1. Future Medical Cost Projections
Module 1
Types of Future Medical Cost Projections

2. Types and Uses for Future Medical Cost Projections
Overview
Discusses different types of future medical cost projections and parties using them
Objectives
Be able to explain why future cost projections are needed
Be able to discuss differences between various types of reports
Be able to identify at least 3 potential marketing opportunities
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Types
Mediation cost projection
Surgical cost projection
Procedural cost projection
Medication cost projection
Life Care Plan
Medicare Set-Aside Allocation (MSA)
Non-covered Allocation (NCA)
Post Settlement Allocation (PSA)
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4. Mediation Cost Projection
Most common type of future medical cost projection
Based on current level of care
Uses standard of care protocol
Lifelong basis
Demands
Hearings
Mediations
Not to be used for basis of expert testimony
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5. Surgical Cost Projection
Limited future medical cost projection
Outlines costs of surgical procedure
Hospital charges
Surgeon’s fees
Anesthesiology fees
Pre-operative clearance
Post-operative rehabilitation
Requested frequently by attorneys
Not to be used for basis of expert testimony
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6. Procedural Cost Projection
Limited future medical cost projection
Facility fee
Provider fee
Professional component
Normal supplies
Requested infrequently
Not to be used as basis for expert testimony
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7. Medication Cost Projection
Limited future medical cost projection
Current formulary of medications
Recommended (but not yet using) medications
Includes prescriptions and over the counter drugs
Uses brand name or generic substitution
Can be lifelong basis or limited to established period of time
Not to be used for basis of expert testimony
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Life Care Plan
Follows standard methodology
Builds a medical foundation
Applies case management protocol
Forms a life care planning opinion
Used as basis for expert testimony
Prepared prior to settlement with many updates expected
Discoverable work product
Certification in life care planning available: see internet sources
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MSA
Medicare Set Aside Allocation
Used in Worker’s Compensation cases
Written to reasonably consider Medicare’s interest
Addresses only medical treatment covered by Medicare
Typically prepared or ordered by insurance carrier
Used as part of settlement negotiations
Apportions the total settlement
Certification available: see internet sources
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NCA
Non-covered allocation
Companion report to MSA
Considers all medical treatment not addressed in the MSA
Typically prepared by plaintiff
Protects plaintiff’s future exposure when transitioning care from worker’s compensation insurance to Medicare insurance
Serves as a ‘due diligence’ report for plaintiff attorney
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PSA
Post-settlement allocation
Used in personal injury cases
Prepared after settlement negotiations are finished
Apportions the total settlement
Discounting factors utilized
Allowable exclusions
Plaintiff responsibility
Not commonly used………..YET
Huge learning curve ahead for all parties
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Uses
Demand letters
Hearings
Mediations
Trials
Post-settlement disbursements
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Market
Plaintiff attorneys
Defense attorneys
Insurance adjusters
Structured settlement specialists
Trust administrators
Families, individuals
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Potential Income
Cost Projection reports range from $800 to over $2500 depending on medical complexity and type of report requested
Completion time for the reports varies from as little as 2 hours to about 10
Overhead is minimal
Profit margins are attractive
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Benefits
Home based operations
Flexible work schedules
Autonomous, self-employed status
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Certification
Completion of all modules
Completion of practicum
Certification examination
Certified Cost Projection Specialist
Endorses commitment to continuous learning
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Homework
Contact a worker’s compensation plaintiff attorney and discuss types of reports used
Contact a personal injury plaintiff attorney and discuss types of reports used
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Contact Information
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