. Her name is Catherine Ryan. It's called Audacity. And I loved it. Because I'm a big, big advocate for you know, women and women's empowerment, things like that. And she just said, you know, I've had the audacity to do a lot of things in my career that I was told I shouldn't do or weren't great for me. She had a child, you know, in her early 20s. And I just thought it was really cool, because, you know, I think some of us should have audacious moments and be bold, and I really enjoyed the book.

Greg Hamlin:

I love that. I love that. Yeah. Matt, Matt said earlier on a different podcast episode to be where your feet are. And I think that's a great example of enjoying that time, together with the people who matter most and couldn't agree more about the importance of audacity. I felt like it's amazing what people do when they dream up big dreams, and then they go do it. So I'm a big, big fan of seeing people do that. Well, Andrea, I've really enjoyed having you on the podcast. I really encourage people if they don't understand custodial counts, to reach out to you. Because I know you guys are doing great work in our space have been a good partner for our company, as well as Matt's. And I would just remind people in general, our theme, which is to do right, think differently, and don't forget to care. And with that, we'll close this episode. Just encourage folks to make sure you subscribe and check in we release episodes every two weeks. And on the off weeks, we do have a blog post that covers the episode. So if you don't have time on your commute, to listen to a podcast, take three to five minutes and read the summary and maybe maybe you'll learn something. So thanks again and we'll see you in the future. Take care guys.