Karen Conger on MCOs

Navigating a workers’ compensation claim can be quite confusing. You may question if the claim is valid or if the treatment is necessary, or you may not understand much of the medical terminology. By working closely with a Managed Care Organization (MCO), you should be able to answer all these questions.

Your MCO should be able to help you understand if the injury and allowed condition(s) “make sense,” based on the injured worker’s job description and description of the injury. Your MCO should take care of all medical management and assist in returning your injured workers to work as soon as possible, and keep you informed regarding progress in the claim. Since all state-funded employers in Ohio are mandated by law to use an MCO, you should make sure that the one you choose provides you with all these services.

“It gives employers the medical experts and expertise at their fingertips,” says Karen Conger, CEO of Ohio Employee Health Partnership. “The MCO helps the employer through all of the medical components of a workers’ compensation claim, and works with the providers returning injured employees to work.”

Smart Business spoke with Conger about the role an MCO plays in a workers’ compensation claim and how to choose a good MCO.

What are the benefits of using MCOs?

You have access to medical experts who are involved in every aspect of the claim, from the date of injury to date of closure. A good MCO will contact and educate you to explain what’s going on medically with the injured worker, and will work to be sure that appropriate medical care is provided in order to help injured workers recover and return to work as soon as possible.

Over time, you should see a reduction in your premium to the Bureau of Workers’ Compensation (BWC), as well as fewer days that injured employees are out of work.

What kind of interaction takes place between the MCO, employer and injured worker?

MCOs are neutral parties, and work with employers, providers and injured workers to improve medical care and return employees to work. A good MCO coordinates all medical aspects of a workers’ compensation claim, and is responsible for reviewing every treatment authorization for reimbursement. A case manager is assigned to each claim to help everyone navigate through what can sometimes be a confusing medico-legal system. MCOs provide identification cards to injured workers, to be presented when visiting their treating physicians. You need to make sure your employees know whom to contact at your MCO, and encourage any injured worker to talk with the MCO case manager about any questions because it is important that the injured worker takes an active role in his or her recovery.

What are some key things employers need to understand about using MCOs?

You should understand the MCO’s role regarding medical management and payment of providers. Your MCO should be communicating with you on these aspects. Work with your MCO long before an injury happens to make sure everything goes smoothly when needed. In this regard, workers’ compensation is a lot like health insurance. You may not know what’s on your health plan until you need it, but you know it’s there. With your MCO, it’s better to know ahead of time whom to contact if an injury happens.