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FAQ's
Common Questions Workers ask about the MCO
- What is a managed care organization?
- How do I know if I’m eligible to be enrolled in the MCO?
- If I wish to change physicians, may I do so within the MCO?
- Who can be an attending physician within the MCO?
- Will I be able to see my family physician for my work injury?
- How will I know which MCO physicians I can see for my work injury?
- Can I be treated by a nurse practitioner?
- My primary care provider is a nurse practitioner and is not on the MCO panel. May I seek treatment with this provider for my work injury?
- My personal physician, an internist, is treating me for a work injury. He/she is not a member of the Providence MCO panel and is not affiliated with Providence Health and Services. Do I have to be referred to specialists within Providence MCO even if my doctor does not know any of the specialty physicians?
- My personal physician is a chiropractor who isn't on the Providence MCO panel. If I am injured on the job and enrolled in Providence MCO, will I be able to be treated by this chiropractor?
- If I refuse to go to any physician on the MCO panel and choose not to participate in the Program, what will happen to my claim?
- If my claim is denied, who will pay my medical bills if I go to MCO providers who do not participate in my group health insurance plan?
- Does the MCO pay time loss and medical benefits?
- What if I still have questions about what the MCO is?
What is a managed care organization?
A managed care organization, or MCO, is a group of medical providers who have obtained certification from the Oregon Department of Consumer and Business Services. These providers contract with workers’ compensation insurers and self-insured employers to provide medical care to employees with work-related injuries.
Back to topHow do I know if I’m eligible to be enrolled in the MCO?
Your employer must be located within the geographic service area of the MCO, and you must live within a 100-mile radius of the MCO’s geographic service area. Any injured worker with a workers’ compensation claim, whether the claim is open or closed, is eligible to be enrolled after the effective date of the contract between the insurer or self-insured employer and the MCO.
Back to topIf I wish to change physicians, may I do so within the MCO?
Yes. You may change attending physicians twice after your initial choice, but you must choose physicians who are members of the MCO panel.
Back to topWho can be an attending physician within the MCO?
Under Oregon law, an attending physician is a physician who is primarily responsible for the treatment of a work injury and who is a medical doctor (MD), a doctor of osteopathy (DO), a doctor of podiatry (DPM), or an oral/maxillofacial surgeon. Providence MCO chiropractors also qualify as attending physicians for the first 60 days of treatment or 20 visits, whichever occurs first, in enrolled claims. The MCO must then review the medical necessity for treatment. A Providence MCO Naturopathic physician (ND) or physician assistant (PA) may act as the attending physician for 60 days from the first visit to any ND or PA on the initial claim.
Back to topWill I be able to see my family physician for my work injury?
Yes, if your family physician is a M.D. or D.O. and is a general or family practitioner or internal medicine specialist and you have treated with that physician before the date of your work injury. However, if you need any specialty care, your family physician must refer you to medical providers who are members of the Providence MCO panel.
If you are a member of a health plan and have designated a primary care physician within the health plan, you may treat with this physician even if you have never received treatment from this physician before, as long as this physician was designated as your primary care physician before the date of your injury.
Back to topHow will I know which MCO physicians I can see for my work injury?
If you do not treat with your personal primary care physician or authorized nurse practitioner, you may select an attending physician or authorized nurse practitioner from the MCO panel. Providence MCO provides a list of participating physicians in the provider directory, which you can request from your workers’ compensation insurer, self-insured employer, or directly from the MCO. If your primary care provider is not on the Providence MCO panel and needs to make a referral for specialty care, his/her office may call the MCO for assistance. You will not be required to treat within the Providence MCO panel until you receive an MCO enrollment from your insurer, employer or directly from Providence MCO.
Back to topCan I be treated by a nurse practitioner?
Yes, with some limitations. Under Oregon law, a nurse practitioner may provide treatment to injured workers only after he or she has completed the requirements of the Department of Consumer and Business Services, and received an “Authorized Nurse Practitioner” number. “Authorized Nurse Practitioners” may provide treatment for a period of 90 days from the first visit and may not authorize time loss for longer than 60 days.
Back to topMy primary care provider is a nurse practitioner and is not on the MCO panel. May I seek treatment with this provider for my work injury?
You may be treated by a non-panel nurse practitioner if all of the following apply:- The nurse practitioner has been authorized by the Department of Business and Consumer Services to treat injured workers, and has received an “Authorized Nurse Practitioner” number;
- the Authorized Nurse Practitioner treated you before your date of injury and/or you selected this nurse practitioner as your designated primary care provider within your group health plan before the date of your injury;
- and the Authorized Nurse Practitioner agrees to the terms and condition of the Providence MCO.
Back to topMy personal physician, an internist, is treating me for a work injury. He/she is not a member of the Providence MCO panel and is not affiliated with Providence Health and Services. Do I have to be referred to specialists within Providence MCO even if my doctor does not know any of the specialty physicians?
Yes. By law, if your personal physician or authorized Nurse practitioner agrees to treat your work injury, he/she must refer you to an MCO provider for any specialty services. These services may include specialist consultation, surgery, physical therapy, lab work, and diagnostic tests. Providence MCO has a large network of providers and is happy to assist your physician with referrals, if needed.
Back to topMy personal physician is a chiropractor who isn't on the Providence MCO panel. If I am injured on the job and enrolled in Providence MCO, will I be able to be treated by this chiropractor?
No. By law, a non-MCO physician must meet the legal definition of a primary care physician (M.D. or D.O. specializing in general practice, family practice or internal medicine) in order to treat MCO enrolled workers. If you receive chiropractic care, you must choose a chiropractor from the MCO panel.
Back to topIf I refuse to go to any physician on the MCO panel and choose not to participate in the Program, what will happen to my claim?
If you do not comply with the program requirements after you have been informed that your claim has been enrolled, your employer and/or insurer have the right to suspend your benefits.
Back to topIf my claim is denied, who will pay my medical bills if I go to MCO providers who do not participate in my group health insurance plan?
Contact your employer/insurer at the time you initially file your claim for direction in your initial choice of physicians. By law, you are not required to be treated within the MCO until you have been notified that you have been enrolled. MCO providers may bill your group health carrier if your claim has been officially denied. Some services may be covered under “interim” medical benefits. Contact your employer/insurer for more information.
Back to topDoes the MCO pay time loss and medical benefits?
No. Providence MCO manages your medical care. We do not make administrative decisions regarding your claim. Your employer’s insurance carrier or administrator is responsible for processing your claim and paying time loss and medical benefits.
Back to topWhat if I still have questions about what the MCO is?
The MCO has customer service representatives available to answer any questions.
Providence MCO
PO Box 4347
Portland, OR 97208
503-574-7640
800-947-4707
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