February 24, 2020

What is a Workers’ Comp Managed Care Organization?

Who is entitled to worker’s compensation benefits?

In the state of Georgia, you are entitled to receive worker’s comp benefits if you are injured on the job and the following criteria are met:

  • You are a regular employee – whether full-time or part-time
  • Your employer has employed 3 or more individuals
  • You are not an Independent Contractor (IC)

Additionally, you cannot be employed in certain industries or occupations such as maritime or railroad, as they provide their own types of benefits insurance. Typically, there are 3 primary forms of benefits:

  • PPD or Permanent Partial Disability
  • TPD or Total Partial Disability
  • TTD or Temporary Total Disability

In addition to the above benefits, your employer is responsible for providing you with the medical care and treatment you need at their expense. Typically, your employer provides you with medical benefits by selecting certain providers of medical care for the injured employee. The listing of medical providers is oftentimes referred to as Managed Care Organizations or MCO’s.

What is a Managed Care Organization?

Managed care is defined as a variety of methods or techniques which are intended for the reduction of costs associated with providing health care and medical benefits. Additionally, the other intention of managed care is to improve the quality of that health and medical care for those organizations that use these methods and techniques. These organizations are referred to as MCO’s or Managed Care Organizations.

The terminology managed care is also used to describe systems for delivering and/or financing health and medical care to enrolees who are organized around certain managed care concepts and techniques. A managed care organization refers to any entity which manages the use of health and medical care as well as the associated costs specific to worker’s compensation claims.

Some of the more common MCO’s

There are several groups of organizations currently providing managed care for employees who have sustained on-the-job injuries. Each of them operate using business models that are slightly different from one another. Some of these organizations are comprised of a mixture of hospitals, physicians, and other health care providers whereas others are comprised exclusively of physicians. The most common MCO’s are:

  • Group practice without walls
  • Independent practice associations
  • Management services organizations
  • Physician practice management companies

Additionally, there are several other network-based MCO’s such as HMO’s (Health Maintenance Organizations, IPA’s (Independent Practice Associations), and PPO’s (Preferred Provider Organizations).