June 9, 2015

What is an MCO in Oregon Workers' Compensation?

The Role of MCOs in Oregon Workers' Compensation Claims

So, you have just received a letter from the insurance company saying you are now in an MCO (Managed Care Organization).  The letter says you must now choose a new provider from their list.

You are rightly wondering what is going on and what this means for your workers' compensation claim.

Will I have to change my attending physician?

Maybe.  If your current attending physician is within the MCO network, you will not have to switch.  If your attending physician is not in the network, you must switch unless they have been your primary doctor from before your work injury.

What if I can't get in to see one of the doctors on the MCO list?

This is a common problem and is extremely frustrating.  The best thing to do is to e-mail the claim adjuster explaining the problem and listing the doctors you have tried to reach.  Continue to use e-mail to communicate so there is a paper trail showing that you cannot get it to an MCO doctor.  The adjuster should help you get set up with a new doctor.

Tip:  Continue to see your original attending physician until you get in with a new doctor so that your time loss is continuous.

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