A Managed Care Organization, also known as an “MCO,” is a group of medical providers who have obtained certification from the Oregon Workers’ Compensation Division. These groups contract with workers’ compensation insurance companies to manage medical care for injured workers. In theory, the managed care organization is supposed to provide quality assurance through monitoring medical care, and review of an injured worker’s case to make sure that he or she is receiving medically necessary and appropriate medical treatment.
In reality, however, many MCO organizations are often tools of the insurance company used to intimidate attending physicians into prematurely closing claims, or denying necessary medical care. This is a shrewd tactic, because all MCO physicians know that the attending physician plays a significant role in ensuring that an injured worker gets the medical care he or she deserves.
A local physician contacted me recently. He told me a story of two different MCO physicians contacting him on two different occasions with promises of future medical care for his patient if he were to agree to close a claim. Thankfully, he contacted her office for some feedback, and we may be able to avoid premature closure of a serious injury claim.
If you are mixed up with an MCO organization, and have questions, call us at 503-325-8600. We help injured workers in Oregon with these issues every day.
