Oregon Workers' Compensation MCO's: An Argument for Reform

Some time ago we posted a blog about how Managed Care Organizations, or MCO's, were bullying doctors trying to treat injured workers.  We continue to see problems with MCO's that make it more difficult for legitimately injured workers to seek the treatment they deserve.

A managed care organization is like an HMO or Health Maintenance Organization.  Oregon Workers' Compensation carriers will contract with these groups to manage medical services for injured workers.  An injured worker can only treat with physicians who are members of these groups, and if a physician is an MCO member, the physician must follow certain rules on the management of an injured worker's medical care.

One of our clients had her clam accepted after a lengthy battle with the employer, and was enrolled in an MCO.  The problem was that none of physicians listed as MCO approved doctors would see her.  Some had a two year wait, and others stated that they do not treat injured workers, which begs the question of what the heck they are doing on the list in the first place.  When our client contacted the MCO, the MCO representative tried to set an appointment with a physician almost 100 miles away, which clearly violates the rules that govern MCO's.  After a few calls to the Oregon Workers' Compensation Division, we were able to get things back on track, but not without a nasty gram from Providence MCO.

We recently consulted with another injured worker who suffered serious orthopedic injuries that required multiple surgeries.  Months later, he was still fighting with the MCO to get follow up care that everyone would agree is necessary, but several mistakes and delays have left this injured worker without care for several months.  This incompetence only delays recovery, and drives up claims costs.

Our experience and our opinion is that MCOs do little more than add red tape to an already overly complicated system, which results in an outcome these organization were intended to prevent.  It is time for the Oregon Workers' Compensation Division to take a hard look at MCO's.

If you are dealing with an MCO on your Oregon Workers' Compensation claim, and you have questions or concerns, call us at 503-325-8600.  We can work to get you back on track, and back to work.

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