Managed Care Organizations (MCOs)

Vanbouchaute v. Montana State Fund [08/23/07] 2007 MTWCC 37 Although the Court doubts neither the sincerity nor veracity of Respondent’s claims examiner’s testimony that she was constrained from approving a surgery after the surgery had been disapproved by a managed care organization with which Respondent contracted, for purposes of determining whether the denial of Petitioner’s surgery was reasonable, the ultimate responsibility rests with Respondent as the insurer.

Robinson v. Montana State Fund [06/29/05] 2005 MTWCC 33 Where a claimant has not been required to seek her medical care from a managed care organization or preferred provider organization, and there is no indication that she will ever be required to do so, she lacks standing to challenge the constitutionality of statutes authorizing insurers to refer claimants to managed care organizations and preferred provider organizations for medical care related to their industrial injuries.